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Population-level environmental and socioeconomic factors may influence cancer burden within communities, particularly in rural and urban areas that may be differentially impacted by factors related to health care access.The University of Kansas (KU) Cancer Center serves a geographically large diverse region with 75% of its 123 counties classified as rural. Using County Health Rankings data and joinpoint regression, we examined trends in four factors related to the socioeconomic environment and health care access from 2009 to 2017 in rural and urban counties across the KU Cancer Center catchment area.The adult health uninsurance rate declined significantly in rural and urban counties across the catchment area (rural annual percent change [APC]=-5.96; 95% CI=[-7.71 to -4.17]; urban APC=-5.72; 95% CI=[-8.03 to -3.35]). Childhood poverty significantly decreased in rural counties over time (APC=-2.94; 95% CI=[-4.52 to -1.33]); in contrast, urban childhood poverty rates did not significantly change before 2012 (APC=3.68; 95% CI=[-15.12 to 26.65]), after which rates declined (APC=-5.89; 95% CI=[-10.01 to -1.58]). The number of primary care providers increased slightly but significantly in both rural and urban counties (APC=0.54; 95% CI=[0.28 to 0.80]), although urban counties had more primary care providers than rural areas (76.1 per 100K population vs. 57.1 per 100K population, respectively;Our findings reveal potential disparities in systemic factors that may contribute to differences in cancer prevention, care, and survivorship in rural and urban regions.

BACKGROUND: Hospice care in rural areas is often characterized by provider shortages and vast geographical service areas to cover, making access to quality end-of-life care challenging. Telemedicine, broadly, is the utilization of interactive televideo (ITV) technology to provide health services over a distance. For over 25 years, telemedicine has been proposed as a solution to address access issues. In 2015, the University of Kansas Medical Center (Kansas City, Kansas) partnered with Hospice Services, Inc. (HSI) (Phillipsburg, Kansas), to augment traditional, face-to-face (FTF) hospice care with hospice care delivered through mobile tablets. OBJECTIVE: This work examines the costs of TeleHospice (TH) (telemedicine use in hospice care) when compared with the costs of FTF hospice services. DESIGN: Detailed administrative data from July 1, 2018, to December 31, 2018, were analyzed to estimate the costs of service after TH use was inculcated into routine practice. RESULTS: his, which averages a daily census of 34 patients, conducted 257 calls, averaging 28 hours a month. The average time for a TH call was 18 and 17 minutes for nursing and medical director calls, respectively. Through various hospice functions, including administrative, patient, and nonpatient-related connections, HSI saved over $115,000 in staff travel time and mileage reimbursement. Administratively, by hosting their weekly 15-member interdisciplinary meeting through ITV, HSI saved $29,869 of staff travel time and mileage reimbursement. CONCLUSIONS: Our estimates indicate substantial cost saving potential with the use of TH services. Further research is needed to assess the effects of TH utilization on the experiences and subsequent cost of hospice care.

PURPOSE The University of Kansas Cancer Center (KU Cancer Center) recently developed a data warehouse to Organize and Prioritize Trends to Inform KU Cancer Center (OPTIK). The OPTIK database aggregates and standardizes data collected across the bistate catchment area served by the KU Cancer Center. To improve the usability of the OPTIK database, we developed shinyOPTIK, a user-friendly, interactive web application for visualizing cancer risk factor and mortality rate data across the KU Cancer Center Catchment area. METHODS Data in the OPTIK database were first consolidated at the county level across the KU Cancer Center catchment area. Next, the shinyOPTIK development team met with the KU Cancer Center leadership to discuss the needs and priorities of the shinyOPTIK web application. shinyOPTIK was developed under the R Shiny framework and consists of a user interface (ui.R) and a web server (server.R). At present, s hinyOPTIK can be used to generate county-level geographical heatmaps; bar plots of demographic, screening, and risk factors; and line plots to visualize temporal trends at different Rural-Urban Continuum Codes (RUCCs), rural-urban status, metropolitan, or county levels across the KU Cancer Center catchment area. RESULTS Two examples, adult obesity prevalence and lung cancer mortality, are presented to illustrate how researchers can use shinyOPTIK. Each example is accompanied by post hoc visualizations to help explain key observations in terms of rural-urban disparities. CONCLUSION Although shinyOPTIK was developed to improve understanding of spatial and temporal trends across the population served by the KU Cancer Center, our hope is that the description of the steps involved in the creation of this tool along with open-source code for our application provided herein will serve as a guide for other research centers in the development of similar tools.

