Foa_Content_of_CDC-RFA-DP-24-0061.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their

Families

CDC-RFA-DP-24-0061

05/06/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-DP- 24-0061. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR)

B. Notice of Funding Opportunity (NOFO) Title:

Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their Families

C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

New- Type I https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-24-0061

E. Assistance Listings Number:

93.376

F. Dates:

1. Due Date for Letter of Intent (LOI):

03/29/2024

2. Due Date for Applications:

05/06/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Thursday, March 21, 2024 3:00pm - 4:30pm - EST

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G. Executive Summary:

1. Summary Paragraph This NOFO will provide support to organizations whose actions will improve the quality of life among young breast cancer survivors (YBCS) and young metastatic breast cancer patients (MBC). Recipients funded under this NOFO will implement proven and innovative strategies to support both YBCS and MBC patients in care and aid in closing the gap in disparities and inequities in the survival and quality of life of women in groups that have been economically and socially marginalized. This NOFO also seeks to leverage the collaborative power of organizations serving YBCS and MBC patients to improve the availability of psychosocial support services and facilitate patient-provider interactions through the education of survivors, their families, healthcare providers, community health workers (CHWs), and patient navigators (PNs).

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$18,400,000

e. Average One Year Award Amount:

$460,000

f. Total Period of Performance Length:

5 year(s)

g. Estimated Award Date:

September 30, 2024

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

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Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Except for certain types of skin cancer, breast cancer is the most diagnosed cancer and second leading cause of cancer death among women. Breast cancer diagnosed in women younger than 45 is often more aggressive1, presents at an advanced stage, impacts life expectancy, and oftentimes results in physical, psychosocial, and financial challenges. Additionally, a significant proportion of young women diagnosed with breast cancer will eventually develop metastatic breast cancer (MBC). MBC care is intense and expensive, particularly in younger women with more aggressive and harder to treat tumors. Psychosocial and structural support services, designed to meet mental, emotional, social, and spiritual needs of survivors and their families, have the ability to improve the quality of life among this population2,3. Communities who would benefit from additional survivorship support include, but are not limited to, women in racial/ethnic groups (e.g., African American, Asian/Pacific Islanders, Hispanic, Native American women), Ashkenazi Jewish, LGBTQIA+ communities, low socio-economic groups, rural communities, and women with physical or mental/emotional disabilities.

In response to the 2010 Education and Awareness Requires Learning Young (EARLY) Act, the CDC Division of Cancer Prevention and Control developed a portfolio of research, health promotion campaigns, and traditional public health programs about breast cancer risk and breast health. This Notice of Funding Opportunity (NOFO) marks the fourth YBCS program cycle and is built on the successes and lessons learned from the previous three program cycles. Findings from previous program evaluations showed fostering meaningful collaborative relationships with organizations aided in implementation of interventions, while other lessons learned underscored the importance of educating and providing access to emotional and psychosocial support systems and resources to survivors and their loved ones. This NOFO seeks to use both proven and new innovative program strategies to achieve the goals of the YBCS program.

This NOFO seeks to 1) increase equitable access and availability of psychosocial and structural support services for YBCS, MBC patients, and their families; and 2) improve patient-provider interactions during follow up and subsequent care. This NOFO will require implementation of health equity strategies that will aid in closing the disparity gaps needed to support both YBCS and MBC patients in care, to move beyond just physical treatment of disease. The full integration of psychological and behavioral resources in survivorship care is hindered by complex billing requirements, minimally qualified staff, complex care settings and the wide variety of patient needs1. This NOFO seeks to leverage the collaborative power of organizations serving YBCS and MBC patients to improve the availability of psychosocial support services and facilitate cultural humility in cancer care.

b. Statutory Authorities Section 10413 Patient Protection and Affordable Care Act (PPACA), SEC. 399NN.

