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This section summarizes ways that Comprehensive Cancer Control (CCC) coalitions can implement their state's cancer control plan goals. The Nine Habits of Successful Comprehensive Cancer Control Coalitions addresses CCC priority work plans (Habit 9). It identifies the two fundamental actions that coalitions must take:
- Determine cancer plan priorities to assure efforts are focused and meaningful, and
- Develop work plans for priorities to ensure that work is effective and progress monitored.
(American Cancer Society and Comprehensive Cancer Control National Partnership, 2014)
To guage your coalition's status, begin with this assessment. The assessment focuses on:
- The frequency with which CCC priorities are reviewed;
- The coalition's focus on those priorities; and
- Members' engagement in developing action plans to implement strategies.
To further your coalition's success in implementing its plan, think about:
- How your coalition prioritizes its work;
- Which partnerships are most influential in successfully implementing your plan;
- How your coalition tracks implementation and measures progress; and
- Success factors/facilitators and barriers to implementation and tracking of your plan.
Disclaimer and an invitation
Information for the Wiki comes from a variety of sources such as published materials, CCC websites, CCC coalition products, informal interviews and correspondence. Examples and perspectives on CCC plan implementation were from 2018 CCC coalition and program staff interviews and correspondence that we have received permission to use. The Wiki is a living resource. If your CCC coalition has a practice, perspective, valuable lesson, or update – please share!
The Iowa Cancer Consortium (the Consortium), Iowa’s cancer coalition, recently revised the Iowa Cancer Plan for 2018 to 2022, in collaboration with the Iowa Comprehensive Cancer Control Program (CCCP) at the Iowa Department of Public Health (IDPH) and other partners. The Iowa Cancer Plan has five priorities (prevention, screening, treatment, quality of life, and health equity) and 15 goals. The health equity priority is new to the Iowa Cancer Plan. The Consortium leadership, staff, and members involved in revising the Iowa Cancer Plan agreed that there needed to be a more significant emphasis on health equity in the new plan. Each of the 15 goals under the five priorities has its own actions, including evidence-based interventions, and data targets. The Consortium provides funding opportunities for projects that align with the Iowa Cancer Plan. These funding opportunities include larger implementation project grants and smaller grants that provide additional funding to amplify existing projects that are implementing the Iowa Cancer Plan.
The Consortium has an Iowa Cancer Plan Project Bank on its website, which is a frequently-updated resource for Iowans to learn about the work that is being done in support of the plan and allow Iowans to share their own work. To monitor progress, the Consortium’s Data & Evaluation Committee, which includes membership from the Iowa Cancer Registry, is currently developing an evaluation plan for the Iowa Cancer Plan that will involve tracking key data targets in the plan. The funded projects are also required to submit evaluation results to the Consortium. Barriers to implementation include funding uncertainty at the state and national levels and recent funding reductions. Success factors for implementation include the Consortium’s passionate membership and staff. Key partnerships for successful implementation include various programs within IDPH, American Cancer Society, the Registry, health care systems and health care providers, and members of diverse communities across Iowa.
Kansas Cancer Partnership is an inclusive coalition that welcomes new members who want to take an active role in working on the goals, objectives and strategies in the Kansas Cancer Prevention and Control Plan, 2017-2022. Information about coalition membership is found on the Kansas Cancer Partnership website (www.kscancerpartnership.org). The coalition meets in-person twice a year, with workgroups meeting more often by video conferencing or conference call. Work on state plan objectives related to tobacco use and HPV immunization is conducted in conjunction with the Tobacco Free Kansas Coalition and Immunize Kansas Coalition, respectively. Shared Board members with these coalitions facilitate this collaboration. Kansas Cancer Partnership members vote on priorities when a new state cancer plan is launched; workgroups revisit priorities annually and adjust as needed. Regional coalitions conduct strategic planning to select locally relevant priorities from the state cancer plan and design interventions specific to the unique characteristics of their regions. Regional coalitions meet approximately monthly by phone or in person. In 2018 there were regional coalitions in the south central, south east and north central areas of the state, with a fourth regional coalition under development in western Kansas.
The state cancer plan has 23 measurable objectives, and the majority of these objectives have baseline data and data targets for 2022. Developing baseline data for the remaining objectives is a priority. Each Kansas Cancer Partnership meeting includes data updates through a presentation or fact sheets. Long-term trends will be documented in a Mid-Course Review in 2020. Implementation projects have process measures and key indicators of success that are closely monitored. These are documented in updates and reports to funders and coalition members.