BACKGROUND The National Clinical Trials Network program conducts phase 2 or phase 3 treatment trials across all National Cancer Institute’s designated cancer centers. Participant accrual across these clinical trials is a critical factor in deciding their success. Cancer centers that cater to rural populations, such as The University of Kansas Cancer Center, have an additional responsibility to ensure rural residents have access and are well represented across these studies. OBJECTIVE There are scant data available regarding the factors that act as barriers to the accrual of rural residents in these clinical trials. This study aims to use electronic screening logs that were used to gather patient data at several participating sites in The Kansas University of Cancer Center’s Catchment area. METHODS Screening log data were used to assess what clinical trial participation barriers are faced by these patients. Additionally, the differences in clinical trial participation barriers were compared between rural and urban participating sites. RESULTS Analysis revealed that the hospital location rural urban category, defined as whether the hospital was in an urban or rural setting, had a medium effect on enrolment of patients in breast cancer and lung cancer trials (Cohen d=0.7). Additionally, the hospital location category had a medium effect on the proportion of recurrent lung cancer cases at the time of screening (d=0.6). CONCLUSIONS In consideration of the financially hostile nature of cancer treatment as well as geographical and transportation barriers, clinical trials extended to rural communities are uniquely positioned to alleviate the burden of nonmedical costs in trial participation. However, these options can be far less feasible for patients in rural settings. Since the number of patients with cancer who are eligible for a clinical trial is already limited by the stringent eligibility criteria required of such a complex disease, improving accessibility for rural patients should be a greater focus in health policy.

Background: In rural communities, providing hospice care can be a challenge. Hospice personnel sometimes travel great distances to reach patients, resulting in difficulty maintaining access, quality, cost-effectiveness, and safety. In 1998, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service. At that time, challenges with broad adoption due to cost and attitudes regarding technology were noted. A second TH project was launched in early 2017 using newer technology; this article updates that ongoing implementation. Methods: The Organizational Change Manager was followed for the guided selection of the hospice partner. The University of Kansas Medical Center partnered with Hospice Services, Inc. (HSI), a leader in rural hospice care, providing services to 16 Kansas counties. Along with mobile tablets, a secure cloud-based videoconferencing solution was chosen for ease of use. Results: From August 2017 through January 2018, 218 TH videoconferencing encounters including 917 attendees occurred. Calls were made for direct patient care, family support, and administrative purposes. These TH calls have been shown to save HSI money, and initial reports suggest they may strengthen the communication and relationships between staff, patients, and the patient’s family. Conclusion: Finding innovative, cost-effective, and community-driven approaches such as TH are needed to continually advance hospice care. TeleHospice’s potential to supplement and improve hospice services while reducing costs is significant, but continued research is needed to understand best fit within frontier hospices, to inform future urban applications, and to address reimbursement.

113 Background: An estimated 327,630 breast cancers (BC) will be diagnosed in the US in 2020, and as high as 14% (45,868) may be related to a hereditary cancer syndrome. Testing eligible patients in clinical practice is hindered by multiple barriers including time, available workforce, cost, lack of organizational pathways, provider knowledge, as well as health disparities. To address some of these barriers, our team provided a telementoring and process improvement intervention for cancer care programs primarily serving rural patients across Kansas and Western Missouri using Project ECHO. We aimed to improve the process surrounding access to genetic education and testing for patients with BC. Methods: Rural and community cancer care teams were invited by the Masonic Cancer Alliance, the outreach arm of the University of Kansas Cancer Center, to participate in ePOST-BC. Five 1-hour Project ECHO sessions (community building, didactic, and case-based learning) covered topics included: 1) essential elements of HCS and genetic testing, 2) guidelines for genetic testing in BC 3) enhanced understanding of risk, screening, and management including precision medicine in HCS, and 4) overcoming barriers to genetic testing and management in low resource settings. Provider and practice readiness was assessed using the Organizational Readiness for Implementing Change survey. A REDCap database was used for registration, surveys and data collection. Results: Ten practices (6 = metro; 4 = rural) participated in the telementoring sessions and five practices participated in the optional process improvement intervention. Provider and clinic interest and participation was high and readiness was varied. Improvements were identified in knowledge, readiness, and patient access to genetic education and testing. The level of engagement in process improvement was impacted by an identified champion (either MD and/or APP), organizational commitment, and motivator (i.e., accreditation standard, business development). Conclusions: Rural and community oncology providers are interested and willing to engage in telementoring to improve implementation of point of service genetic education and testing. This improves provider knowledge, readiness and implementation of testing. Demonstrating a change in testing completion for eligible patients is difficult in a community setting without intensive data collection. Next steps include the incorporation of technology and standardized tools into practice to address provider and care team burden.

