Expanding Rural Access: Distance Delivery of Support Groups
| Institution: | Northern Sierra Rural Health Network | ||
| Investigator(s): |
Mary Anne Kreshka , M.A. -
Susan Ferrier , R.N. -
Cheryl Koopman , Ph.D. -
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| Award Cycle: | 2007 (Cycle 13) | Grant #: 13BB-2401 | Award: $228,567 |
| Award Type: | CRC Full Research Award | ||
| Research Priorities | |||
| Disparities>Disparities: eliminating the unequal burden of breast cancer | |||
This is a collaboration with: 13BB-2400 -
Initial Award Abstract (2007)
Strong research evidence demonstrates that professionally led support groups can significantly improve quality of life for women with breast cancer. However, women with breast cancer who live in rural areas have little or no access to professionally led support groups. Northern Sierra Rural Health Network (NSRHN) serves a nine-county region of NE California covering 33,000 square miles with an average of fourteen residents per square mile (compared to two hundred thirty-two for the state as a whole). The primary sources of medical care are community health centers and small rural hospitals. Residents have to travel great distances over two-lane roads to access specialty care. In our CBCRP-CRC pilot study conducted collaboratively by NSRHN and Stanford University in 2003-05, we tested the feasibility of offering professionally led support groups to women with breast cancer using the workbook journal “One in Eight” by videoconferencing. A small group of women can be together in one location that is familiar to them (their local clinic), while they participate interactively with a facilitator and other women at other sites by video. Using a split-screen, the women in each site see the women in all the other sites and the facilitator. Based on the success of that project, we are proposing a controlled study to assess the general acceptability and therapeutic value of this support group format on a larger sample of women. The study will answer two questions about women with breast cancer in rural communities: 1) Will they find this support group format utilizing videoconferencing acceptable and rewarding?; and 2) Will they report a greater sense of emotional and informational support, and less depression and traumatic stress, than the control groups of women who wait to participate until after the first groups have ended? A total of 100 women with breast cancer in the north state will participate in the study. They will be randomly assigned either to an immediate eight-week support group using videoconferencing and the workbook journal, or an eight-week group that will begin after the first group ends (“wait-listed”). The women who are wait-listed will serve as the control for the women receiving the support group. The women in both groups will complete questionnaires before and after the first group. Results of the women who participated in the group will be compared with those who did not. Thirty of the women in the groups will also be interviewed afterwards to get their direct feedback on the support groups. The wait-listed women will receive the support group after their data have been collected. Videoconferencing technology allows multiple sites to connect into real-time interactive meetings. Thus, women isolated by distance, weather and cost can experience the benefits of interpersonal support without leaving their home communities. NSRHN is the largest rural telemedicine network in California, with equipment in 31 rural/frontier healthcare facilities. It has been used primarily for specialty medical consults (over 5,000 since 2000). This technology is increasingly available in rural communities throughout the state and the nation. We are proposing an innovative use of this already existing network to fill a need for professionally led support groups for women with breast cancer. Over 2.5 million women live in rural California statewide, over 33 million in rural areas across the United States. These figures suggest that over 312,000 women in California, and over 4 million women nationwide, could potentially benefit from support groups by videoconferencing. This project will also suggest the effectiveness of videoconferencing support groups for other conditions (e.g., rural residents with HIV/AIDS; family caregivers of individuals with dementia).
Progress Report 1 (2008)
In the sparsely populated rural Intermountain Region of northeast California (Modoc, Plumas, Siskiyou, Shasta, Lassen, Trinity, Sierra, Nevada, and Tehama Counties), women lack adequate psychosocial support for coping with a diagnosis of breast cancer. However, our partnership has successfully pilot-tested an intervention that holds promise for providing psychosocial support to this population--the use of video-conferencing as a modality for providing professionally led breast cancer support groups that are guided by the content of our "One In Eight" workbook-journal. We are now in our first year of a follow-up study--a randomized clinical trial (comparing women wait-listed to receive the support groups after other women receive them). This study addresses the 2 aims we proposed in our grant, plus an additional 3rd aim:
- Demonstrate that professionally-led support groups using videoconferencing and “One in Eight” are an acceptable and satisfactory form of psychosocial support for women living with breast cancer in nine rural counties in the Intermountain Region of northeastern CA.
- Evaluate the efficacy of this support group intervention for meeting the psychosocial support needs of women with breast cancer in these counties.
- Describe the types of primary care and breast cancer care for which women in these counties lack adequate access. We added this aim to provide further context and justification for the need for identifying effective sources of psychosocial support for this population.