Young Women's Breast Health Awareness And Support of Young Women Diagnosed With Breast Cancer https://pubmed.ncbi.nlm.nih.gov/23819024/ https://pubmed.ncbi.nlm.nih.gov/28049576/ https://pubmed.ncbi.nlm.nih.gov/20669419/

Section 399NN of the Public Health Service Act, 42 U.S.C. 280m, and Section 301 of the Public Health Service Act, 42 U.S.C. 241

c. Healthy People 2030 This NOFO addresses the following Healthy People 2030 topic areas:

• C-11: Increase the proportion of cancer survivors who are living 5 years or longer after diagnosis

• C-R01: Increase quality of life for cancer survivors

• C-04: Reduce the female breast cancer death rate

• C-01: Reduce the overall cancer death rate

d. Other National Public Health Priorities and Strategies CDC's Division of Cancer Prevention and Control (DCPC) has identified strategic priorities 1) to ensure the elimination of preventable cancers, 2) that all people get the right care at the right time for the best outcome, and 3) cancer survivors live longer, healthier lives. This NOFO aligns with the DCPC strategic priority to improve health outcomes for cancer survivors.

e. Relevant Work This NOFO builds upon past and current programs and activities including:

• Buchanan N, et.al. 2013. Opportunities for Public Health Communication, Intervention, and Future Research on Breast Cancer in Younger Women. Journal of Women?s Health;

22 (4):293-298.

• Documents and materials shared during public meetings of the Advisory Committee on Breast Cancer in Young Women, 2011-2013.

http://www.cdc.gov/cancer/breast/what_cdc_is_doing/meetings.htm

• NOFO DP19-1906: Multiple Approaches to Support Young Breast Cancer Survivors and Metastatic Breast Cancer Patients

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA- DP-24-0061

Logic Model: Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their Families

Bold indicates period of performance outcome

Strategies and Activities

Short-term Outcomes

Intermediate Outcomes Long-Term Outcomes

Mobilize and foster meaningful collaborative

Improved engagement and contribution of

Increased Health Care Providers knowledge and comprehension of https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-cancer-survivors-who-are-living-5-years-or-longer-after-diagnosis-c-11 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-cancer-survivors-who-are-living-5-years-or-longer-after-diagnosis-c-11 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-quality-life-cancer-survivors-c-r01 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/reduce-female-breast-cancer-death-rate-c-04 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/reduce-female-breast-cancer-death-rate-c-04 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486009/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486009/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486009/ http://www.cdc.gov/cancer/breast/what_cdc_is_doing/meetings.htm https://grants.gov/search-results-detail/310243 https://grants.gov/search-results-detail/310243 relationships with nongovernmental organizations that represent and serve priority populations, with emphasis on those from groups that have been economically and socially marginalized.

Foster collaborative relationships with Comprehensive Cancer Control (CCC) coalitions to support the implementation of initiatives that support YBCS across the United States, Tribes and Tribal organizations, US territories, and United States Affiliated Pacific Island Jurisdictions.

Educate and inform survivors, caregivers, family members, and friends on 1) assistance in coping with the effects of treatment (e.g., psychosocial health, reproductive health, financial concerns);

and 2) provision of cancer care plans (e.g., information about follow-up care, risk of recurrence and new malignancies, organizations that serve YBCS, MBC patients, caregivers, family, and friends to structural and psychosocial support services.

Increased use of culturally appropriate interventions to expand program reach among survivors that come from various cultures, identities, and backgrounds.

Increased awareness of successful and sustainable policy, system, and environmental change (PSE) strategies to mitigate sexual dysfunction, fertility, mental health, and healthy lifestyles among cancer survivors, caregivers, and their families.

Increased awareness and understanding among health care providers for the physical, emotional, psychological, and how and where to access emotional/psychosocial support systems among cancer survivors, caregivers, and their families.

Improved access and use of lifestyle programs, clinical preventive services, and follow-up cancer care for cancer survivors.

Established and maintained structural and psychosocial services in settings that are readily patronized by patients, survivors, caregivers, families, and friends.

Improved patient-provider communication and overall health care provider practices.

Increased HCP education regarding physical and mental health needs of YBCS

Increased health and quality of life for all

YBCS.

Increased support for caregivers, family members, and friends of YBCS.

Improved reach of patient-provider interactions regarding breast cancer risk, screening, and treatment.

Increased equitable access to psychosocial and structural support services for ALL YBCS, including MBC patients, and their families by supporting organizations and entities that serve this population.

Improved quality of life among all

YBCS

fertility, psychosocial support, risk of family members developing breast cancer, genetic testing, general health promotion, and including quality of life).

Identify and cultivate a sustainable action plan for the policy, systems, and environmental change agenda.