With a 5 year survival rate of approximately 80%, there is an increasing number of childhood cancer survivors in the United States. Childhood cancer survivors are at an increased risk for physical and psychosocial health problems many years after treatment. Long-term follow-up care should include education, development of individualized follow up plans and screening for health problems in accordance with the Children's Oncology Group survivor guidelines. Due to survivor, provider and healthcare system related barriers, adult survivors of childhood cancer (ASCC) infrequently are receiving care in accordance to these guidelines. In this paper we describe the stepwise process and collaboration between a children's hospital and an adult academic medical center that was implemented to develop the Survivorship Transition Clinic and address the needs of ASCC in our region. In the clinic model that we designed ASCC follow-up with a primary care physician in the adult setting who is knowledgeable about late effects of childhood cancer treatment and are provided transition support and education by a transition nurse navigator.

Supplemental Digital Content is available in the text., Purpose Patients benefit from receiving cancer treatment closer to home when possible and at high-volume regional centers when specialized care is required. The purpose of this analysis was to estimate the economic impact of retaining more patients in-state for cancer clinical trials and care, which might offset some of the costs of establishing broader cancer trial and treatment networks. Method Kansas Cancer Registry data were used to estimate the number of patients retained in-state for cancer care following the expansion of local cancer clinical trial options through the Midwest Cancer Alliance based at the University of Kansas Medical Center. The 2014 economic impact of this enhanced local clinical trial network was estimated in four parts: Medical spending was estimated on the basis of National Cancer Institute cost-of-care estimates. Household travel cost savings were estimated as the difference between in-state and out-of-state travel costs. Trial-related grant income was calculated from administrative records. Indirect and induced economic benefits to the state were estimated using an economic impact model. Results The authors estimated that the enhanced local cancer clinical trial network resulted in approximately $6.9 million in additional economic activity in the state in 2014, or $362,000 per patient retained in-state. This estimate includes $3.6 million in direct spending and $3.3 million in indirect economic activity. The enhanced trial network also resulted in 45 additional jobs. Conclusions Retaining patients in-state for cancer care and clinical trial participation allows patients to remain closer to home for care and enhances the state economy.

Lifestyle interventions targeting exercise and weight control in cancer survivors have become increasingly common due to the strong associations with improvements in function, quality of life, and cancer prognosis [1]. One of the most challenging aspects of conducting these trials is recruitment, especially for underserved populations. Rural residents who represent 20% of the U.S. population experience many of the same disparities as other minority groups including poorer lifestyle behaviors [2] and higher obesity rates [3]. Rural cancer survivors have less access to survivorship care, poorer mental health and quality of life [4, 5] and limited access to lifestyle intervention [6]. Geographic isolation and travel requirements pose additional barriers, however, little has been written about successful recruitment of this group. This paper describes the recruitment of rural breast cancer survivors into a randomized trial investigating the effects of an 18-month intensive lifestyle intervention. We describe a variety of recruitment methods and data on participant yield by different recruitment strategies.

11535 Background: Hospice care in rural areas is often characterized by provider shortages and vast geographical service areas to cover, making access to quality end-of-life care challenging. Telehospice, the utilization of interactive video (ITV) technology to provide health services over a distance for hospice patients, has been proposed as a solution to address access issues. In 2017, the University of Kansas Medical Center (Kansas City, Kansas) partnered with Hospice Services, Inc. (HSI) (Phillipsburg, Kansas) to augment traditional, in-person hospice care with hospice care delivered via mobile tablets.This work examines the costs of Telehospice when compared with the costs of in-person hospice services. Methods: Detailed administrative data from July 1, 2018 to December 31, 2018 was analyzed to estimate the costs of service after Telehospice use was inculcated into routine practice. Results: Hospice Services, Inc., which averages a daily census of 34 patients, conducted 257 calls, averaging 28 hours a month. The average time for a Telehospice call was 21 and 18 minutes for nursing and medical director calls, respectively. Through various hospice functions, including administrative, patient, and non-patient related connections, HSI saved over $115,000 in staff travel time and mileage reimbursement. Administratively, by hosting their weekly 14-member interdisciplinary meeting via ITV, HSI saved $29,869 of staff travel time and mileage reimbursement. Conclusions: Our estimates indicate substantial cost saving potential with the use of Telehospice services. Further research is needed to assess the effects of Telehospice utilization on the experiences and subsequent cost of hospice care. Additional cost data specifics will be presented in poster form. [Table: see text]

