How Can Project ECHO Be Implemented in Lebanon to Increase Cancer Patient Access to Care in Rural Areas?

OBJECTIVE: Elicit information from stakeholders to plan implementation of the Extension for Community Healthcare Outcomes (Project ECHO) model in Lebanon to improve cancer diagnosis and treatment in underserved and rural areas. DESIGN: A qualitative descriptive study guided by the Greenhalgh diffusion of innovation framework. Semi-structured interviews explored five diffusion components: relative advantage, compatibility, low complexity, potential risks, and needed support. SETTING: Lebanon. PARTICIPANTS: Twenty-six purposively sampled leaders representing governmental, non-governmental, academic, clinical, and public health sectors. MAIN OUTCOME MEASURE: The interviews were coded and thematically analyzed to characterize the perceived facilitators, barriers, and implementation considerations related to Project ECHO adoption. RESULTS: Following a standardized introduction to the ECHO model, participants generally perceived the model as acceptable and potentially beneficial for building primary care providers' (PCPs) knowledge and increasing patient access to quality care in underserved communities. Collectively, these leaders recommended careful pilot planning of infrastructure readiness, identification of clinical champions, and the use of performance indicators to monitor and evaluate implementation progress. They identified long-term sustainability, consistent financial support, workforce engagement, and medico-legal considerations as potential barriers to successful ECHO adoption. They viewed the current unstable environment in Lebanon as both a challenge and an opportunity for system transformation through strengthened collaboration, capacity building, and multi-level commitment to improve community health outcomes. CONCLUSIONS: Findings suggest the need for a structured, evidence-based approach to guide the implementation of Project ECHO in Lebanon. Potential early benefits may include strengthening PCP knowledge, confidence, and capacity in underserved communities. The findings provide an evidence-informed foundation for organizations and governmental agencies to support national-level adoption of the ECHO model. Future efforts should prioritize developing a practical action plan that includes provider training, infrastructure development, and sustainable funding to improve cancer care in rural areas.