One challenge that we encountered is that a few data indicators identified by the coalition are not the same as the data indicators available in the Chronic Disease Management Information System.
The Kentucky Cancer Consortium (KCC) uses cancer surveillance data to inform all our efforts. The Consortium maintains a strong working relationship with the state’s Cancer Registry as well as Kentucky’s Behavioral Risk Factor Surveillance System Program in order to compile and analyze timely and accurate cancer control data. To implement Kentucky’s comprehensive cancer control (CCC) plan, or Cancer Action Plan, we examine the Registry’s cancer incidence and mortality data to identify cancers with the highest burden in the state. We then identify which cancers are either preventable or have an approved screening method, and compile for these cancers any related behavioral data from the Kentucky Behavioral Risk Factor Survey (i.e. screening rates, smoking rates, etc.). We further narrow the field by identifying where the momentum lies in our Consortium and in which areas our partners are willing to focus or have the most resources. Much of this is accomplished during our quarterly in-person meetings as well as smaller group discussions via video conferencing throughout the year. After finding general consensus on draft objectives, KCC staff conduct an online survey to allow for discreet voting on approval of goals and objectives for incorporation in the Cancer Action Plan, and priority areas for implementation efforts.
KCC currently has three active workgroups that are the vehicle for implementation of the Cancer Action Plan: the Colon Cancer Committee, Lung Cancer Network and Radon Coalition. Through these smaller, action-oriented workgroups, we choose evidence-based strategies from our cancer plan for implementation. We work to ensure that all Cancer Action Plan objectives are specific, measurable, achievable, realistic and time-bound (S.M.A.R.T.), most frequently utilizing available Behavioral Risk Factor Surveillance System and Registry data to measure progress. However, for some priority implementation areas, finding statewide data can be a challenge. For example, the Radon Coalition faced initial barriers to measuring implementation progress due to a lack of available state-level radon test data. KCC approached a key academic partner who was funded in research around radon awareness, testing and mitigation, working with them to use their data to help KCC develop objectives and measure our progress as a coalition.
Almost universally, comprehensive cancer coalitions find that certain core partners are essential to their implementation efforts – those that can compile and analyze data, those who have frontline community staff statewide, cancer focused non-profits, health plans and academic medical centers and universities. Some of KCC’s influential partners have also included organizations which are able to do direct lobbying and advocacy, which KCC is unable to do because of our federal funding restrictions. For example, the KCC Colon Cancer Committee depended on 501(c)(4) policy partners, as well as non-profit partners with registered lobbyists, to advocate for legislation that broadened access to colon cancer screening.
Another way KCC tracks our partners’ implementation efforts is through a simple online survey administered every two to three years. The survey reflects the broad categories of the Cancer Action Plan, and prompts members to select the areas on which they are working from a drop-down menu. We generate a list of names and e-mail addresses from the survey which are shared upon request to other Consortium members who are looking for partners working in similar areas. The survey does not provide exact measures for progress at the strategy level, but broadly indicates which cancer plan objectives coalition members are implementing.
KCC has been successful in forging long-term organizational relationships with key cancer control partners. Part of this success is attributable to KCC staff’s intentionality in acting as a neutral convener of organizations with similar workplans and potentially competing funding sources, and being consistent and concise in our ongoing communication. This consistency builds trust among Consortium partners who share information and join workgroups to implement our objectives. Additionally, having a Consortium staff member with process evaluation skills has contributed to the success of tracking implementation of the Cancer Action Plan. As in all coalitions, we have faced difficulties – particularly in the ebb and flow of key partner organizations’ staffing and their subsequent ability to invest as a collective. We’ve learned that whenever possible, prioritizing implementation objectives that garner broad interest among cancer partners such as those related to smoking and obesity might show more promise for success. These cross-cutting risk factors effect multiple cancers and therefore interest multiple partner organizations, increasing the potential for more active involvement.
In 2000, as part of the American Indian Screening Initiative, the leadership of the Montana Cancer Control Programs (MCCP) formed the Montana American Indian Women's Health Coalition (MAIWHC), bringing together American Indian women representing tribal communities, tribal health systems, urban health programs and urban communities. MAIWHC is a grassroots coalition that was formed to assist MCCP in recruitment and screening of American Indian women for breast and cervical cancer, and has evolved into a coalition that addresses issues along the cancer continuum.