Provide innovative educational opportunities for health care providers

Mobilize and educate community health workers and patient navigators to reach groups that have been economically and socially marginalized to enhance their access to and utilization of YBCS services and programs.

Provide equitable access to psychosocial support for YBCS, MBC patients, caregivers, and multigenerational social needs of cancer survivors.

Increased informed decision making among YBCS and MBC patients as it relates to treatment, follow up, and preventative care.

families to manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control.

i. Purpose Through the implementation of health equity strategies, activities funded under this NOFO are intended to:

• Increase availability of psychosocial support services for YBCS and MBC patients and their families.

• Establish and provide education opportunities for providers on:

o Incorporating palliative care early in cancer care trajectory o Navigating difficult conversations o Cultural awareness, competency, and humility

• Improve post treatment opportunities for YBCS/MBC patient survivor groups that have been economically and socially marginalized.

ii. Outcomes Recipients are expected to achieve the following outcomes by the end of the period of performance:

Short-term:

• Improved engagement and contribution of organizations that serve YBCS, MBC patients, caregivers, family, and friends to structural and psychosocial support services.

• Increased use of culturally appropriate interventions to expand program reach among survivors that come from various cultures, identities, and backgrounds.

Intermediate-term:

• Established and maintained structural and psychosocial services in settings that are readily patronized by patients, survivors, caregivers, families, and friends.

Long-term:

• Increased equitable access to psychosocial and structural support services for all YBCS, including MBC patients, and their families by supporting organizations and entities that serve this population.

• Improved quality of life among all YBCS.

iii. Strategies and Activities Recipients will be required to address the following strategies during the period of performance:

1. Mobilize and foster meaningful collaborative relationships with nongovernmental organizations that represent and serve priority populations, with emphasis on those from groups that have been economically and socially marginalized. Examples of organizations that may be uniquely positioned to represent and/or serve priority populations include Faith-Based Organizations, Community Organizations, Historically Black Colleges and Universities, Hispanic Serving Institutions, the Hispanic Association of Colleges and Universities, Tribal Colleges and Universities, the National Pan-Hellenic Council, and the National Association of Latino Fraternal Organizations. Recipients will partner with entities that can employ intercultural strategies that prioritize engagement of young survivors from disparate populations and who are able to maximize reaching young survivors through focused interventions. Activities for this strategy include:

a. Conduct partnership assessment.

b. Convene a network of providers, survivors, and caregivers to educate and inform key interested parties on health issues that can be addressed through environmental change.

c. Conduct a SOAR (strengths, opportunities, aspirations, and results) analysis to identify collaborative activities to engage YBCS and MBC patients.

d. Use data to identify 3 - 5 priorities that can be addressed through the partnership network.

e. Ensure that the partnership network's priorities and actions align with the program's action plan for PSE interventions.

f. Monitor, track, and evaluate partner contributions to collaborative activities that support young breast cancer survivors.

2. Foster collaborative relationships with CCC coalitions to support the implementation of initiatives that support YBCS across the United States, Tribes and Tribal organizations, US Territories and Freely Associated States.

a. Provide information to CCC coalitions regarding organization mission and efforts to support YBCS and MBC patients.

b. Consult CCC coalitions on model cancer plan goals and strategies that support the needs of YBCS and MBC patients.

c. Provide model practices/activities/interventions to CCC coaltions that engage and support YBCS and MBC patients.

3. Educate and inform survivors, caregivers, family members, and friends on 1) assistance in coping with the effects of treatment and 2) provision of cancer care plans.

a. Topics related to the assistance of coping with the effects of treatment could include psychosocial health, reproductive health, and financial concerns.

b. Topics related to provision of cancer care plans could include information about follow-up care, risk of recurrence and new malignancies, fertility, psychosocial support, risk of family members developing breast cancer, genetic counseling and testing, general health promotion, and strategies to improve quality of life.

c. To reach a broader audience, utilize innovative approaches such as the development of mobile applications, use of social media platforms and TED talk videos to provide psychosocial support and disseminate relevant health messages to YBCS and MBC patients.

d. Ensure educational opportunities reach YBCS and young women living with MBC from multiple racial, ethnic, geographic, and socio-economic backgrounds.