A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers1, Lisa Simpson2 1Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA; 2AcademyHealth, Washington, DC, 20036, USA For the second year in a row, we are pleased to be able to share the proceedings of the Annual Conference on the Science of Dissemination and Implementation in Health, a large meeting reflecting the expanding and evolving research field that seeks to optimize the use of evidence, interventions, and tools from health research within the myriad of settings where people receive health care, make health-related decisions, and increase knowledge of influences on the health of the population. We once again benefitted from a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), the US Department of Veterans Affairs (VA), and the WT Grant Foundation. In addition, we benefitted from the collaboration of staff from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). NIH and AcademyHealth again co-led the program planning committee, which focused on the development of the plenary sessions, and convened a scientific advisory panel to suggest speakers and advise on the overall conference development. The planning committee identified four key areas around which to focus the plenary panels and keynote address. Dr. America Bracho, M.D., M.P.H., Executive Director of Latino Health Access in Orange County, California, spoke about the opportunities for implementation science to inform efforts to improve community health and engage underserved populations. The three plenary panels each focused on a significant future direction for dissemination and implementation (D & I) research: the interface between D&I science and population health, emerging opportunities for global implementation science, and the challenges around implementation of precision medicine. The plenary sessions were complemented by facilitated lunchtime discussions on the same three topics, which offered participants an opportunity to identify key research questions for each and brainstorm next steps. Synopses of the lunchtime discussions are included in this supplement. Given the overwhelming success of the 2014 conference and the large number of abstracts received in 2014 (660), the program planning committee identified eight program tracks for abstract submitters to respond to, and through which the concurrent sessions of the conference would be organized. These tracks—Behavioral Health, Big Data and Technology for Dissemination and Implementation Research, Clinical Care Settings, Global Dissemination and Implementation, Promoting Health Equity and Eliminating Disparities, Health Policy Dissemination and Implementation, Prevention and Public Health, and Models, Measures and Methods— were designed to enable conference participants to follow a consistent theme across the multiple sessions of the conference and form the structure of this supplement. The call for abstracts, including individual paper presentations, individual posters and panel presentations, resulted in 515 submissions, spread across the eight thematic tracks. Over one hundred reviewers devoted their time to ensuring a comprehensive and expert review, and reviews were conducted within each track and coordinated by the track leads. For the final program, 64 oral presentations, 12 panels, and 263 posters were presented over the two-day meeting. Slides for the oral presentations and panels (with the agreement of the authors) were posted on the conference website (http://diconference.academyhealth.org/archives/2015archives) and all abstracts were included on the conference webapp (https://academyhealth.confex.com/academyhealth/2015di/meetingapp.cgi). This supplement has compiled the abstracts for presented papers, panel sessions, and lunchtime discussions from the 8th Annual Meeting on the Science of Dissemination and Implementation in Health: Optimizing Personal and Population Health. We are pleased to have the abstracts from the conference together in one volume once again, and look forward to the 9th Annual meeting, scheduled for December in Washington, D.C.

This study tested the feasibility of promoting 1-800-4-CANCER through partnerships with organizations serving African American and Hispanic communities. Small-media and client reminders about human papillomavirus vaccination were made available through local agents to 28 community organizations. Organizations ordered 79 932 resources and distributed them to young women and parents of girls-;African Americans in St Louis, Missouri, and Hispanics in the Lower Rio Grande Valley of Texas. Pre- to postintervention calls to 1-800-4-CANCER increased 38% in these communities, while declining 15% in comparison communities of Kansas City, Missouri, and El Paso, Texas (F = 8.6, P = .004) and 1.4% in the United States as a whole.

