Characterization of Research Priorities Among LMICS: A Qualitative Content Analysis of Cancer Control Plans

Background: The Cancer Resolution approved at the 2017 World Health Assembly highlighted the need to improve the evidence base for cancer prevention and control through research. Research priorities articulated in national cancer control plans can promote effective cancer control, especially in low and middle-income countries (LMIC) that bear a significant cancer burden and where local research is scarce. Understanding how LMICs address research in their cancer control plans may enhance integration of research and control efforts. Aim: We sought to systematically identify and characterize the research priorities in select LMIC cancer control plans. Methods: LMIC plans published in English and in 2016 or later, that met World Bank and Human Development Index criteria and were identified. Key terms were used to identify relevant research-related content. A systematic, inductive approach was used to examine for clusters of concepts or topics, and codes were applied to characterize the research priorities into categories, phases, types, dimensions and aspects. Results: A total of 12 LMIC plans were deemed to be eligible for the analysis. Two overarching categories of research-related content were identified: Establishing a Research Agenda (ERA), where specific types and topics of research were articulated, and Building Research Capacity (BRC), for content describing intention to plan or facilitate research. Six LMICs included a total of 67 ERA priorities involving five types of research. Health Services Research was the most frequently reported type of research (31%). The research topics in the treatment/management phase were most frequently identified (30%). Three of the six countries had the most number of ERA research priorities. A total of 126 BRC priorities were identified across five dimensions. Two BRC dimensions were most frequently proposed: Enhance Cancer Surveillance (44%) and Establish Research Infrastructure (24%), and subsequent aspect codes elucidated a range of activities. Five aspects characterized focal areas in cancer surveillance while two aspects revealed focal areas for research infrastructure. Country-specific variation in ERA and BRC priorities were seen. Priorities were mapped to illustrate the breadth and depth of research priorities in LMICs' plans. Details of the distribution of research by country and by dimensions will be discussed. Conclusion: This first comprehensive examination of research priorities in LMIC cancer plans revealed countries' commitment to incorporate research into their cancer control efforts. The extent of research-related priorities demonstrates promise for transnational research collaborations. Next steps include improved understanding of key factors in achieving successful integration of research and control efforts through cancer control plan implementation.

Evaluation of the Project Echo Tele-Mentoring Model for Knowledge Sharing and Technical Assistance in Cancer Control Planning and Implementation

Background: There is increasing demand for dissemination and implementation of evidence-based guidelines in cancer control. In 2017, the National Cancer Institute's Center for Global Health (NCI-CGH) partnered with University of New Mexico and The University of Texas MD Anderson Cancer Center to provide the Project ECHO (Extension for Community Healthcare Outcomes) model of tele-mentoring as an extension of existing programs that convene relevant stakeholders for knowledge sharing and technical assistance in national cancer control planning. In early 2018, NCI-CGH launched Project ECHO programs in the Caribbean, Asia-Pacific, and sub-Saharan Africa regions, and began plans for implementation in south Asia. As a new approach for the center in program development, NCI-CGH included evaluation measures from the inception of the program to adequately measure its efficacy. Aim: Evaluation of NCI-CGH Project ECHO programs will guide future program development, and assess achievement of the program's goals: (1) to increase individual participant knowledge in specific areas; (2) to improve application of the knowledge learned; and (3) to increase collaboration within and among countries. Methods: Using Project ECHO Evaluation 101, a guide developed by the New York Academy of Medicine, NCI-CGH developed a comprehensive logic model including a concise list of program outcomes prior to the launch of ECHO programs. NCI-CGH used the logic model to develop and pilot-test a Web-based baseline and post-ECHO survey, to be completed by participants in each program, that measures participants' knowledge of cancer control planning principles and strategies. NCI-CGH conducted the baseline survey for all three ECHO programs. The post-ECHO survey will be distributed at the conclusion of each program. Each program is expected to run for approximately six months to one year. Results: Response rates for baseline surveys were: 32% in the Caribbean, 43% in Asia-Pacific, and 78% in sub-Saharan Africa. Respondents (by region) reported high levels of knowledge of the following evidence-based principles and guidelines: the Caribbean - HPV vaccination, Asia-Pacific - cervical cancer early diagnosis, sub-Saharan Africa - raising awareness. Low levels of knowledge were reported for: psychosocial support for cancer patients, family members, and caregivers in the Caribbean; survivorship care for cancer patients in Asia-Pacific; and alcohol consumption control in sub-Saharan Africa. This presentation will highlight baseline and post-ECHO survey analysis findings and the impact of these data on future program development. Conclusion: Inclusion of evaluation measures in the design phase of NCI-CGH Project ECHO tele-mentoring programs enhanced planning efforts by providing a blueprint for developing program curricula, creating an embedded system for gathering data from participants, and informing the pathway to future improvements.