The Leslie (Les) J. Fleming Churchill Fellowship to investigate sustainable methods of improving the health and well-being of rural cancer survivors

Recommendations Conduct further research to determine causes of survival disadvantage in rural cancer patients globally, and identify key intervention targets.

• Develop new strategies in consultation with rural people so they fit the local context—one strategy will not suit all rural Australians and people who ‘speak their language’ need to deliver them.
• Ensure new strategies build on the existing strengths of rural communities (and not simply assume deficits.
• Ensure new strategies elicit patient-directed goals and are flexible enough to meet them.
• Encourage researchers, policymakers and health professionals to apply a ‘rural lens’ and consider the implications of their decisions on rural people affected by cancer.
• Consider implementation of lay patient navigators for rural cancer patients (and other at-risk groups) to help overcome social, educational, geographical and economic determinants of health, with the capacity to triage to clinical nurse navigators when necessary.
• Explore the potential for rural practice nurses to adopt new models of care to cancer survivors (particularly post-treatment) and other chronic diseases.
• Work with the creators and evaluators of existing online interventions to adapt them to meet the supportive care needs of people who have finished treatment and are returning home to rural Australia.
• Reduce duplication of cancer-related information on the internet and ensure what is available appropriately considers the unique needs of rural people affected by cancer.
• Develop a depository of online interventions and system for ensuring they remain publicly available post-research funding cycles. \\ Explore barriers to the delivery of more chemotherapy in rural areas where the lack of this is considered by locals to be problematic (particularly for palliative patients) and strategies that may be borrowed from other contexts to help overcome them.
• Test the feasibility and acceptability of gardening-based interventions to improve the diet, physical activity and mental health of cancer survivors in rural Australia.
• Test the feasibility of delivering new supportive-care focused interventions to rural people affected by cancer via our well-established telehealth networks.
• Implement systems for gathering patient-reported outcomes that are integrated in electronic medical records and inform consultations, improve care coordination/referrals, identify unmet needs in stoic people who would otherwise be reluctant to report them and facilitate measurement of the impact of new strategies and systems.
• Adopt methods from community-based participatory action research, intervention mapping, implementation science and the business/ marketing world, to progress work in this field. Keywords: Cancer, oncology, rural, remote, regional, country, psychosocial, supportive care, e-Health, eMental Health