In 2015, members of MAIWHC met with the Montana Cancer Coalition to review progress on objectives and strategies in the Montana Comprehensive Cancer Control (CCC) Plan 2011-2016, and to begin work on the development of an updated CCC plan for 2016-2021. MAIWHC drafted a complementary companion plan that specifically addressed the needs of American Indians, while incorporating the overarching objectives and goals from the Montana CCC Plan. Strategies were then developed to adapt these objectives to the American Indian population in order to address cancer-related health disparities within that specific demographic.
Since 2016, MAIWHC has worked as one unified group to annually identify priority objectives specific to the needs of Montana's American Indian communities and develop yearly projects that advance these objectives. Such projects include:
- Providing a mammography bus and education on the importance of screening and early detection during Pink Ribbon Bingos
- Partnering with the American Cancer Society to offer the Circle of Life cancer education training
- Conducting education and outreach regarding the importance of screening at Powwows and other events
MCCP staff oversee evaluation activities in close collaboration with MAIWHC leadership. MAIWHC monitors progress toward targets noted in the MAIWHC plan through process measures, such as the number of cancer screening forms submitted during a Pink Ribbon Bingo event, or the number of active participants that attend MAIWHC meetings. These measures are essential to achieving the goals of MAIWHC.
Selection of targets is based on considerations such as existing baseline and trends, goals that other states have proven achievable and the desire to attain health equity. MAIWHC objectives related to cancer prevalence rely on data from the Montana Central Tumor Registry. Due to data tracking and dissemination of such information, as well as the consistent reporting of outcomes from screening events, MAIWHC has become a valuable partner in the work to reduce the cancer burden in Montana's American Indian population. This year, it was reported by the Montana Central Tumor Registry that cancer incidence has decreased significantly among Montana American Indians since 2006, with an average annual percent change of -3.3%.
The MAIWHC plan is the only one of its kind in the nation. Both the MAIWHC coalition model and plan have been used as an example for other tribal and public health organizations in various states that look to achieve data-driven progress in their local, regional and statewide American Indian health initiatives.
In 2015, the Montana Cancer Coalition (MTCC) began the process of updating content for the 2016-2021 Montana Comprehensive Cancer Control (CCC) Statewide Plan (the Plan). MTCC collaborative partnerships ranging from hospital systems, cancer care focused non-profit organizations, local health departments, tribal health organizations and the state of Montana Department of Public Health and Human Services Chronic Disease Bureau, created this framework for action to address the cancer burden in the state of Montana. MTCC has updated many of the goals and objectives noted in the new five-year plan, as well as the annual identification and prioritization process of these objectives worked on by its seven implementation teams:
- Prevention: Sun Safety
- Prevention: Nutrition and Physical Activity
- Screening and Early Detection
- Early Detection: Lung Cancer Screening
- Treatment and Research
- Quality of Life and Survivorship
- Pediatric Cancer
The Plan delivers objectives and strategies to ensure unified forward momentum to providers, educators, policymakers, the public health community and other stakeholders. Selection of targets included in the Plan is based on considerations such as the existing baseline and trends, goals that other states have proven achievable and the desire to attain health equity. The Plan's content is consistent with content from the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services, Healthy People 2020, the Montana State Health Improvement Plan and the Montana American Indian Women's Health Coalition (MAIWHC) five-year companion plan.
In order to accomplish all of the goals noted in the five-year plan, the seven MTCC implementation teams, in conjunction with the rest of the steering committee leadership, annually evaluate progress on priority objectives and identify priorities for the upcoming year. Some objectives will only take a single year to accomplish, while some will take longer due to the depth of the work involved to achieve the end goal. To begin the process, the MTCC steering committee convenes during their annual spring leadership retreat. Implementation team co-chairs:
- Identify and discuss the objectives they would like to pursue during the upcoming year with the rest of the steering committee.
- Discuss any potential barriers they anticipate may surface and strategize about how to overcome these barriers.
- Work with the steering committee to develop an agenda for the annual MTCC statewide meeting that focuses on coalition successes and the important work that lies ahead.
During the statewide meeting, the implementation team co-chairs facilitate breakout sessions and convene with their team members to identify what objective(s) they as a group agree to focus on for the upcoming year. Once these objectives are identified, the teams choose priority strategies and develop their yearly strategic action plan. This action plan outlines projects for the year and assigns responsibilities to team members. It also allows for the recruitment of new members to join the team to accomplish the tasks.
