Avera McKennan Hospital and University Health Center
Report date
August 2017
What has been most instrumental to your progress?
The Rural Cancer Board served as the focus group to develop a new 24/7 call-in center that was named the Avera Cancer Institute Navigation Center. From their own personal experiences, they provided feedback and suggestions that truly shaped the design and offerings of this service to better meet the needs of rural patients. An example is one of the participants shared that when his wife was diagnosed with cancer they would not have called the navigation center but would have appreciated a call. This has lead to a process where out bound calls are now being made by the center. They also provided questions that they thought people would ask when they called in from rural areas such as 'how do we tell our children who live far away' and questions about support groups for college students when they have a parent being treated for cancer. The center also expanded the time it would answer the phone to 24 hours since there are issues in the middle of the night and people need support. It was very impactful to have these members share the barriers in rural areas that need to be addressed by the new navigation center.
Through this process, Avera was able to create relationships with people in rural areas across the state of South Dakota. The members shared what barriers existed to receiving cancer care in rural and frontier communities and provided us with information about resources that exist in various counties in SD. The list of resources were used to populate our database thereby allowing the navigators in the call-in center to provide a wide array of local resources for people who called in needing assistance. An example of a resource is a group of farmers who will assist with crops and other chores while someone is undergoing cancer care. There are also financial resources in local communities that assist people pay for gas, food and lodging during their cancer treatments away from home.
One of the board members, Walt Bones, is a former Secretary of Agriculture for the state of SD. He raises cattle, corn, soybeans, and wheat. He has been active in a number of related associations, including the National Corn Growers Association, the Midwest Dairy Association, the South Dakota Hereford Association, the South Dakota Cattleman’s Association, and the South Dakota Farm Bureau. He invited and hosted physicians and medical staff to join him at his farm near Parker, SD. Providers learned firsthand about the occupations of their patients who are farmers. They were able to tour the fields of crops as well as see the cattle operation and dairy barn. Some of the attending physicians had not been on a farm before so this provided a hands-on opportunity for them.
Key lessons learned
We absolutely learned that meeting times with farmers and ranchers needed to be set around their busy times of year such as planting, harvesting and calving.
We learned that our board members were very engaged in their communities and they were taking information shared at the meetings to their home communities and talking about the importance of screening and the resources that are available. They would give examples of times they talked about screenings such as colonoscopies with their coffee groups and other gatherings in their community. They also invited Avera providers to talk to various groups such as the SD Corn Growers and Cattlemen's Association. Our rural neighbors were very interested in seeing a presentation on cancer care and new developments, research and services such as the new navigation center.
Reflections on the community innovation process
The most important aspect was listening to the barriers that exist and generating solutions with them that would truly meet their needs.
Progress toward an innovation
The Avera Cancer Institute Navigation Center was one of the innovations that came out of this process of meeting with farmers and ranchers. We learned how isolating it feels to live in rural areas and be receiving treatment for cancer. The navigation center is a novel program and based on what we have learned, is the only offering of its kind in the United States. In addition, the group is now a strong advocate of the center and refer their community members to this center when they hear there has been a person diagnosed with cancer. Outreach to farmers and ranchers on preventative services in another outcome that has been delivered and will continue to expand in rural areas.
What it will take to reach an innovation?
NA
What's next?
At the last meeting, board members completed surveys to determine the value they found and also to see if they would be interested in continuing as a group. The plan is to continue meeting annually. The group also wants to receive updates on new programs and program changes affecting cancer care in rural areas. These email updates will also offer them an opportunity to update Avera on what is going on in their communities.
If you could do it all over again...
One of our goals was to have meetings in different locations throughout the state which was not accomplished. The board members did not see this a negative. In order to have physicians across the table, we needed to meet in Sioux Falls and the members appreciated having the opportunity to visit with providers.
When writing the grant we did not include having a facilitator; however, we did use a consultant who grew up on a farm/ranch and also previously worked in a healthcare setting. We found this to be greatly beneficial in conducting these meetings.
When writing the grant we did not include having a facilitator; however, we did use a consultant who grew up on a farm/ranch and also previously worked in a healthcare setting. We found this to be greatly beneficial in conducting these meetings.
One last thought
At the last meeting, 14 of the 23 members completed surveys about their experiences serving on this board. Overall, the members were very pleased with their experiences and all felt they had learned consistently more than expected. They all strongly agreed or agreed that they were able to communicate the rural cancer needs and that leaders listened to their feedback. They also strongly agreed or agreed that the work of this committee was important. When asked for their recommendations, their comments included a request for regular updates; the possibility of branching to other rural health needs such as mental health and elder care; and replying that the meeting content was powerful including great presentations at each meeting. One of the board members stated: 'I really cannot think of any changes. The committee provided such insight into so many aspects of rural cancer care needs, it was inspiring! The staff and all those in charge of implementing the people and structure of this committee did an excellent job in combining people and resources to serve.'