85 Background: While evidence-based guidelines for survivorship care exist, implementation in oncology and primary care practices has fallen short. There is little evidence of the barriers preventing successful implementation in rural primary care and oncology practices. We sought to assess knowledge gaps and barriers to successful implementation of evidence-based survivorship care guidelines in rural Kansas practices. Methods: Midwest Cancer Alliance, outreach arm of the University of Kansas Cancer Center, and Kansas Patients and Providers Engaged in Prevention Research, completed interviews in rural primary care and oncology practices. Results: Primary Care (n=7) and Oncology Practices (n=4): Interviews with primary care physicians, medical oncologists, advanced practice providers, nurses, tumor registrar, outreach coordinator, and office management & staff. Conclusions: Rural primary care and oncology practices experienced barriers to delivering survivorship care including: educational gaps, communication of history, treatment, and recommendations, EHR integration, and lack of resources. Next steps focus on a unified approach to state-wide survivorship education of patients, primary care and oncology practices. [Table: see text]

160 Background: Childhood cancer survivors (CCS) face complex psychological late effects. The need for systematic screening for psychosocial distress has been clearly identified; however, less clarity exists around characterizing factors that might identify patients at higher risk to support targeted treatment. The purpose of this study was to examine the results of psychological screening in a clinic for adult survivors of childhood cancer using the validated NCCN Distress Screening Thermometer and modified Needs Assessment and exploring the results with other patient factors. Methods: Retrospective chart review was completed on 117 CCS seen in our Survivorship Transition Clinic (STC) between 2014 and 2017. The NCCN Distress Thermometer and Needs Assessment were administered to patients attending the STC. Results were then analyzed with a number of additional factors to explore association. These factors included intensity of treatment (by Children’s Hospital of Philadelphia Intensity of Treatment Rating scale or ITR3), gender, and age at diagnosis. Results: Of 117 patients, 54 had low intensity ITR3 scores (1 or2) and 63 had high intensity ITR3 scores (3 or 4). Mean distress score was 2.669 for the group. A weak but statistically significant association existed between ITR3 scores and distress scale scores (r = 0.2, n = 117, p = 0.022). Mean distress scale scores did not differ between men (2.26 +/- 2.09) and women (2.92 +/- 2.6) nor were they significantly related to age at diagnosis (p = 0.242). Needs assessment identified emotional, nutritional, and physical as the most frequent concerns. Care needs mostly commonly identified were feeling anxious/worried/irritable, being concerned with weight control, or problems with pain / fatigue. Conclusions: While we did not identify statistically significant differences in distress based on gender or age at diagnosis, we did find weak statistical association between higher treatment intensity and higher distress scores. Needs assessment helped guide care plan development. As childhood cancer survivor rates increase, we have an obligation to evolve our understanding of not only physical late effects but also psychological late effects.

33 Background: With growing numbers of childhood cancer survivors (CCS), having systems for survivorship care coordination is imperative. While studies have compared the comfort and knowledge between primary care and oncology physicians in providing CCS care, few have analyzed primary and subspecialty care rates. Referral trends can be informative for institutions developing systems of care. Correlative measures with referral needs may help institutions prioritize process development for patients. Methods: Retrospective chart reviews were completed on 117 adult CCS from Survivorship Transition Clinic (STC) between 2014-2017. Upon arrival, STC patient self-reports were recorded regarding existing PCP status. Patients with PCPs were enrolled in survivorship consultation care, those without enrolled in survivorship and PCP care. Referrals were tracked by electronic medical record. Two oncology providers performed blinded independent reviews treatment summaries and scored treatments using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Final scores were matched with data on subspecialty referral patterns. Results: Of 117 patients, 65 (57%) needed both PCP and survivorship care while 50 (43%) had established PCPs. ITR3 scores were low intensity (1 or2) for 54 patients and high intensity (3 or 4) for 63 patients. The low intensity group had 157 total referrals (3 per patient) compared to 391 total referrals (6 per patient) in the high intensity group. The top 5 subspecialty referrals (by patients referred) were psychological services (46), dermatology (44), fertility (29), hematology / oncology / BMT (22), cardiology (20). Conclusions: Our care coordination trends suggest many CCS do not have established PCPs despite their complex care needs. Not surprisingly, higher intensity treatment correlates with higher subspecialty care needs. Psychological care remains the most prevalent need in our patient population. [Table: see text]

