Search Results (130)

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 6% of adults in the United States and contributes to a significant economic burden. Telehealth has emerged as a vital tool in the management of ADHD, offering improved access to care, especially for individuals in underserved communities. Despite its growing role, there remain critical gaps in understanding how social determinants of health (SDOH) are associated with disparities in telehealth utilization for ADHD treatment. Objectives and Methods: This study analyzed data from the National Center for Health Statistics (NCHS) Rapid Surveys System (RSS) Round 2: ADHD (October–November 2023), a nationally fielded survey of U.S. adults. Respondents were classified into three groups: never diagnosed, previously diagnosed, and currently diagnosed with ADHD. The study aimed to (1) compare the distribution of SDOH across ADHD status groups and the general adult population to identify factors associated with ADHD diagnosis; (2) assess the homogeneity of SDOH distributions across ADHD groups; (3) evaluate telehealth utilization among adults currently diagnosed with ADHD; and (4) examine the relationship between SDOH and telehealth use for ADHD treatment. Multivariable logistic regression (MVLR) served as a benchmark model, while machine learning (ML) models—including regularized linear regression, support vector machine (SVM), random forest (RF), LightGBM, multilayer perceptron (MLP), and Few-Shot Learning (FSL)—were trained to identify key predictors. Results: A total of 7009 survey responses were analyzed: 124 had a past diagnosis, 444 were currently diagnosed, and the remainder had never been diagnosed with ADHD, corresponding to a current ADHD prevalence of 6.3%. Adults with current ADHD were more likely to be male, single, younger, white, non-homeowners, and frequent users of online health resources. They also reported lower education, income, and financial security. About 70% used telehealth for counseling and prescriptions; insurance covered telehealth visits for 82.32% of users, yet 38.76% reported no coverage of ADHD-related diagnostic or treatment costs. Nineteen SDOH elements across four domains—demographic, socioeconomic, neighborhood/built environment, and healthcare access—were identified as predictors. ML models outperformed MVLR, with SVM and FSL achieving the highest F1 (both 0.63), and FSL the highest recall (0.69). Age, race, marital status, difficulty paying bills, home ownership, education, and household size were the most consistently important variables. Limitations: This study is limited by a cross-sectional design, reliance on self-reported ADHD diagnoses, and a lack of genetic or family-history measures. Additionally, the omission of complex sampling weights limits the national representativeness of these findings. Finally, the small effective sample size poses risks of model overfitting, and the generalizability of the models could not be externally validated due to the unavailability of comparable independent datasets. Conclusions: Despite widespread internet access, disparities in telehealth use for ADHD persist. Among 19 SDOH predictors, age (aOR = 0.56), difficulty paying medical bills (aOR = 2.52), and race (aOR = 1.37) were significantly associated with telehealth use, and all ML models outperformed the MVLR benchmark, though bootstrap CIs overlapped. Future research should incorporate inclusive data collection and stratified modeling to better represent disadvantaged populations and inform equitable access strategies. Full article

Home enteral nutrition (HEN) is essential for patients with a functioning gastrointestinal tract who cannot meet nutritional needs orally, yet outpatient management remains complex, resource-intensive, and supported by a limited evidence base. Artificial intelligence (AI) may augment HEN care by extending monitoring, education, risk assessment, documentation support, and operational coordination into the home environment. Consistent with the narrative review format, this article uses a pragmatic, transparent synthesis of influential HEN-specific literature, relevant clinical nutrition evidence, and background knowledge from adjacent fields, including home healthcare, chronic disease management, oncology nutrition, telehealth, and software regulation. Direct evidence in established HEN populations remains scarce; therefore, most AI applications should be considered hypotheses or early implementation opportunities rather than proven standards of care. The strongest near-term opportunities are clinician-supervised patient education, symptom triage, adherence support, remote monitoring, and workflow automation. Predictive analytics, smart pumps, and precision enteral prescription tools are promising but require prospective HEN-specific validation, interoperability with electronic health records and home-infusion systems, reimbursement pathways, and governance safeguards. Key barriers include dataset bias, limited external validation, alert fatigue, privacy and regulatory concerns, unclear accountability, digital equity, cost uncertainty, and the risk of dehumanizing care. AI should be viewed as a complement to multidisciplinary HEN expertise. Priorities for the near future include HEN registries, standardized outcomes, prospective validation, pragmatic implementation trials, health-economic evaluation, and transparent oversight that preserves clinician accountability and patient-centered care. Full article

