Rural comprehensive cancer care: Qualitative analysis of current challenges and opportunities

Sydney Evans; Aaron T Seaman; Erin C Johnson; Jacklyn M Engelbart; Xiang Gao; Praveen Vikas; Sneha Phadke; Mary C Schroeder; Ingrid M Lizarraga; Mary E Charlton

doi:10.1111/jrh.12842

Rural comprehensive cancer care: Qualitative analysis of current challenges and opportunities

J Rural Health. 2024 May 16. doi: 10.1111/jrh.12842. Online ahead of print.

Authors

Sydney Evans¹, Aaron T Seaman^{2

3}, Erin C Johnson⁴, Jacklyn M Engelbart⁵, Xiang Gao⁵, Praveen Vikas⁶, Sneha Phadke⁶, Mary C Schroeder⁷, Ingrid M Lizarraga^{3

5}, Mary E Charlton^{3

8

9}

Affiliations

¹ Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
² Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
³ Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA.
⁴ Tippie College of Business, University of Iowa, Iowa City, Iowa, USA.
⁵ Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
⁶ Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
⁷ Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.
⁸ Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
⁹ Iowa Cancer Registry, College of Public Health, University of Iowa, Iowa City, Iowa, USA.

PMID: 38753418
DOI: 10.1111/jrh.12842

Abstract

Purpose: While limited resources can make high-quality, comprehensive, coordinated cancer care provision challenging in rural settings, rural cancer patients often rely on local hospitals for care. To develop resources and strategies to support high-quality local cancer care, it is critical to understand the current experiences of rural cancer care physicians, including perceived strengths and challenges of providing cancer care in rural areas. METHODS: Semi-structured interviews were conducted with 13 cancer providers associated with all 12 non-metropolitan/rural Iowa hospitals that diagnose or treat >100 cancer patients annually. Iterative thematic analysis was conducted to develop domains.

Findings: Participants identified geographic proximity and sense of community as strengths of local care. They described decision-making processes and challenges related to referring patients to larger centers for complex procedures, including a lack of dedicated navigators to facilitate and track transfers between institutions and occasional lack of respect from academic physicians. Participants reported a desire for strengthening collaborations with larger urban/academic cancer centers, including access to educational opportunities, shared resources and strategies to collect and monitor data on quality, and clinical trials.

Conclusions: Rural cancer care providers are dedicated to providing high-quality care close to home for their patients and would welcome opportunities to increase collaboration with larger centers to improve coordination and comprehensiveness of care, collect and monitor data on quality of care, and access continuing education opportunities. Further research is needed to develop implementation approaches that will extend resources, services, and expertise to rural providers to facilitate high-quality cancer care for all cancer patients.

Keywords: cancer; community; qualitative research; rural hospitals.

Abstract

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