Key Dates

Related Announcements

PAR-21-190 - Modular R01s in Cancer Control and Population Sciences (R01 Clinical Trial Optional)

PAR-21-035 - Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required)

PAR-19-348 - Innovative Approaches to Studying Cancer Communication in the New Information Ecosystem (R01 Clinical Trial Optional)

PAR-19-350 - Innovative Approaches to Studying Cancer Communication in the New Information Ecosystem (R21 Clinical Trial Optional)

Issued by

National Cancer Institute (NCI)

Purpose

The purpose of this Notice of Special Interest (NOSI) is to highlight the interest of the NCI’s Division of Cancer Control and Population Sciences in receiving investigator-initiated applications for conducting research on the use of telehealth in cancer-related care. Studies focused on populations that experience inequities in access to care and have worse cancer outcomes compared to the general population are strongly encouraged. This NOSI for R01 and R21 applications is a companion announcement to the RFA titled “Centers on Telehealth Research and Cancer-Related Care” (RFA-CA-21-029).

Background

Telehealth encompasses a variety of clinical interactions and communication modalities. As defined by the Centers for Medicare and Medicaid Services, “telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health.” The Health Resources and Services Administration extends this definition to include the use of telecommunications technologies to support distant clinical health care, patient and professional health-related education, public health, and health administration.

Telehealth interactions can occur between clinicians (i.e., provider-provider interactions) or between clinicians and patients (including interactions with family members or other caregivers of patients). Telehealth interactions can also be categorized as synchronous (real-time) or asynchronous (sequential). Synchronous telehealth examples include telephone calls and videoconferencing; asynchronous telehealth examples include the capture and forwarding of medical images and secure messaging. The use of telehealth has grown in recent years, and the rapid and widespread adoption of virtual visits has been facilitated by recent changes in coverage and reimbursement for telehealth. Telehealth is especially helpful to patients who face transportation, logistical, or other challenges to in-person visits. Telehealth can also support exchange of information and collaboration among clinicians, which is essential to providing coordinated and timely cancer-related care. The technology used for telehealth includes hardware (such as computers, cameras, mobile phones, wearable devices, and sensors) and software (such as electronic health records [EHRs], patient portals, image processing software, digital aids to support cognition and behavior change, and clinical decision support systems).

Research Objectives

NCI is interested in studies that will advance actionable knowledge on the optimal use of telehealth in support of patient and clinician interactions during the course of cancer care delivery. The scope of telehealth research encompassed by this NOSI includes synchronous and asynchronous communications and other digital interactions between clinicians and patients (including family members and other caregivers) as well as communications and other digital interactions between and among clinicians. The proposed telehealth research can focus on any part of the cancer care continuum (ranging from cancer prevention to end-of-life care) for patients of all age groups in all types of care settings. Telehealth studies that are implemented and tested in both pediatric and adult care settings are welcome. This research may use either observational or interventional study designs, or a combination of both.

This NOSI encourages research focused on patient-provider interactions including, but not limited to, studies that:

• Examine the utilization of and evaluate the effectiveness of telehealth for primary and secondary cancer prevention such as counseling for tobacco, alcohol, physical activity, diet, HPV vaccination, and mental health; provide genetic counseling for germline mutations; provide shared decision making for preference-sensitive cancer screening tests; and improve adherence to cancer screening.
• Evaluate the effectiveness of telehealth interventions aiming to increase cancer screening rates, improve the accuracy and timeliness of cancer diagnoses, and initiate appropriate cancer treatment.
• Evaluate the effectiveness of telehealth in improving treatment and management of cancer and/or the provision of palliative care.
• Evaluate the use of telehealth to support cancer survivors, including surveillance for adverse effects of cancer treatments, recurrence of cancer, and treatment of co-morbidities.
• Evaluate the impact of telehealth on patient, family, and caregiver experiences with care and quality of life in the context of cancer care.
• Evaluate the quality and effectiveness of telehealth interactions in promoting patient-centered communication.
• Understand the tasks, and the time and cognitive burden of performing the tasks, imposed by the telehealth interactions on patients and their caregivers.

This NOSI also encourages research focused on provider-provider telehealth interactions including, but not limited to, studies that:

• Evaluate the effectiveness of telehealth in improving communication and coordination of oncology care, including communication and coordination between oncology care and primary care providers.
• Evaluate the effectiveness of telehealth for precision oncology, including the use and interpretation of tests for genomic or other molecular markers.
• Understand the clinical workflow and the cognitive and other burdens imposed by current clinical information technology (IT) systems on providers in their telehealth-related interactions.
• Understand how organizational policies, clinical team interactions, and the configuration of IT systems influence the clinical workflow and delivery of telehealth.
• Examine the cost effectiveness of telehealth in cancer-related care.

Studies that examine interactions at multiple levels (i.e. patient, provider, and care delivery system-level) or intervene at multiple levels are also of interest. In addition, it is important that studies use best practices for interoperability across IT systems and devices and also ensure that patient privacy and confidentiality are protected as required by applicable laws and regulations.

NCI encourages research on populations that experience inequities in access to care, have limited access to broadband and digital technologies, have low health and/or digital literacy, and have worse cancer outcomes compared to the general population, especially those accessing care in community oncology practices, including those in rural areas or those serving under-served populations. NCI also strongly encourages research that examines how telehealth can be implemented without creating or exacerbating health disparities, as well as research that examines how telehealth can be used to address health disparities and promote health equity. Applications in response to this NOSI should strive to advance actionable knowledge on the optimal use of telehealth in support of patient and clinician interactions during the course of cancer care delivery.

R21s may support formative work to develop telehealth interventions or examine their impact in pilot studies. R01s may support projects that integrate and evaluate telehealth interventions in a cancer care delivery context. Applicants are encouraged to identify the aspects of telehealth that are being tested in order to isolate their effects on variability in specified patient outcomes.

Applications Not Responsive to this FOA

The following types of studies are not responsive to this FOA. Applications proposing such studies will be considered non-responsive and will not be reviewed.

• Studies examining aspects of patient self-management without any interaction with an oncology care team.
• Stand-alone mHealth studies.
• Web-based interventions or decision support tools that do not have an explicit connection with care delivery.
• Studies where the focus is on the development of new drugs or devices.

Application and Submission Information

This notice applies to due dates on or after June 5, 2021, and subsequent receipt dates through March 8, 2024.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcements through the expiration date of this notice.

For other NCI funding opportunities relevant to healthcare delivery research and behavioral research, please visit the NCI Healthcare Delivery Research Program’s Funding Opportunities page (https://healthcaredelivery.cancer.gov/funding/) and the NCI Behavioral Research Program’s Funding Opportunities page (https://cancercontrol.cancer.gov/brp/funding).

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

• For funding consideration, applicants must include “NOT-CA-21-043” (without quotation marks) in the Agency Routing Identifier field (box 4b) of the SF424 R&R form. Applications without this information in box 4b will not be considered for this initiative.

• Applicants considering an R01 application requesting a budget of $500,000 or more in any budget year must contact NCI before submitting an application.

• All applicants are strongly encouraged to contact the NCI program contacts, Gurvaneet Randhawa and Kelly Blake, to discuss the specific aims of the application before submission.

Applications nonresponsive to terms of this NOSI will be not be considered for the NOSI initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.

Inquiries

Scientific/Research Contact(s)

Gurvaneet Randhawa, M.D., M.P.H.
National Cancer Institute
Telephone: (240) 276-6940
Email: Gurvaneet.Randhawa@nih.gov

Kelly Blake, Sc.D.
National Cancer Institute
Telephone: (240) 281-5934
Email: kelly.blake@nih.gov