On behalf of the Canadian Association of Psychosocial Oncology, we are pleased to present the abstracts from the 2026 Annual Conference, titled “A New Horizon: Expanding the Access and Impact of Psychosocial Oncology”. The 41st Annual CAPO Conference was held in St. John’s, Newfoundland from 8 June 2026 to 9 June 2026. As we stand at a new horizon in psychosocial oncology, we recognize the unprecedented opportunities to expand both the access to and the impact of comprehensive cancer care. This conference will explore innovative strategies for breaking down traditional barriers that have historically limited access to psychosocial support, including geographic isolation, resource constraints, cultural disparities, and systemic inequities in healthcare delivery. This expansion of reach and influence represents not merely growth in service numbers, but a fundamental transformation in how we conceptualize, design, and implement patient-centered psychosocial care across diverse communities and care settings. We will explore scalable solutions that amplify impact while maintaining the deeply personal, human-centered approach that defines excellence in psychosocial oncology. From telehealth innovations and peer support networks to community-based interventions and integrated care models, this conference will showcase evidence-based strategies that expand our collective ability to support individuals and families navigating the cancer journey, wherever they may be. This conference brought together key stakeholders including multidisciplinary professionals from nursing, psychology, psychiatry, social work, spiritual care, nutrition, medicine, rehabilitation medicine, occupational health and radiation therapy for both adult and pediatric populations. Participants included clinicians, researchers, educators in cancer care, community-based organizations and patient representatives. Patients, caregivers and family members presented abstracts that speak to their role in managing cancer experiences and care. Over one-hundred and fifty (150) abstracts were submitted for presentation as symposia, 20 min oral presentations, 10 min oral presentations, 90 min workshops and poster presentations. We congratulate all the presenters on their research work and contributions. Full article

Background: Anxiety and depression are major contributors to mental-health burden and frequently co-occur in clinical practice. In tele–mental health, routinely captured operational variables such as consultation duration, visit frequency, and follow-up cadence may provide clinical digital phenotypes that complement conventional symptom scales. This study aimed to characterize anxiety–depression comorbidity in a large real-world tele–mental health cohort and to determine whether symptom severity was associated with distinct patterns of healthcare utilization. Methods: We conducted a retrospective real-world study of 3467 patients followed in psychiatry and psychology teleconsultations. Patients were classified as anxiety only, depression only, comorbid anxiety–depression, or neither. Symptom severity was categorized as mild, moderate, or severe using validated questionnaire-based measures; to improve comparability across instruments, scores were additionally harmonized using z-score normalization. Associations between anxiety and depression severity within the comorbid subgroup were examined using a chi-square framework. Telehealth utilization endpoints included consultation duration, number of consultations, and inter-visit interval, analysed overall and stratified by sex, age group, and symptom severity. Results: Anxiety and/or depression were present in 61.7% of the cohort (2140/3467), and anxiety–depression comorbidity accounted for 43.8% of all patients (1520/3467), indicating substantial real-world overlap. Within comorbid cases, anxiety and depression severity were strongly coupled, with depression severity varying systematically across anxiety severity strata (chi-square p = 9.88 × 10⁻¹⁰²). Compared with isolated anxiety or depression, comorbidity was associated with a more intensive healthcare-utilization profile, characterized by a higher mean number of consultations and shorter inter-visit intervals. Among comorbid patients, females showed greater longitudinal service use than males, with more visits and closer follow-up. Resource use also varied according to symptom burden, mainly in depression, supporting a graded relationship between clinical severity and operational care demand. Conclusions: In this large real-world tele–mental health cohort, anxiety–depression comorbidity was highly prevalent, clinically structured, and associated with distinct and measurable resource-use signatures. These findings highlight the novelty and practical value of integrating symptom severity with operational telehealth data to derive pragmatic digital phenotypes of care intensity. Such phenotypes may support risk stratification, triage, follow-up scheduling, and capacity planning in tele–mental health, with potential translational relevance for broader mental healthcare systems. However, these findings should be considered descriptive and hypothesis-generating and warrant further longitudinal validation in other clinical settings. Full article