Study purpose: The aim of this study was to further explore the lived experiences of women with metastatic breast cancer (MBC), to inform the development of interventions to enhance survivorship care for women with advanced disease. Methodology: Four semi-structured focus groups were conducted with women with MBC. The data was analysed using qualitative content analysis. Results: Participants described the challenges of living with uncertainty, as a result of a lack of information regarding treatment options and symptom management, and a sense of the unknown related to prognosis and survival. Of major concern were changes in role functioning, altered relationships, and self-image. Conclusion: Women with metastatic breast cancer must cope with dramatic changes in all aspects of their lives. Clinicians should tailor survivorship care and evidence-based interventions to individuals’ concerns with changes in role functioning, fatigue, relationships, and self-image. A multidisciplinary approach should be used to address practical and existential concerns focused on improving quality of life.

Background Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke's Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. Community context As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. Methods The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. Outcome MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. Interpretation Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support.

Lifestyle interventions may be effective for enhancing quality of life and prognosis among breast cancer survivors, but expanding their reach to underserved rural communities presents some unique challenges.Recruitment for this lifestyle intervention trial among rural breast cancer survivors was carried out by developing local partnerships with rural oncology practices and hospitals who were members of regional community oncology organizations.Recruitment strategies included mailing a tailored study brochure accompanied by a cover letter from providers and an opt-in/opt-out postcard, media coverage, clinic-based oncologist referrals, and community outreach.Mailing the tailored study brochure with the opt-in postcard yielded the highest number of survivors who enrolled in the lifestyle intervention trial.Oncologist referrals yielded a small number of participants but had the highest enrollment rate, and thus appear to play an important role in motivating some patients.

This study addresses the following research questions: (a) What are the various types of family structures that exist in urban African American households? and (b) to what extent do differences in family structure influence social, psychological, and economic well-being as reported by urban African American women? The authors present findings from 301 African American women who participated in a community-based nutrition prevention program in a large Midwestern urban center. This study's results indicate that family structure has more influence on African American women's economic well-being than do social and psycho-logical factors. Implications of these findings for intervention are presented.

PURPOSE/OBJECTIVES To report functional (physical and cognitive) late effects, experiences, and information needs of adult survivors of childhood cancer. DESIGN Descriptive, mixed methods survey. SETTING Two pediatric oncology programs in the Midwest. SAMPLE Convenience sample of 272 young adult survivors. METHODS Voluntary survey completion by young adult survivors regarding late effects, experiences, and educational needs to develop appropriate comprehensive care programs for care provision before, during, and after transition to adult care. Survey domains were identified from existing survivorship literature and focused on all aspects of survivorship; however, this article focuses on results specific to the functional domain. MAIN RESEARCH VARIABLES Functional late effects, experiences, information needs, age, gender, and treatment intensity of young adult survivors of childhood cancer. FINDINGS Response rate was 48%. Functional late effects, perceptions, and information needs all correlated with intensity of treatment (those survivors most heavily treated experienced the most symptoms). Survivors wanted more information about late effects and how to deal with them. Women wanted more information about fertility-related topics, and participants who received more intense treatment generally wanted more information. Brain tumor survivors perceived greater cognitive difficulties, cognitive late effects, fatigue, and financial difficulties. CONCLUSIONS Survivors experience myriad physical late effects and require ongoing access to information as needs change over time. IMPLICATIONS FOR NURSING Identifying new and innovative ways to reach survivors and better meet needs is important for care, research, and program development. KNOWLEDGE TRANSLATION The findings of the research underscore the importance of continuous learning opportunities for adult survivors of childhood cancer. The findings also highlight the need for healthcare teams to better understand the current and long-term needs of this population. In addition to traditional communication approaches, technologies such as social media and telemedicine can provide innovative ways to deliver patient-centered care.

The potential for Comprehensive Cancer Control (CCC) across the nation has been realized in the last decade with 69 Coalitions developing and implementing CCC plans. Many partners at all levels--national, state, jurisdictional, tribal and communities--have contributed to this success. This article details the contribution of these partners across these various levels, with a selection of the many activities contributing to this success. Consequently the cancer burden, although still of major importance, continues to be addressed in significant ways. Although there are future challenges, CCC coalitions continue to play an important role in addressing the cancer burden.