4. Identify and cultivate a sustainable action plan for the policy, systems, and environmental change agenda.

a. Use data to inform the development of an action plan agenda that facilitates policy, system, and environmental changes that supports the unique needs of young breast cancer survivors.

b. Develop an action plan agenda that supports health systems, institutional/organizational, and policy change strategies. The action plan agenda should reflect recipient's scope of work and commitment to the populations of focus. Possible examples of agenda strategies include: 1) health systems changes requiring use of multi-disciplinary cancer care teams for young women diagnosed with breast cancer; 2) health system changes to provide equitable access to patient navigation (PN) services to support young women diagnosed with breast cancer;

and 3) health system policy change to assure that all YBCS have access to electronic/mobile versions of their cancer care plans.

c. Develop and implement a media plan that will support the implementation of PSE change agenda.

d. Implement at least one policy, systems, and environmental change intervention based on the action plan agenda annually.

5. Provide innovative educational opportunities for health care providers.

a. Trainings should relate to the equitable provision of mental/emotional health services, equitable and appropriate use of cancer care plans, and awareness and utilization of appropriate clinical trial resources for all YBCS and eligible young women living with MBC.

b. Opportunities must allow for the achievement of Continuing Medical Education (CMEs) for practitioners.

c. Educational opportunities should make use of existing educational resources when available. Recipients are also encouraged to develop new resources as needed.

6. Mobilize and educate community health workers and patient navigators to reach groups that have been economically and socially marginalized to enhance their access to and utilization of YBCS services and programs.

a. Develop a repository of resources/programs available to YBCS and young women living with MBC to provide to patient navigators and community health workers.

b. Promote and coordinate existing educational resources to community health workers and patient navigators, as well as develop new resources if needed.

c. Provide trainings for patient navigators and community health workers to increase their awareness of strategies on how to reach groups that have been economically and socially marginalized and recommend culturally/medically appropriate resources/programs.

a. Identify resources available for psychosocial support for these groups, with particular attention to including those from diverse racial, ethnic, geographic, and socioeconomic backgrounds.

b. Use innovative approaches to reach a diverse population of focus, including those that provide for the widest reach, particularly for those that may have differing access to in person and virtual services.

7. Provide equitable access to psychosocial support for YBCS, young women with MBC, caregivers, and multigenerational families to manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control.

a. Identify resources available for psychosocial support for these groups, with particular attention to including those from diverse racial, ethnic, geographic, and socioeconomic backgrounds.

b. Use innovative approaches to reach a diverse population of focus, including those that provide for the widest reach, particularly for those that may have differing access to in person and virtual services.

1. Collaborations

a. With other CDC projects and CDC-funded organizations:

Applicant must develop and maintain meaningful relationships with entities funded through CDC-funded programs. If funded, the applicant is expected to work collaboratively with other entities funded through this cooperative agreement, thereby forming a partnership network of organizations uniquely positioned to implement interventions for YBCS. Successful applicants are also expected to establish collaborations that include, but are not limited to entities funded by CDC such as: the National Comprehensive Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, the Provision of Training and Technical Assistance to Enhance Comprehensive Cancer Control Outcomes, and the CDC’s National Networks Driving Action: Preventing Tobacco- and Cancer-Related Health Disparities by Building Equitable Communities. Collaborations with CDC and its funded partners should be driven by each organization's capacity to serve the population of focus identified by the applicant, provide subject matter expertise related to risk factors and health behaviors associated with YBCS, and to advance program activities that are of high quality and are non-duplicative. Applicant must provide an MOU/MOA, or letters of support/letters of agreement to verify, or as evidence for collaboration. The collaborations described by the applicant should strive to reduce duplication of initiatives to support YBCS and MBC patients, increase program efficiency, and create program synergy. Applicants must also describe how each collaboration will assist in implementation of activities and achievement of the NOFO performance outcomes.

Applicants must file the MOU or MOA, as appropriate, name the file "MOUs/MOAs", and upload it as a PDF file at www.grants.gov.

Applicants must file letters of support/letters of agreement, as appropriate, name the file "Letters of support/Letters of agreement", and upload as a PDF file at www.grants.gov.

b. With organizations not funded by CDC:

Applicants are required to describe intentions to build and maintain collaborative working partnerships with organizations external to CDC that support implementation of the activities and achievement of the performance outcomes for this NOFO.