Cancer patients receiving systemic therapy experience substantial treatment-related symptoms. Nurse-led digital health interventions, e.g., interactive voice response systems, web platforms, mobile apps, and telehealth, have emerged as strategies to strengthen supportive care. To evaluate its effectiveness, this systematic review summarizes evidence exclusively from randomized controlled trials (RCTs). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, four databases were searched from inception to January 2025 for eligible RCTs involving adults undergoing anticancer therapy; evaluating nurse-led or nurse-co-led interventions using digital or telecommunication technologies; reporting validated symptom or health-related quality of life (HRQoL) outcomes. Risk of bias was assessed. Nine RCTs (N = 3344) met criteria; seven had low risk of bias. Interventions using telephone systems, web portals, mobile apps, or videoconferencing reduced symptom burden and improved HRQoL. The Symptom Care at Home system reduced symptom burden by ~43%, with greatest effects from combined automated monitoring and nurse practitioner follow-up. Additional benefits included improved anxiety, self-efficacy, patient participation, fewer severe toxicities and hospitalization days. In conclusion, nurse-led digital interventions effectively reduce symptom burden and support HRQoL during systemic therapy. Multicomponent models integrating automated monitoring with structured nursing follow-up and decision support appear most beneficial. Full article

Background: Sustainable head and neck cancer (HNC) surgery is challenged by environmental impact, workforce shortages, inequitable access to advanced techniques, and policy constraints. Addressing these areas is critical for equitable, high-quality care. Methods: This structured narrative review synthesizes evidence on environmental sustainability, workforce development, technological innovation, health policy, and socioeconomic determinants in HNC surgery, without aiming to provide a systematic or exhaustive evidence synthesis. Sources included peer-reviewed literature, global workforce surveys, and international policy reports, with a focus on disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Results: Operating rooms produce up to 70% of hospital solid waste and consume 3–6 times more energy than other units; reusable instruments and improved waste segregation can reduce carbon footprints by over 50%. Workforce shortages are severe in LMICs, where subspecialty training is scarce; global partnerships, bidirectional education, and simulation-based learning can expand local capacity. Telemedicine, artificial intelligence, and three-dimensional printing enhance surgical planning, training, and access but may widen disparities without equitable deployment. Policy tools—including diagnosis-related groups, bundled payments, and universal coverage—affect access and innovation uptake. Pandemic preparedness underscores the value of resilient systems with flexible staffing and telehealth integration. Conclusions: HNC surgery requires coordinated action across environmental, workforce, technological, socioeconomic, and policy domains; however, future systematic reviews are needed to comprehensively map the evidence base and assess its methodological quality. Embedding sustainability in clinical practice, ensuring equitable innovation access, and aligning reimbursement with high-value care can strengthen system resilience, improve outcomes, and support long-term surgical service viability. Full article

Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways. Full article

Background: Multiple sclerosis (MS) is a condition that requires long-term, multidisciplinary management. The growing digital transformation in healthcare has highlighted the central role of nurses in supporting key aspects such as patient self-management, continuity of (at home) care, and patient empowerment. However, evidence on nurse-led digital interventions in MS remains fragmented. Objective: To map the available literature on nurse-led digital interventions in MS, focusing on the role of nurses, clinical outcomes, and research gaps. Methods: The review was conducted using the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. A systematic search was performed in PubMed, Scopus, Web of Science, and CINAHL. Studies were included if they described digital or telehealth interventions led or coordinated by nurses in patients with MS. Results: A total of 12 studies published between 2015 and 2025 met the inclusion criteria. Four main thematic areas were identified: (1) telenursing and empowerment-based interventions; (2) mobile and web-based patient self-management programs; (3) digital systems for monitoring and integrated care pathways; and (4) digital interventions targeting symptom management and psychosocial outcomes. Across the studies, nurse-led digital interventions were associated with improvements in self-management, treatment adherence, self-efficacy, and health-promoting behaviors. Positive effects were also reported on clinical outcomes such as fatigue, sleep quality, and balance, as well as on psychosocial variables including quality of life, coping strategies, and emotional well-being. Furthermore, the identified systems, in general, contributed to enhanced continuity of care, patient engagement, and organizational efficiency. Conclusions: Nurse-led digital interventions represent a promising approach in the management of patients with multiple sclerosis, supporting both clinical and psychosocial outcomes while enhancing continuity of care. However, the current evidence base remains limited by small sample sizes, heterogeneity of interventions, and short follow-up periods. Future research should prioritize multicenter randomized studies with larger samples and long-term follow-up to strengthen the evidence. Additionally, the integration of digital interventions into routine clinical practice, along with targeted training for nurses, is essential to ensure sustainability, accessibility, and equitable implementation. Further studies should also explore cost-effectiveness and the impact on caregivers and long-term quality of life. Full article

Background/Objectives: Colorectal cancer is a leading cause of cancer-related mortality worldwide, and early detection of gastrointestinal (GI) polyps through endoscopy is critical for improving patient outcomes. However, access to specialist gastroenterology care remains severely limited in Federal Health Professional Shortage Areas (HPSAs), particularly for high-acuity geriatric patients. This study proposes GeriAIGastroNet, a clinically oriented deep learning framework designed to support AI-assisted tele-gastroenterology workflows in resource-limited settings, with the primary objective of enabling AI-powered risk stratification and colonoscopy referral triage for elderly patients who lack on-site gastroenterology access. Methods: The framework integrates an EfficientNet-B4 backbone with multi-scale attention fusion and a geriatric severity-aware classification head to enable accurate GI polyp segmentation and automated clinical risk stratification from endoscopic images. Patients identified as high-risk are referred to colonoscopy-capable centers; such centers typically offer diagnostic colonoscopy with polypectomy capability for smaller and intermediate-complexity polyps, while patients with larger, sessile, or morphologically complex lesions requiring advanced endoscopic resection (e.g., endoscopic mucosal resection or endoscopic submucosal dissection) are further referred to tertiary endoscopy centers with specialized expertise. The model was trained and evaluated on the publicly available HyperKvasir dataset (1000 annotated polyp images). Results: GeriAIGastroNet achieved a classification accuracy of 96.77%, F1-score of 96.90%, Dice coefficient of 89.18%, and Intersection over Union (IoU) of 80.80%, outperforming established baselines, including U-Net, Attention U-Net, TransUNet, and Hybrid CNN-Transformer architectures. The integrated tele-gastroenterology decision support layer enables severity-based patient triage and automated referral triggering. Conclusions: These results demonstrate the potential of AI-powered polyp analysis to strengthen equitable access to GI care by facilitating risk stratification and specialist referral in HPSAs where direct endoscopy is unavailable, making the system deployable in telehealth infrastructures serving underserved elderly populations. Full article

Background: Adults with type 2 diabetes increasingly use patient portals, telemonitoring systems, mobile applications, text messaging programs, and other digital services to support self-management. In practice, however, these approaches often still depend on nursing support to help patients understand, use, and sustain digital care in everyday settings. This scoping review mapped how nurses are involved in supporting adults with type 2 diabetes to use digital tools, information, and services for self-management across care settings. Methods: This scoping review followed Joanna Briggs Institute methodology and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review question was guided by the Population, Concept, and Context framework. A literature search was conducted in January 2026 in PubMed, Scopus, Embase, and EBSCO/CINAHL. A total of 230 records were identified, 71 duplicates were removed, and 159 records underwent title and abstract screening. Fifty-three full-text articles were assessed for eligibility, and 15 studies met the inclusion criteria. Data were extracted using a structured charting table and synthesized descriptively and thematically. Results: The 15 included studies were published between 2021 and 2026 and represented evidence from 10 countries across primary care, community health centers, telehealth programs, and hospital-linked services. Five interrelated themes were identified: nurses as digital self-management educators; nurses as remote monitors and care coordinators; nurses as facilitators of digital engagement, confidence, and supported use; nurses as implementation partners in digital diabetes care; and equity, access, and context as shaping conditions of digital diabetes support. Only one study directly measured digital health literacy, whereas the remaining studies addressed digital engagement more indirectly through onboarding, portal communication, telemonitoring, reminders, tailored feedback, and implementation work. Common barriers included workload, unclear responsibilities, technical difficulties, age- or literacy-related access challenges, language needs, and uneven infrastructure. Conclusions: The included studies suggest that nurses commonly contributed to making digital diabetes care more understandable, usable, and actionable for adults with type 2 diabetes. Their roles were described across education, monitoring, coordination, implementation, and support for digital engagement. Future studies could measure digital health literacy more explicitly, describe nursing tasks in greater detail, and examine how equity-related factors shape digital diabetes care. Full article

