Creighton awarded $2.3M to expand rural surgical cancer care
Creighton University School of Medicine has received a $2,388,300 award through Nebraska’s LB595 program to launch a groundbreaking six-year initiative aimed at improving access to surgical cancer care in rural communities. The program, titled Developing a Research Agenda in Rural Surgical Cancer Care: Advancing Access and Quality, will unite leading experts across the country to address longstanding disparities in care, workforce and patient outcomes.
The initiative is led by Waddah B. Al-Refaie, MD, FACS, Dr. and Mrs. Arnold W. Lempka Endowed Chair and chair of the Department of Surgery for both Creighton University School of Medicine and CHI Health. It represents one of the most comprehensive efforts to date to strengthen rural cancer surgery through three interconnected projects, each combining research, workforce development and technological innovation. Jillian Timperley, Mark Pedersen and Kathleen Guinn were important contributors to the development and execution of this grant.
Advancing access and outcomes in rural cancer care
The first project will develop and validate a new framework to better understand and improve surgical cancer care for rural patients. The framework will identify the unique barriers these patients face, from geographic isolation to resource shortages, and translate findings into actionable solutions.
“A major barrier to improving rural care is the lack of actionable data and research,” making it difficult to fully capture the scope of rural surgical disparities, says Dr. Al-Refaie. The investigators seek to remedy this situation through extensive data gathering, including interviews with rural patients and providers about access and outcome issues they face.
Developed in collaboration with the American College of Surgeons (ACS), the project will culminate in a national educational curriculum to prepare surgeons and others interested in the field to practice effectively in rural settings and develop research infrastructure.
Team leads for this phase include Naomi Schmalz, PhD; Kyle Cassling, MD, MEd; and Bonnie Simpson Mason, MD, FAAOS.
Building and sustaining the rural surgical workforce
“Across all fields of medicine, we produce too few generalists in the U.S., and in Nebraska. Creighton’s Institute for Population Health and Department of Surgery share a commitment to addressing the general surgical workforce shortage to improve access to care and health outcomes for those living in rural communities,” says Scott Shipman, MD, MPH, who serves as team lead for the second project, alongside Jennifer Tseng, MD, MPH, and Ryan Walters, PhD. “This grant will provide the opportunity to identify and study surgical care deserts in rural Nebraska and engage with policymakers and rural communities to identify actionable solutions to address the shortages.”
Undertaken in partnership with the American Board of Surgery (ABS), the second project will examine Nebraska’s rural surgical landscape to identify factors that attract or deter surgeons from rural practice. Findings will inform targeted strategies to mitigate workforce shortages and improve long-term retention.
“Many rural hospitals struggle to recruit and retain surgeons,” Al-Refaie explains. “In a rural hospital, even one or two surgeons can make the difference between financial stability and closure.” Given that each practicing general surgeon generates anywhere from $1 million to nearly $3 million annually for his or her hospital, supporting the surgical workforce means strengthening entire healthcare systems.
Researchers will engage both rural and urban surgeons to better understand their motivations, challenges and needs. The resulting insights will guide new education and policy approaches to make rural practice both sustainable and fulfilling, including economic support in the form of assistance with stipends and debt from student loans.
Harnessing artificial intelligence for postoperative care
The third project will explore the use of artificial intelligence (AI) to improve continuity of care after cancer surgery, especially for patients living far from major medical centers. Building on Creighton’s ongoing NIH-funded research with MedStar Georgetown, the team will develop an AI-powered chatbot that allows surgical teams to monitor the cancer surgery journey in real time. Through continuous communication, and integration of social determinants of health and well-being and emotional health of patients, the system can detect early signs of complications, prompt timely interventions and even reduce unnecessary travel or hospital readmissions.
“This innovative technology allows specialists to oversee recovery remotely and helps us intervene early when issues arise,” Al-Refaie says. “It’s an exciting opportunity to blend technology with compassion, improving both safety and the human experience of care.”
Nawar Shara, PhD; Erin Gillaspie, MD, MPH; and Anne O’Keefe, MD, join Al-Refaie as team leads for this third project.
National collaboration for greater impact
A defining feature of the initiative is its national scope. The program brings together a distinguished roster of collaborators from ACS, ABS and several leading universities. By aligning academic expertise with national professional organizations, the research team aims to produce results that extend well beyond Nebraska’s borders.
“These collaborations bring together people with diverse expertise and perspectives, ensuring our findings reflect the full range of rural experiences across the country, and help make our results actionable, guiding future policy and education to improve surgical care in rural communities nationwide while positioning Creighton as a leader in this important space,” says Al-Refaie.
Advancing Creighton’s Jesuit mission
For Creighton University, the project reflects the institution’s Jesuit mission of service and commitment to health equity. By addressing the challenges facing rural patients, who often travel long distances for cancer surgery or face limited local options, the initiative embodies the University’s dedication to advancing the common good through research and innovation.
“Creighton’s mission is rooted in service, justice and care for the whole person,” Al-Refaie says. “This work embodies that mission by focusing on those who too often fall through the cracks—patients in rural communities who deserve the same quality of surgical cancer care as anyone else.”
With its blend of clinical insight, technological innovation and cross-sector collaboration, Creighton’s rural cancer care initiative stands to redefine how access and outcomes are measured—and how equity in surgical care is achieved—across the nation.