Applicant must describe the fostering of new collaborations as well as the sustaining of collaborations that will support the goals of this NOFO. Applicants must describe how each collaboration will assist the applicant in implementing activities and achieving the NOFO period of performance outcomes. Specifically, strategic alliances should be formed with both traditional and non-traditional public health partners (e.g. governmental organizations, professional associations, health plan payers, business owners, decision makers, media, and faith-based organizations) and the level of involvement or collaboration (i.e. networking, cooperating, coordinating, collaborating) should be clearly defined. If applicable, applicants should also describe collaborations with Faith-Based Organizations, Community Organizations, Historically Black Colleges and Universities, Hispanic Serving Institutions, the Hispanic Association of Colleges and Universities, Tribal Colleges and Universities, the National Pan-Hellenic Council, and the National Association of Latino Fraternal Organizations. For each level of involvement describe each partners' exchange of information and resources. For example, an entity forming a partnership with a national medical society may collaborate to provide educational activities for health care providers in this NOFO.

If the applicant forms external collaborations, it must provide evidence of this collaboration through memorandum of understanding, letters of support, or some other written form of partner commitment.

Applicants must file the MOU or MOA, as appropriate, name the file “MOUs/MOAs”, and upload as a PDF, Word, or Excel file format at www.grants.gov

2. Population(s) of Focus The population of focus for this NOFO is young breast cancer survivors, defined as 15 to 44 year old women diagnosed with breast cancer and, when appropriate, their caregivers. The NOFO specifically focuses efforts on YBCS and MBC patients in groups that have been economically and socially marginalized that would benefit from additional survivorship support. These include, but are not limited to, women in racial/ethnic groups (e.g. African American, Asian/Pacific Islanders, American Indian, Alaska Natives, Hispanic, American Indian/Alaska Native), young women facing breast cancer in high risk (e.g., Ashkenazi Jewish), LGBTQIA+ communities, low socio-economic groups, rural communities, or women with physical or mental/emotional disabilities.

This NOFO focuses on these populations because young women living with a breast cancer diagnosis have reported experiencing disease that is more aggressive and have a poorer prognosis than older women. They also face medical treatment-related side effects that affect their quality of life (e.g., infertility, cognitive dysfunction, muscular and skeletal symptoms, and cardiac and vascular disease). In addition, this population faces difficult psychosocial and financial challenges related to their breast cancer diagnosis and treatment and often times are at increased risk of developing new malignancies, gaining weight, binge drinking, and using http://www.grants.gov tobacco. From the perspective of cancer control, YBCS are an important population of focus for interventions that focus on their overall health and well-being, cancer prevention, risk reduction, and other quality of life-related issues (e.g., careers, families, personal relationships, reproduction and family planning, and finances).

Applicants must provide specific information on disparities experienced by the proposed population of focus and justification for focusing on the proposed geographical area(s).

Specifically, applicants will identify disparities observed in survival and quality of life among women in groups that have been economically and socially marginalized. Data sources should be cited and used to define and describe the population(s) with descriptions including, but not limited to demographic characteristics, health status, and geographic area. Recipients will use data to identify populations of focus which will inform the development and selection of 3 - 5 priorities that will be addressed through policy, system, and environmental change strategies needed to expand program reach.

This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of race, color, national origin, disability, age, sex (including gender identity, sexual orientation, and pregnancy) or other constitutionally protected statuses.

a. Health Disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Broadly defined, social determinants of health are non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces (e.g., racism, climate) and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. See content below and in other sections (e.g., Approach, Collaborations, Populations of Focus) for information on how this specific NOFO affects social determinants of health.

A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged. Health disparities are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these diseases and conditions.

The NOFO aims to reduce health disparities observed in YBCS and individuals with MBC in groups that have been economically and socially marginalized that would benefit from additional survivorship support. These populations include, but are not limited to, women in racial/ethnic groups (e.g. African American, Asian/Pacific Islanders, American Indian, Alaska Natives, Hispanic, American Indian/Alaska Native) Ashkenazi Jewish, LGBTQIA+ communities, low socio-economic groups, rural communities, or women with physical or mental/emotion disabilities.

Applicants must describe how identified activities will reduce health disparities in populations of focus. Disparities by race, ethnicity, geography, disability, primary language, gender, sexual orientation, health literacy, and other relevant dimensions (e.g. income) should be considered.