Background. Competency-based education allows public health departments to better develop a workforce aimed at conducting evidence-based control cancer. Methods. A 2-phased competency development process was conducted that systematically obtained input from practitioners in health departments and trainers in academe and community agencies (n=60). Results. Among the 26 competencies developed, 10 were rated at the beginner level, 12 were intermediate, and 4 were advanced. Community-level input competencies were seen as beginner level, whereas policy-related competencies were rated as advanced. Conclusion. Although adaptation to various audiences is needed, these competencies provide a foundation on which to build practitioner-focused training programs.

84 Background: Children's Mercy (CM) established a cancer survivorship clinic that cares for approximately 180 survivors a year. A third of the survivors are 18 years or older requiring transition to adult care. The importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain. Barriers include patient and provider anxiety, difficulty navigating the complex health care system and lack of knowledge regarding late effects. CM and The University of Kansas Cancer Center (KUCC) collaborated to decrease barriers to transition for childhood cancer survivors. Methods: The work group met for 2 years to develop the clinic at KUCC. Models and delivery of survivorship care, including the breast cancer survivorship clinic at KUCC, were reviewed. A shared nurse navigator was identified as an essential component to a seamless transition. Philanthropic support was obtained and job description was developed. Contracts were negotiated to allow the navigator to be present at both institutions. Results: The Survivorship Transition Clinic (STC) at KUCC launched July 2014, with a navigator supporting patients at CM as they begin their transition. The same navigator then meets with the patient at KUCC STC as they initiate care. The navigator provides treatment summaries, patient education and navigates the referral services for survivors. Since clinic launch, 16 survivors out of 16 have successfully transitioned from pediatric to adult survivorship care. Positive feedback was received from patient satisfaction surveys that were administered. A common theme showed a relief from anxiety due to having a contact person to facilitate communication among providers in a complex healthcare system. Conclusions: The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at CM, and then is able to provide continuity as they transition to the STC at KUMC. The navigator also improves communication between pediatric providers, adult primary care providers and sub-specialists caring for the patients. Overall, our transition process has been effective and is now serving as a model across both institutions.

40 Background: Long-term survival is an expected outcome for childhood cancer patients. Caring for adults who are childhood cancer survivors requires dedicated late effects monitoring. Recognizing transition challenges from pediatric to adult and oncologic to primary care settings, we developed a dedicated monthly survivorship transition clinic (STC) in an internal medicine office at the University of Kansas Medical Center. We describe the first year practice experience (2014-2015). Methods: Retrospective chart review was completed on 41 STC patients - age 20 to 52 years. Each survivor self-selected to establish in STC, with either consultative survivorship care (correspondence sent to existing primary care physician (PCP)) or combined primary and survivorship care (if no established PCP). Selections were recorded. Two oncology providers performed blinded independent reviews of treatment summaries and scored these using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Scores were provided to the STC and unblinded. ITR-3 scores were matched with data on subspecialty referral patterns for each survivor to determine if ITR-3 scores correlated with referral needs. Results: Of 41 patients, 26 (63%) requested PCP and survivorship care. Only 15 (37%) had an established PCP. Survivors were grouped by ITR-3 into low (1 or 2) or high (3 or 4) intensity scores. Subspecialty referrals in each group were analyzed as follows: total number of referrals / average referrals per survivor / median referral number. Referral data: low intensity group 14 / 1.27 / 1, high intensity group 96 / 3.56 / 3. Conclusions: Despite complex medical histories and long term follow-up needs, a high percentage of Midwest cancer survivors were in need of survivorship, PCP and subspecialty care emphasizing the importance of intentional transition efforts. ITR-3 scores correlated with subspecialty referral needs. Future research will include an increased number of survivors to determine further predicative value of this scale in estimating survivor needs complexity.

