The goal of this research is to change the patterns of continuing cancer care by creating nurse centered provider networks that will deliver state- of-the-art cancer care in rural communities (STACCRC). These provider networks will link local physicians, hospitals, nurse centered satellite clinics and community health and social agencies. To deliver STACCRC the provider networks in the targeted rural communities will be linked with the Cancer Center at Michigan State University, the Kalamazoo Community Oncology Program, and the Kalamazoo Center for Medical Studies. These programs will deliver needs based professional education, respond with information to providers in the targeted communities, and host the training of nurses in the satellite clinics. The intervention will draw on the rural health initiative for third party reimbursement for nurses. To implement the intervention, community assessment surveys will identify patients and families needs for cancer care, providers needs for professional education and enhanced collaborative arrangements with the tertiary center, and health and social agencies needs for linkage to cancer care networks. In the four targeted communities two classes of patients will be recruited; 1) continuing care patients who have had cancer for varying periods of time; 2) inception patients recruited following diagnoses at the community hospitals or tertiary care center. For comparison, inception patients from a control community will be recruited. The intervention will; 1) credential clinic nurses, as appropriate, 2) link nurses in clinics and local physicians to one another, the tertiary system, and agencies to deliver STACCRC, 3) employ protocols and standards of care for pain, symptoms, and detection of problems and complications. Quarterly assessments of patients and families along with records of all clinic interactions will mark the changes in patterns of care, provider behaviors, agency use, and patient outcomes. Through this intervention we plan to create a model of continuing cancer care that is integrated into, sustainable by, and transferrable to other rural communities once research is concluded.