Applicants are encouraged to consider people with disabilities in all aspects of the program (e.g., advisory boards, planning committees, programs/interventions). Applicants should ensure that data, including burden data, are used to identify activities to reach the populations of focus.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

Since this NOFO does not involve the generation or collection of public health data, a Data Management Plan is not required for this NOFO.

Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their Families supports organizations who are positioned to develop services and support for YBCS and MBC patients. This program aims to increase availability of psychosocial support services for YBCS/MBC populations and their families, establish and provide education opportunities for providers, and improve post treatment opportunities for YBCS/MBC survivor groups that have been economically and socially marginalized. This program builds upon the successes of previous programs DP11-1111, DP14-1408, DP19-1906 respectively; however, in order for the program to continue to grow and evolve, an evaluation that articulates outcomes and drives program improvement is required.

The evaluation will assess the extent to which the program: 1) increases equitable access and availability of psychosocial and structural support services for YBCS, MBC patients, and their families and 2) improves patient-provider interactions during follow up and subsequent care.

CDC will conduct a utilization focused evaluation of the overall funded program that will articulate program outcomes and facilitate program improvement. Key evaluation questions to be answered will include (but are not limited to):

1. To what extent do recipients formulate meaningful relationships with organizations to effect change that supports YBCS/MBC patients and their families?

2. To what extent do recipients a) develop and implement a program plan to support YBCS and MBC, b) utilize data to inform program efforts, and c) identify mechanisms to sustain programmatic efforts post funding?

3. To what extent do recipients support/increase the reach of evidence-based and promising practices interventions/strategies for YBCS and MBC patients?

4. To what extent do recipients increase awareness among the YBCS and MBC patients regarding: 1) assistance in coping with the effects of treatment and 2) provision of cancer care plans?

5. To what extent do recipients implement interventions to increase access to support services and resources for YBCS and MBC patients?

6. To what extent do recipients increase awareness among healthcare providers, community health workers, and patient navigators of strategies on how to increase accessibility for YBCS and MBC patients services, especially as it relates to groups that have been economically and socially marginalized?

CDC evaluation efforts will follow the CDC framework for program evaluation and will include the following steps:

• Convene workgroup of interested parties to further define key evaluation questions.

• Design a comprehensive evaluation.

• Collect and analyze data.

• Conduct programmatic review utilizing program plans, evaluation plans and reports, and work plans.

• Conduct key informant interviews and focus groups of program implementers and key interested parties.

• If warranted, utilize electronic survey engine to conduct surveys.

Performance Measures

Recipients will be required to report on the following performance measures:

Outcome Performance Measure Short-term Outcomes

Improved engagement and contribution of organizations that serve YBCS, MBC, caregivers, family, and friends to structural and psychosocial support services.

• Number and type (e.g., information sharing, coordination, cooperation, collaboration) of partner engagement strategy approaches including frequency of interaction and interaction type (e.g., information sharing, coordination, cooperation, collaboration)

• Number and type of strategy approaches and interventions partners contribute to

Increase use of culturally appropriate interventions to expand program reach among survivors that come from various cultures, identities, and backgrounds.

• Number of priority populations reached by culturally appropriate intervention (by cultural identity and background)

Intermediate-term Outcome

Establish and maintain structural and psychosocial services in settings that are readily patronized by patients, survivors, caregivers, families, and friends

• Number of structural and psychosocial services (program name and type) by setting and patronage (patient, YBCS, MBC, caregiver, family member, and friend)

Long-term Outcomes

Increase equitable access to psychosocial and structural support services for ALL young breast cancer survivors, including metastatic breast cancer patients, and their families by supporting organizations and entities that serve this population

• Number and type of psychosocial and structural support services that Community Health Workers and Patient Navigators refer to young breast cancer survivors and their families

Improved quality of life among all YBCS • Mental health quality of life (healthy days measure) among breast cancer survivors under 45 years of age

• Physical quality of life (healthy days measures) among breast cancer survivors under 45 years of age

Dissemination and Use of Evaluation Findings

CDC will disseminate findings and improve program efforts. Dissemination products that articulate evaluation findings and recommendations include but are not limited to:

• Manuscripts

• Program publications (trend reports, state of the program, program profiles, success stories, etc.)

