title: Creating a "culture of research" in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program.
abstract: BACKGROUND
  The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute's Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period.
  
  
  METHODS
  To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials.
  
  
  CONCLUSIONS
  The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to identify and collect. The model requires a strong emphasis on outreach that challenges hospitals to improve and expand their reach, particularly into underrepresented populations and catchment areas. These efforts build on trust and a referral pipeline within the community which take time and significant commitment to establish.
  
  
  CONCLUSIONS
  The National Cancer Institute Community Cancer Centers Program experience provides a relevant model to broadly address creating a culture of research in community hospitals that are increasingly networked via systems and consortiums. The strategies used align well with the National Cancer Institute-American Society of Clinical Oncology Accrual Symposium recommendations for patient-/community-, physician-/provider-, and site-/organizational-level approaches to clinical trials; they helped sites achieve organizational culture shifts that enhanced their cancer research programs. The National Cancer Institute Community Cancer Centers Program hospitals reported that the strategies were challenging to implement yet proved valuable as they provided useful metrics for programmatic assessment, planning, reporting, and growth. While focused on oncology trials, these concepts may be useful within other disease-focused research as well.
authors.affiliation: Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA dimonde@mail.nih.gov.
authors.forename: Eileen P
authors.initials: EP
authors.lastname: Dimond
authors.affiliation: Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: St Germain
authors.affiliation: St. Joseph Hospital, Orange, CA, USA.
authors.forename: Lianne M
authors.initials: LM
authors.lastname: Nacpil
authors.affiliation: St. Joseph's/Candler, Savannah, GA, USA.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Zaren
authors.affiliation: Mercy Medical Center, Des Moines, IA, USA.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Swanson
authors.affiliation: Albert Einstein Healthcare Network, Philadelphia, PA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Minnick
authors.affiliation: Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Carrigan
authors.affiliation: Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Denicoff
authors.affiliation: Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Igo
authors.affiliation: Queen's Medical Center, Honolulu, HI, USA.
authors.forename: Jared D
authors.initials: JD
authors.lastname: Acoba
authors.affiliation: St. Joseph Hospital, Orange, CA, USA Roy and Patricia Disney Family Cancer Center, Providence Saint Joseph Medical Center, Burbank, CA, USA.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Gonzalez
authors.affiliation: Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Worta
authors.initials: W
authors.lastname: McCaskill-Stevens
mesh_terms: D035843:Biomedical Research / Q000458:organization & administration*; D057191:Capacity Building / Q000458:organization & administration; D003299:Cooperative Behavior; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D007857:Leadership; D054547:National Cancer Institute (U.S.) / Q000458:organization & administration*; D009369:Neoplasms / Q000628:therapy*; D015279:Organizational Culture; D014481:United States
keywords: Clinical trials; National Cancer Institute Community Cancer Centers Program; community; community hospital research; culture of research