Existing reviews of technology-enabled care for older adults have primarily focused on technology usability, patient acceptance, and clinical outcomes. However, there remains limited synthesis of the organizational and system-level factors influencing the implementation of technology-enabled care in rural, regional, and remote contexts. This review addresses this gap by mapping barriers and facilitators using the Consolidated Framework for Implementation Research. Using technology to enable or enhance healthcare, rehabilitation, and self-management offers significant potential to improve access, outcomes, and equity for older adults; however, adoption and sustained use in rural, regional, and remote (RRR) settings remain limited. This scoping review aimed to identify factors influencing the implementation of technology-enabled care interventions for community-dwelling older adults in RRR contexts. Searches were conducted in PubMed, MEDLINE, CINAHL, Web of Science, and Scopus for empirical studies published from 2014 onwards. Barriers and enablers were mapped to the Consolidated Framework for Implementation Research (CFIR) and synthesized narratively. The search identified 807 records, of which 433 remained after duplicate removal and 105 proceeded to full-text assessment. Five studies met the inclusion criteria, examining telehealth, telerehabilitation, remote monitoring, and mobile health applications. Across the included studies, 71 implementation factors were identified, comprising 39 barriers and 32 enablers mapped across five CFIR domains and 20 constructs. The most frequently reported barriers related to innovation recipients’ capability, innovation design, innovation complexity, and outer setting local conditions. The most frequently reported enablers related to innovation adaptability, innovation complexity, and innovation recipients’ motivation. Findings suggest that implementation in RRR settings depends less on technological sophistication than on aligning design and delivery with user capability and local system capacity, reducing cognitive and technical burden, and embedding relational and contextual support. Full article

As the global cancer burden rises, adults with advanced cancer face significant physical and psychosocial symptoms requiring early integration of palliative and supportive care. Nurses in oncology, emergency, and community settings are central to symptom assessment, care coordination, communication, and advance care planning, yet their roles in early integration remain underexplored. This scoping review mapped nursing contributions to early palliative and supportive care for adults with advanced cancer and described related patient, caregiver, and system outcomes. A search of PubMed, CINAHL, Scopus, and ScienceDirect was conducted for English-language studies published between January 2016 and November 2025 involving nursing-relevant interventions in early palliative or supportive care. Fourteen studies were included: trials, observational studies, qualitative research, reviews, and a meta-analysis. Six domains emerged. Early integration consistently improved quality of life and reduced symptom burden. Nurse-led interventions increased end-of-life discussions and advance directive completion. Telehealth and telephone follow-up proved feasible for symptom management. Studies noted moderate palliative competence but gaps in communication and structural support. Caregiver-focused interventions enhanced caregiver quality of life and self-efficacy. Conclusions: Nurses are pivotal in early palliative care. Expanding structured nurse-led models, strengthening communication training, and addressing organizational barriers are essential to deliver timely, person-centered care. Full article

