OERC Draft Proposal
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OERC PROPOSAL DRAFT TO BE SUBMITTED TO HEWLETT

DEADLINE SEPTEMBER 30, 2008

CHAPTER I

INTRODUCTION

By 2010, the World Health Organisation (WHO) has estimated that cancer will become the leading cause of death in the world. The International Agency for Research on Cancer, part of the WHO, has estimated that by 2030, the global burden of cancer could be as high as 17 million new cases per annum. An increasing fraction of this burden of cancer – presently more than half of all cancer and 70% of cancer deaths – will fall on the developing countries as their populations continue to expand and age and epidemiological transitions result in a reduction in the burden of disease caused by infectious diseases. This rapidly increasing importance of cancer as a public health problem has been recognized by the World Health Assembly, in resolution WHA58.2 of May 20051.
A major obstacle to effective cancer treatment and cancer control in developing countries is the deficiencies in human capital and material resources and the lack of scope for capacity development at both quantitative and qualitative levels2 .

OBJECTIVES
We are proposing to provide open source learning modules that will be available to all physicians, nursing and teaching staff as well as patients in the area of cancer research and training worldwide. The plan is to make such materials available to cancer institutions in at least 40-50 countries. As open education resources these materials will include access to full courses, training modules, course modules, research information and news through a web portal3 at no cost.

= OERC MISSION STATEMENT
 To enhance knowledge sharing between countries on cancer control strategies
 To enhance the capacities of physicians, nurses and care givers in developing countries to treat cancer patients
 To make available cutting edge research information on cancer care in an easily accessible format at no cost on a worldwide scale
 To make available latest clinical trials information to cancer patients and their physicians
 To enhance knowledge sharing and collaboration between stakeholders
 To put into action what was proposed in the latest WHO report on cancer for knowledge sharing4
 To contribute to the development of a research infrastructure and a research ethos for cancer care and prevention at a global level

Training modules and courseware, video lectures or downloadable content based on curriculum already being taught in some of the leading medical institutions in the US and Europe, will be used as well as similar materials from international and national organizations concerned with cancer and relevant reviews in specific areas summarizing existing evidence. We also plan to encourage major medical training and research institutions, in the selected 40-50 countries to participate in this effort both as contributors and consumers in order to ensure that a significant proportion of the content is relevant to the developing countries. In this way, we hope to create a broad knowledge sharing capability that will greatly enhance the capacity of health policy makers, medical educational institutions and hospitals and clinics in developing countries to access knowledge and research results related to cancer and to improve their own ability to contribute to the global knowledge base. In this way, the project should have a direct effect on the ability to control cancer in specific national contexts as recommended by resolution WHA 88.22.

THE ROLE OF OPEN EDUCATION RESOURCES FOR CANCER
There are many approaches to education and many different constituents that require education (and a correspondingly broad range of education needs). While information technology may not be able to replace many standard educational approaches (although its applications continue to expand – even simulations, e.g., of invasive diagnostic techniques and surgery are already possible and are likely to become increasingly widespread), it can nearly always enhance the educational experience and certainly improve access to information. At least some broad-band access to the internet is required, within a country or region, but even in the absence of widespread primary access, educational tools and materials can be downloaded at specific points for dissemination to elements of the community that do not have broadband internet access, and used in free-standing computers (with or without projection such that a greater number can be simultaneously taught). Even the availability of informational documents can considerably improve the ability of existing educators to fulfill their pedagogical responsibilities. In other circumstances, health providers or public health officials, medical students and nurses could take courses over the web, and specialists could have improved access to relevant scientific literature and to training tools such as libraries of images required, for example, for more effective training of pathologists and radiologists. Finally, the ability to upload images to specific servers accessible to consultants could play a role in both improving diagnosis and providing continuing education to pathologists, radiologists etc.

While a major component of OERC will comprise educational and research results available on line, this will not be the exclusive approach. As the project evolves, it is envisaged that partnerships with organizations such as the NCI (via its Cancer Expert Core Program) and INCTR (via its Visiting Expert and Partnership Programs), as well as with medical institutions in Europe and the USA will lead to “in-person” visits to identified institutions in participating countries to provide relevant education and consultation in a wide range of areas relevant to the establishment of effective cancer public health programs and accessible and efficient cancer care (including palliative care). An additional role of visiting experts will be to assess access to OERC on-line in the countries and institutions they visit and the uses to which such materials are put, as well as to identify specific needs that may result in improved access and use of the available materials.

Finally, OERC will encourage the development of additional evidence in multiple ways: through the provision of information relevant to identifying gaps in the evidence base that should be filled if effective cancer control is to be accomplished, through the provision of information on how to institute high quality research projects designed to fill such gaps (supplemented where appropriate by collaborations with other participating institutions) and through the provision of tools that will enable researchers to more readily collect data, assess its quality and analyze the results. OERC will, in effect, contribute to the development of a research infrastructure and a research ethos – both of which are essential if cancer is to be more effectively controlled.

