Avera McKennan Hospital and University Health Center CI Report – Interim

What has been most instrumental to your progress?

The Avera Cancer Institute (ACI) Rural Advisory Board had a strong start after partnering with Dr. Dan Gee from South Dakota State University. Dr. Gee founded the SD Agriculture and Rural Leadership, a private non-profit organization, focused on identifying and developing leadership for rural communities to enhance the quality of life in SD. He joined the board and recruited other board members from across the state. To kick off our activities, one of our ACI Rural Advisory Board members invited the group to tour his farm. Walt Bones is a partner in Hexad Farms near Parker, a sixth-generation farm. He served as the South Dakota Secretary of Agriculture from 2011 – 2013. Walt provided an excellent tour of his large farming operation to the group which included oncologists from Avera. They learned firsthand about the occupation of many of their patients and how farming has changed over the years. It was important to have a collective understanding of current farming operations. The board’s work focuses on discovering the barriers that exist for people in their rural communities and what local resources are available to assist patients and families impacted by cancer.

In January 2016, the ACI Rural Advisory Board hosted a panel discussion in conjunction with the Sioux Falls Farm Show at the Convention Center. The panel discussion titled ‘Leaders in Genomic Transformation – from Plants to Animal to Humans’ and included panelists Dr. Eddie Sullivan, president and CEO/Co-Founder of SAB Biotherapeutics, Inc., a biotechnology executive, charting the vision of SAB which creates life-saving therapeutics, curently using bovines; Dr. Peter Guzman who oversees the commercial pipeline breeding operations for Monsanto; and Dr. Casey Williams, the Director of Molecular Medicine for the Avera Cancer Institute. The panelists shared developments from their work in biotech, specifically genomics such as: making human proteins/therapeutics in other species to benefit humans; developing crops wtih enhanced nutrition profiles that solve vitamin and nutrient deficiencies like the golden rice, or breeding for particular traits to increase yield and eliminate disease; and helping to treat cancer through personalized medicine, so physicians can better predict what treatments are likely to work, and what treatments are likely not to work on each patient.

The ACI Rural Advisory Board members have played a vital role in the development of the new Avera Cancer Institute Navigation Center. They have served as the focus group for this new program and have provided input and suggestions regarding hours of operations for the call center as well as what type of questions patients will ask when they call for help. The board has worked hard to discover local resources in their communities and the other rural counties they selected at the first board meeting. The resources have been provided to Avera and a database has been created to assist our ACI Navigation Center staff to provide local resources to patients in need. The Navigation Center focuses on reducing burdens and overcoming barriers for patients by providing personalized support, as nobody should face cancer alone. Navigators provide information such as locating oncology providers, local, regional and national resources on cancer diagnosis, treatment, survivorship or caregiving; cancer prevention services, emotional support and coping strategies including support groups, transportation services, and financial resources or insurance expertise.

Key lessons learned

When writing a Community Innovation grant, it is difficult to predict what will develop when you listen to and seek input from farmers, ranchers and rural South Dakotan citizens. We begin each meeting with a round table discussion about what is going on in reference to cancer or what they have learned in their communities. The stories they have shared about their own personal or family member journeys have been profound. It is humbling to listen to their stories about how alone and isolated a person can feel living in a rural setting after being diagnosed with cancer. Through their discussions, we have learned how to better meet the needs of those affected by cancer in rural communities. Several board members live very near Indian reservations in SD, and there has been discussions regarding lack of access to healthcare on the reservations and as a result, we will be attending the Great Plains Tribal Health Summit in Rapid City. In addition, they have expressed concern about the delivery of cancer prevention services to rural communities. The lessons learned is that when we listen to the true needs of our board, what we thought we might focus on is not what the need truly is.

Having partners that include the former SD Secretaries of Agriculture, Walt Bones and Bill Even, along with Dr. Dan Gee professor from SDSU has allowed us to be very successful in the recruitment of high level board members. It required us to step up our game and have the same high level presenters and facilitators in the room. The internal steering committee spends considerable time planning and organizing the meetings. We have also had to adjust the original budget that was requested from the Bush Foundation as we had more than 15 members volunteer and we wanted good representation from around the state and region. It was important to cover their travel expenses, especially since several board members were traveling over 300 miles and needed lodging accommodations. It has also been more expensive to host the meetings and provide meaningful presentations as well as a facilitator.

Reflections on inclusive, collaborative or resourceful problem-solving

The ACI Rural Advisory Board has been successful from all the collaborations they have facilitated. The collaboration with the SD Agriculture and Rural Leadership organization led to the recruitment of rural leaders across the state. The SD Cancer Control Project invited us to speak about the ACI Rural Advisory Board at their state conference and then they provided training to our board members. The Cattlemen’s Association has invited us to speak at their annual conference next December to share our progress. Collaboration with our board members has led us to be part of their community offerings such as the Women in Agriculture event in Faulkton, SD with over 250 women attending. We were also invited to attend the Indian Health Services Health Fair in Ft. Thompson and the upcoming regional Tribal Health Summit in Rapid City. A board member served on the Cancer Moonshot panel in June. The board members have also volunteered to attend their local county fairs to distribute cards about the Avera Cancer Navigation Center and the services offered to anyone impacted by cancer, no matter where they receive care.

Other key elements of Community Innovation

Relationship building has been another element that has been instrumental to the success of the grant. The internal organizing group has spent time in the rural communities visiting with the board members and others in the community about the programs that the board is addressing.

Understanding the problem

The ACI Rural Advisory Board was formed for Avera to better understand the needs of those in rural communities as it relates to cancer. We have gained a deeper appreciation for the barriers to care that they face and the need for unique and out of the box thinking to better meet those needs. The ACI Navigation Center has greatly benefited from this board’s input; however, we have also uncovered other needs that will require novel approaches such as alternative methods to engage farmers and ranchers in cancer prevention strategies and screenings.

If you could do it all over again…

Due to the sophistication of the board members, we would have been more apt to engage a local yet professional facilitator earlier in the process. Although it was before our first meeting that we identified this need, had we been able to anticipate this need, we would have prepared a budget that would have covered that person.

One last thought

Thanks to the Bush Community Innovation Grant, we have exceeded our expectations on the impact of creating the Avera Cancer Institute Rural Advisory Board. The advisory board has allowed us to have a wider view of the needs of our rural communities and how we can work together to better meet those needs related to cancer prevention, screening and treatment. This has been an incredible opportunity to have such an engaged board who is passionate about lessening the burden of cancer in their communities and in the state of SD.