Table 3 Contextual factors potentially unique to small and rural cancer programs
Program characteristic | Domain | Testing | Treatment |
|---|---|---|---|
Small program size | Motivation | • Smaller cancer programs were cognizant of the volume required to cover fixed costs of testing, in contrast to providers at larger programs | • Smaller sites expressed more concerns about their ability to deliver targeted therapy, acknowledging institutional costs and staffing limitations |
Capability | • Fewer staff have expertise in targeted therapy | ||
Opportunity | • May not have the volume required to cover fixed costs of in-house testing | • Have staffing limitations compared to larger organizations with a greater number of provider types (e.g., nurse practitioners and pharmacists) available to help with the delivery and management of targeted therapy • Perceived greater pre-authorization burdens • Experienced more limitations from drug wholesalers • Had fewer reserves to absorb non-reimbursed care • Could not have in-house specialty pharmacies to draw on for drug acquisition • Lacked navigation programs to help patients manage the complexity of targeted therapy • Lacked tumor boards • Lacked staff to deploy to facilitate reimbursement for targeted therapies • Lacked staff for “teach” appointments to facilitate adherence to oral targeted therapy and surveillance appointments | |
Rural | Motivation | • Saw great potential advantage of liquid biopsy over tissue testing to address unique delivery needs | |
Opportunity | • Hospital has invested in infusion center as a way to increase revenue • “It’s getting harder and harder to find RNs. We have several openings right now for RNs. We’ve had a lab position open for two years. We have to use an agency.” [Rural Administrator] • Facility lies outside of the shipping zone for targeted therapy |