CONCLUSION
Working behind the scenes with a network of colleagues, representing leading institutions both in the North and the South we are in the early phases of developing a proposal to seek funding from the Hewlett Foundation and others for developing open education resource materials as well as the technology required for delivery. iBharti Health Foundation, based in the US and the International Network for Cancer Treatment and Research (INCTR) based in Belgium are leading this effort. Our colleagues, Ian Magrath from INCTR and Joe Harford from the National Cancer Institute (NCI) will be attending the World Cancer Congress in Geneva. August 27-31, 2008. This would be an opportune time to engage several developing country partners in this effort.

Our goal is to have a proof of concept prior to the INCTR meeting in Antalya, Turkey in March of 2009, in order to solicit valuable feedback from our colleagues and partners and improve the OERC functionalities and usefulness5 and move to the next phase which is final deployment of the learning resources for cancer care and prevention.

CHAPTER II

TECHNICAL APPROACH

5. Inputs
6. Techncial Inputs
7. Demand Mapping
8. Technology Road Map

CHAPTER III

PROGRAM IMPLEMENTATION

4. Activities
5. Outcomes
6. Evaluations

CHAPTER IV

LEGAL CONSIDERATIONS

1.Intellectual Property Rights

CHAPTER V

APPROACH TO PROGRAM EVALUATION AND QUALITY CONTROL

3. Logic Model
4. Measurement Indicators

CHAPTER VI.

PROGRAM SUSTAINABILITY

CHAPTER VII.

PROJECT SCHEDULE

CHAPTER VIII.

PROJECT BUDGET

APPENDIX A

TABLE 1

Resource Examples Value Beneficiaries
Libraries
Pathology Images Lymphoma library Training, reference Pathologists
Radiological Images Mammography library Training reference Radiologists
Documents WHA 58.22 FTCT Helsinki Declaration Reference Broad range of individuals involved in cancer control
Flash/other presentations, including animation Broad range of informational material On-line Learning Broad range of individuals involved in cancer control
PowerPoint presentations Broad range of informational material Off-line Learning Teaching Broad range of individuals involved in cancer control
Videos Breast examination; public service announcements; information for patients Can provide vital information without the need for an expert presence Broad range of individuals involved in cancer control; the general public
Brochures, Booklets Elements of the cancer control plan; How to establish a program in cervical cancer screening; symptomatic control in cancer Wide dissemination of basic knowledge required for effective cancer control Broad range of individuals involved in cancer control
Scientific Publications Data base on breast cancer control; Data base on cancer control in developing countries divided into early detection, diagnosis, treatment Rapid access to data required for the development and implementation of cancer control plans, improved patient care, advanced training and education Health professionals, particularly specialists in public health or clinical care
On-line Courses
Training courses Essentials of GCP; basic and advanced data management, developing a cancer control plan On-line learning for potential health workers and policy makers which could include accreditation Broad range of individuals involved in cancer control
Continuing Education courses Ethical principles Preparation of chemotherapy drugs Maintenance and expansion of knowledge of existing personnel Broad range of individuals involved in cancer control
Live Conferences
Multidisciplinary conferences Discussions of all aspects of specific cases More effective decision making; improved communication among clinicians; education of junior staff Clinical care providers
Distance lectures Treatment of specific cancers; elements of palliative care; improving referral practices Broad range of training and educational opportunities with live interactions Broad range of individuals involved in cancer control
“Ask the Expert” Access to a range of experts Answers to specific questions that may not be addressed in available materials Broad range of individuals involved in cancer control
Communities of Practice
Portals (password protected) which permit uploading and downloading, discussion groups, surveys etc. Clinical communities such as pediatric oncologists, orthopedic surgeons; public health communities; management communities etc. Learning from each other; creating an ongoing process that can evolve rather than remain as static as its component documents Broad range of individuals involved in cancer control
Consulting Cancer network groups and other interested educators and academic researchers Knowledge sharing Larger community
Troubleshooting Medical and IT Communities Knowledge Sharing and collaborations IT networks and medical communities

1 Resolution WHA 58.22 states that members states should: collaborate with the Organization in developing and reinforcing comprehensive cancer control programmes tailored to the socioeconomic context, and aimed at reducing cancer incidence and mortality and improving the quality of life of cancer patients and their families, specifically through the systematic, stepwise and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, rehabilitation and palliative care and to evaluate the impact of implementing such programmes.

2 It is in this context that the idea for the OERC project came up in a conversation between Mr. Anil Srivastava and Dr. Lessin in 2007. This was further developed in a subsequent meeting with Mike Smith of Hewlett Foundation and Raj Shah of Capital Technology Information Services, Inc. (CTIS). Through subsequent meetings we have been able to develop a core consortium of institutions and consultants who have pledged their support towards this effort

3 APPENDIX A., Table 1. Provides an outline of the types and potential uses to which open access resources could be put, including online tools and downloadable educational objects.

4 “If the knowledge, technology and control strategies outlined in the World Cancer Report were applied globally, we would make major advances in preventing and treating cancers over the next twenty years and beyond.” says Bernard W. Stewart, Ph.D., co-editor of the WHO report, Director of Cancer Services, and Professor, Faculty of Medicine, University of New South Wales, Australia.

5 This paper provides a broad overview of our proposed project. Other important areas and issues such as, standardization of technology, monitoring and evaluation of curriculum and training materials, action plan for program sustainability, development of a common terminology and constant research updates have not been addressed here, but will be given a great deal of attention by our team of experts as we develop the project further.


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