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      Creating a “culture of research” in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program

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          Abstract

          Background

          The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute’s Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period.

          Methods

          To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials.

          Limitations

          The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to identify and collect. The model requires a strong emphasis on outreach that challenges hospitals to improve and expand their reach, particularly into underrepresented populations and catchment areas. These efforts build on trust and a referral pipeline within the community which take time and significant commitment to establish.

          Conclusion

          The National Cancer Institute Community Cancer Centers Program experience provides a relevant model to broadly address creating a culture of research in community hospitals that are increasingly networked via systems and consortiums. The strategies used align well with the National Cancer Institute—American Society of Clinical Oncology Accrual Symposium recommendations for patient-/community-, physician-/provider-, and site-/organizational-level approaches to clinical trials; they helped sites achieve organizational culture shifts that enhanced their cancer research programs. The National Cancer Institute Community Cancer Centers Program hospitals reported that the strategies were challenging to implement yet proved valuable as they provided useful metrics for programmatic assessment, planning, reporting, and growth. While focused on oncology trials, these concepts may be useful within other disease-focused research as well.

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          Most cited references21

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          The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: summary and recommendations.

          Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions.
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            Randomized clinical trials--removing unnecessary obstacles.

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              Racial/ethnic differences in clinical trial enrollment, refusal rates, ineligibility, and reasons for decline among patients at sites in the National Cancer Institute's Community Cancer Centers Program.

              This study examined racial/ethnic differences among patients in clinical trial (CT) enrollment, refusal rates, ineligibility, and desire to participate in research within the National Cancer Institute's Community Cancer Centers Program (NCCCP) Clinical Trial Screening and Accrual Log.
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                Author and article information

                Journal
                Clin Trials
                Clin Trials
                CTJ
                spctj
                Clinical Trials (London, England)
                SAGE Publications (Sage UK: London, England )
                1740-7745
                1740-7753
                June 2015
                June 2015
                : 12
                : 3
                : 246-256
                Affiliations
                [1 ]Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
                [2 ]St. Joseph Hospital, Orange, CA, USA
                [3 ]St. Joseph’s/Candler, Savannah, GA, USA
                [4 ]Mercy Medical Center, Des Moines, IA, USA
                [5 ]Albert Einstein Healthcare Network, Philadelphia, PA, USA
                [6 ]Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
                [7 ]Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
                [8 ]Queen’s Medical Center, Honolulu, HI, USA
                [9 ]Roy and Patricia Disney Family Cancer Center, Providence Saint Joseph Medical Center, Burbank, CA, USA
                Author notes
                [*]Eileen P Dimond, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA. Email: dimonde@ 123456mail.nih.gov
                Article
                10.1177_1740774515571141
                10.1177/1740774515571141
                4420772
                25691600
                1c656750-63ae-479a-acb4-792107748256
                © The Author(s) 2015

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( http://www.uk.sagepub.com/aboutus/openaccess.htm).

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                Categories
                Articles

                Medicine
                clinical trials,community,culture of research,community hospital research,national cancer institute community cancer centers program

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