Identifying barriers and facilitators to timely, adjuvant head and neck cancer treatment in the rural setting.

460 Background: Oncology guidelines recommend that the time from surgery to post-operative radiotherapy (S-PORT) for head and neck squamous cell carcinomas should not exceed six weeks. However, in the United States, approximately 40% of people do not achieve timely S-PORT; this metric is worse for people living in rural areas. As a preparatory step to develop a multilevel intervention that improves timely S-PORT in rural communities, we engaged in community-engaged research dialogues with patients, caregivers, and staff in two rural cancer clinics to identify barriers and facilitators to timely, adjuvant head and neck cancer treatment in this context. Methods: We used a community-engaged research approach with distinct phases performed at two Cancer Center facilities, one in Lebanon, NH, and one in St. Johnsbury, VT. First, we conducted two facilitated dialogues (Partnership Academies) with patients, caregivers, and multidisciplinary health professionals. These dialogues were recorded, transcribed, and coded with patient and caregiver partners. Informed by the Intervention Mapping conceptual model and the Consolidated Framework for Implementation Science Research, we used an inductive-deductive approach to identify barriers and facilitators. To enhance our understanding of the local context, we conducted three additional dialogues (Community Engagement Studios): two with patients and caregivers, and a third with clinical staff. These dialogues were summarized by their facilitators. We performed member-checking by reviewing the results at an institutional retreat for the Head and Neck Cancer program. Results: In the first phase of dialogues, we had 11 participants with the following roles: patient, caregiver, social worker, dentist, master's student, nurse navigator, psychiatry researcher, cancer center administrators (2), radiation oncologist, and medical oncologist. In the second phase of dialogues, we had 18 participants: 11 patients, 2 caregivers, and 5 staff. We identified five barriers to timely S-PORT: 1) Communication; 2) Care coordination; 3) Access to dental care; 4) Confronting negative emotion; and 5) Transportation. We identified four facilitators: 1) Leveraging preexisting strengths; 2) Rural culture; 3) Caregivers; and 4) Key staff as a central node of contact. Our themes patient and caregiver desires for solutions included: 1) Peer support; 2) Information support beyond the treatment period; 3) Adaptation to the steep learning curve after cancer diagnosis; and 4) Using organizations within their communities. Conclusions: Our study was innovative for its focus on improving S-PORT in the rural setting and methodologically novel by using two community-engaged research techniques in a phased approach. Our findings emphasize the importance of leveraging community resources, enhancing communication, and providing ongoing support to improve care.