Once each group has a new action plan developed, teams meet monthly to discuss progress, and, if needed, modify plans and plan activities. Tracking of progress is measured through the submission of a monthly meeting report by implementation team co-chairs through a private portal on the MTCC website. This report is then reviewed by Montana Cancer Control Programs staff as well as the MTCC administrative team.
The steering committee reviews progress and provides feedback to implementation team co-chairs throughout the year and offers additional assistance when needed. In order to communicate the five-year plan progression, an annual report is developed and presented at the MTCC annual spring statewide meeting, published on the MTCC website, and communicated through the CCC work plan reporting submitted to CDC.
Mountains of Hope (MOH), the West Virginia Cancer Coalition (Coalition), is a group of individuals and organizations in WV who are part of the coordinated efforts in the state to reduce the human and economic impact of cancer. MOH members include CDC-funded, state cancer prevention and control programs; representatives of advocacy and prevention organizations, such as the American Cancer Society and the American Lung Association; medical schools and pharmacy schools in the state; individual community activists; Commission on Cancer-accredited cancer centers; hospice and palliative care organizations; health statistics organizations; and others. MOH authors the WV Cancer Plan (the Plan) that serves as a framework to provide healthcare practitioners, policymakers, advocates, the public health community, and other stakeholders a common set of objectives and strategies designed to encourage collaboration and consensus building. The 2016-2020 plan includes five overarching goals that encompass the broad scope of cancer care for all West Virginians and 25 Aims.
The five goals are:
- Prevent cancer from occurring;
- Detect cancer at its earliest stages;
- Treat cancer patients with the most appropriate and effective therapy;
- Improve the quality of life for every West Virginian affected by cancer; and
- Achieve health equity across the cancer care continuum.
MOH works to secure funding from the government, private entities, and other sources in order to implement activities related to the Plan. MOH also recognizes that its members (state and local government, private and nonprofit organizations, faith-based organizations, academic institutions, researchers, cancer survivors, caregivers, and advocates ) and partner organizations (WV Program to Increase Colorectal Cancer Screening, WV Breast and Cervical Cancer Screening Program, American Cancer Society and many others) are the Coalition's strongest assets. Their dedication and in-kind support remain the most critical component to meeting the Plan's goals.
MOH is comprised of a steering committee that directs the efforts of the Coalition and workgroups. Every two years, Coalition members vote to select priority Aims, which are derived from evidence-based strategies. For the current Plan, five priority Aims were selected and a corresponding number of workgroups were formed to work on each one.
The current priority aims:
- Aim 1- Reduce the use of tobacco products and electronic nicotine delivery systems among adults.
- Aim 10-Increase the immunization rates for vaccines shown to decrease the risk of cancer.
- Aim 11- Increase risk-appropriate screening for colorectal cancer.
- Aim 14-Increase risk-appropriate screening for lung cancer.
- Aim 20-Improve the quality of life for cancer survivors in WV.
Each workgroup creates a plan, conducts extensive research, and works to accomplish set goals. This allows the Coalition to track progress and determine barriers. The Coalition works to overcome barriers such as budget cuts, rurality of the state, and health disparities. The workgroups often work to achieve positive policy changes that will provide a foundation for long-lasting, population-wide improvement in health outcomes. These changes can be laws, resolutions, mandates, regulations, or rules. Another source of positive change has is the diligent education on different types of prevention and early detection of cancer through regular screenings. Through a partnership with the WV Program to Increase Colorectal Cancer Screening, American Cancer Society and the National Colorectal Cancer Roundtable, MOH has taken part in the 80% by 2018 movement to get 80% of the population screened for colorectal cancer. Through these efforts and various partnerships, MOH has had a positive impact in the state. MOH will continue to utilize the Plan as a way to reach the goals of the Comprehensive Cancer Control Program, the Coalition, and West Virginians. The Coalition is able to track successes through the Behavioral Risk Factors Surveillance System and West Virginia Health Statistics Center. Some successes include legislative passage of restrictions on teen indoor tanning, the ability of pharmacists to administer HPV vaccines, and the creation of a palliative care task force in the state.
American Cancer Society and Comprehensive Cancer Control National Partnership. (2014). Nine Habits of Successful Comprehensive Cancer Control Coalitions. Retrieved from http://bit.ly/9CoalitionHabits
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