Background: Rural communities face persistent healthcare barriers related to workforce shortages, geographic isolation, transportation limitations and constrained emergency response capacity. Nurse-led mobile clinics may support healthcare access, continuity of care, and disaster preparedness in underserved settings. This study examined the Texas A&M University (TAMU) nurse-led mobile clinic model with respect to rural service delivery, health equity, operational considerations, and disaster preparedness. Methods: A mixed-methods descriptive program evaluation was conducted using programmatic operational data, survey responses, and preparedness-planning records. The TAMU mobile clinic serves six rural counties through primary, preventive, and behavioral healthcare delivery using in-person care, telehealth, and home visits. Disaster preparedness activities were integrated through the annual Disaster Day interprofessional simulation involving approximately 600–700 learners. A 2025 Central Texas flooding event served as a case study to evaluate operational preparedness and system readiness. Results: Mobile clinic operations supported healthcare access, continuity of care, and community engagement in rural settings. Interprofessional education simulation findings demonstrated perceived gains in teamwork, triage, communication, and rapid decision-making. During the 2025 flooding event, activation protocols were initiated; however, deployment was not authorized, highlighting system-level constraints related to administrative approval pathways despite operational readiness and workforce preparedness. Conclusions: Nurse-led mobile clinics may serve as an adaptable infrastructure for improving rural healthcare access, supporting continuity of care, and strengthening disaster preparedness. Findings further emphasize that clinical preparedness alone is insufficient without coordinated administrative processes, interoperable systems, and governance structures capable of supporting rapid emergency deployment. Full article

Background: Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on their roles, the challenges they face, and the outcomes associated with their contributions remains fragmented. Objective: To map the roles, challenges, and reported outcomes of nurses working in rural and remote healthcare settings, and to examine the quality and scope of the available evidence. Design: This study employed JBI scoping review methodology and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Methods: Eligible studies involved registered nurses (RNs) and nurse practitioners (NPs) providing care in rural or remote settings and reporting at least one outcome related to patients, services, or health systems. Six bibliographic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, Cochrane Library) plus Google Scholar for supplementary grey literature retrieval and targeted grey literature were searched (from 1 January 2000 to 30 September 2025). The lead author conducted screening and data extraction, supported by a 10% calibration pilot and structured peer debriefing. Design-specific critical appraisal was undertaken descriptively to inform interpretation but did not determine inclusion. Results: From 22 primary empirical studies (plus 2 contextual-only entries; 24 total, nurses’ roles clustered into direct clinical care, care coordination/navigation, telehealth facilitation, and health promotion. Reported outcomes were predominantly in access/utilization (e.g., time-to-care), quality and safety indicators, and patient-reported outcomes/experiences; clinical endpoints were less common. Conclusions: Nurses in rural and remote settings enact broad, adaptive roles that appear to support healthcare access and service continuity. The evidence base is predominantly descriptive, and causal claims about effectiveness cannot be drawn from the available studies. Standardized outcome frameworks, multi-reviewer methodologies, and effectiveness-focused primary research are needed to advance this field. Full article

Background: Delivering comprehensive cancer prevention, diagnosis, and treatment across Hawaiʻi and the U.S.-Affiliated Pacific Islands (USAPI) is constrained by geographic isolation, oncology workforce shortages, and persistent cancer inequities. Objectives: The University of Hawaiʻi Cancer Center, the state’s only National Cancer Institute-designated cancer center, partners with community healthcare systems to address cancer health disparities. Here, we describe an implementation-focused strategy initiated in December 2024 that is designed to improve equitable access to evidence-based oncology services across the catchment area. Approach: This program description integrates publicly available demographic and health system data and presents a structured implementation framework centered on (1) workforce development and oncology training pathways; (2) a statewide clinical oncology network supported by telehealth; (3) community-engaged screening and early detection outreach; and (4) strengthening clinical research and trial infrastructure with deliberate inclusion of underserved populations. Evaluation: We outline an evaluation framework incorporating process and outcome metrics spanning workforce capacity, screening participation, timeliness of care, clinical trial enrollment, and equity indicators stratified by county, island, and population group. Conclusions: This approach offers a scalable, implementation-oriented model for developing an academic oncology ecosystem that emphasizes measurement, accountability, and equity, with potential applicability to other geographically dispersed and ethnically diverse regions. Full article