23 Background: Advances have been made in elevating cancer survivorship as a public health priority and defining elements needed to deliver high-quality follow-up care to survivors. However, a lack of research on how best to care for survivors and the most effective and efficient strategies for delivering survivorship care in the community setting still exists. We report our assessment of the current state of practice, knowledge and professional development, and plan to increase access to care of urban and rural practices across the state of Kansas. Methods: In 2014, the Midwest Cancer Alliance (MCA), a membership-based outreach arm of The University of Kansas Cancer Center, convened an educational summit and survey to assess the survivorship landscape in Kansas. Post-summit, individual interviews were conducted. Survey and interviews included questions regarding health records, treatment summaries, survivorship care plans (SCP), availability of survivorship programs and resources, access to primary care and specialists, distress screening, community support, and educational needs. Results: Ten MCA member health systems were invited to participate and 7 indicated interest in participating in the project. Only one organization provided an SCP to survivors. Barriers included lack of an integrated approach and knowledge. A majority of survivorship care could be delivered close to home, however, services including fertility preservation, genetic counseling, oncology rehab, sexual health, and second opinions, required travel of more than 50 miles. Identified educational needs focused on comprehensive survivorship care across the health care team. Conclusions: Survivorship care remains fragmented across the state of Kansas. Based on this project, we have secured a CDC survivorship grant that will facilitate clinical and technical assistance related to process improvement and electronic health record integration focused on survivorship care and delivery of an SCP. Next steps include engaging primary care providers and survivors to assure the SCP meets the needs of stakeholders. This work will focus on a translational process to meet the growing needs of the survivors and complex health care organizations.

236 Background: The Midwest Cancer Alliance (MCA), the outreach arm of the University of Kansas Cancer Center, developed psycho-oncology services over videoconferencing in partnership with its rural members. The collaborative goal is to address patient-identified psychosocial needs that are not currently being met in the communities. Methods: Following telemental health best practices, MCA personnel, rural site leaders, local oncology and behavioral health teams, and telemedicine staff collaborated closely to establish the service. They developed detailed protocols related to: referral and scheduling; technical training and support; paperwork; videoconferencing sessions; post-visit follow-up/documentation; and emergency management procedures. Attention was given to: confidential space; equipment to meet therapy needs; the telemedicine coordinator’s role; and completion of professional requirements (e.g., licensing, credentialing, malpractice coverage). Results: Credentialing, site implementation, and patient recruitment took longer than anticipated. To date, 15 patient visits have occurred through the psycho-oncology service across two rural sites. Worsening illness has impacted referrals as well as retention in therapy. Videoconferencing services have approximated onsite psycho-oncology strategies, with focus on evidence-based care. In general, patients have had advanced medical illness as well as significant premorbid psychosocial difficulties, such as mood disorders, substance abuse history, and relationship problems. Basic challenges to care have remained, including lack of consistent transportation. The telepsychologist’s role in relation to the rural medical team expectations is still evolving. Conclusions: The early lessons learned will continue to strengthen the psycho-oncology service as videoconferencing services expand in order to increase access. Ongoing, site-specific needs assessment remains essential, as “one size does not fit all.” Future plans include improving recruitment by coordinating referrals with distress screening. In order to provide sites with maximum flexibility, new methods of communication will be offered as they become available.

217 Background: With increased survival rates, adult survivors of childhood cancers (ASCC) face lifelong screening and healthcare needs. Given increasing costs and demands across healthcare institutions, there is a significant need for survivorship models that emphasize regional collaboration, transition of pediatric patients to adult care, and focus on survivor-centered outcomes. Specific aims: Over the last two years, the presenters developed and implemented a survivor-centered regional approach to meet ASCC needs, addressing system, provider, and survivor barriers to successful transition and ongoing ASCC care. Methods: The presenters will describe community engagement strategies utilized to build a successful, sustainable survivor-centered approach across the region. The Midwest Cancer Alliance (MCA), the outreach arm of University of Kansas Cancer Center (KUCC), provides a supportive, neutral environment to bridge institution-specific concerns. Interdisciplinary teams from Children’s Mercy Hospital and University of Kansas’ Pediatrics department developed a formal working group with KUCC adult-focused partners. The group has taken an inclusive approach, bringing together pediatric and adult healthcare teams as well as expertise in outreach, patient navigation, telemedicine, education, and evaluation/research. Emphasis will be placed on how the team has prioritized needs-driven deliverables across metropolitan and rural communities. Results: The transitions program has maintained monthly working group meetings; completed a survivor needs assessment and disseminated findings; and initiated a cross-institutional transitions clinic. The team is collaborating on a comprehensive survivorship training approach to educate regional healthcare providers. The presenters will describe the team’s performance improvement processes to monitor outcomes and continuously refine the ASCC/AYA model. Conclusions: Community engagement is an ideal platform for regional program development to meet ASCC survivor needs. Future steps include measuring program outcomes, working toward EHR integration, increasing survivor input, and incorporating education into residency/fellowship training.