• Presentations

• Guidance documents describing promising practices with recommendations for scale up.

In addition to conducting a formal evaluation, CDC will use performance measures to assess recipient compliance with the requirements of this funding opportunity. Performance measures will be collected annually and will be used to:

• Make budgeting decisions

• Inform guidance and technical assistance

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

• How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement, including, as applicable to the award, how findings will contribute to reducing or eliminating health disparities and inequities.

• How key program partners will participate in the evaluation and performance measurement planning processes.

• Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant).

• How evaluation findings will be disseminated to communities and populations of interest in a manner that is suitable to their needs.

• Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additional-requirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant should be directed to:

• Describe the type of evaluations (i.e., process, outcome, or both).

• Describe key evaluation questions to be addressed by these evaluations.

• Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, if applicable, within the first 6 months of award, as described in the Reporting Section of this NOFO.

Evaluation plans should also define both process and outcomes (short-term, intermediate and long-term) measures and associated activities. The evaluation plan should consider components identified in the CCC Program Evaluation Toolkit.

At minimum, applicants' annual comprehensive evaluation plan must:

• Identify key evaluation interested parties and describe the interested parties engagement strategy;

• Describe evaluation stakeholder's potential role in evaluation planning and implementation;

• Describe how evaluation interested parties will utilize evaluation findings;

• Include a logic model to illustrate program design;

• Establish specific, measurable, and realistic short-term (one year), intermediate, and long-term program objectives consistent with the purpose of this funding opportunity for the accomplishment of program activities and to ensure sustainability after CDC funding;

• Address how the applicant intends to assess the extent to which recipient activities are implemented appropriately as well as the extent to which these activities yield the intended outcomes;

• Describe available data sources, feasibility of collecting appropriate evaluation and performance data;

https://www.cdc.gov/grants/additional-requirements/ar-25.html http://www.cdc.gov/cancer/ncccp/prog_eval_toolkit.htm

• Describe how findings will be disseminated from this program to CDC and key interested partiesin order to support the use of evidence-based and practice based strategies/interventions;

• Describe how evaluation findings will be used to enhance program implementation efforts. At the completion of each budget period, recipients will be responsible for submitting an evaluation report that summarizes key findings.The evaluation plan will be updated to reflect evaluation findings and program improvement measures.

CDC and recipients will use evaluation and performance measurement to determine if program activities are scalable and effective at reaching the priority populations. In developing evaluation and performance measurement plans, applicants are encouraged to use: CDC Framework for Program Evaluation in Public Health.

c. Organizational Capacity of Recipients to Implement the Approach Applicants should describe existing program infrastructure and organizational capacity to develop and implement the strategies as outlined in the NOFO. Applicants should describe the following:

1. A management plan that includes structure/staffing and fiscal management (i.e., organizational charts; curricula vitae).

2. A communication plan that describes engagement with key interested parties about cancer burden, interventions, and impact.

3. Ability to develop a partnership evaluation plan for new partnerships and maintaining existing partnerships.

4. Ability to develop a 5-year program plan that serves as a road map for the achievement of project period goals and objectives.

5. Ability to develop a sustainability plan post CDC funding.

6. Collection of data elements essential to program evaluation and performance measurement.

Applicants should describe organizational capacity and readiness to meet the requirements of this NOFO. Organizational capacity to develop and implement strategies as specified in the NOFO will be evidenced by:

• A description of the applicant's documented history of providing structured support services YBCS (including women with metastatic breast cancer).

• History of reaching young women facing breast cancer in high risk (e.g., Ashkenazi Jewish), racial/ethnic, or groups that have been economically and socially marginalized (e.g., Hispanic, Asian/Pacific Island, Native American/Alaska Native, African Americans, , LGBTQIA+).

• History of formalizing partnerships as evidenced by MOA, MOU, letters of support, or letters of agreement which constitute a formal commitment to contribute to proposed work/initiatives.

• Ability to implement valid promising practices that are sustainable and add to the knowledge base.

• Previous experience identifying innovative methods to promote and disseminate structured support services that saturated the YBCS community.

https://www.cdc.gov/evaluation/ https://www.cdc.gov/evaluation/

• Ability to collect relevant data element needed to support program evaluation and performance management.

• Previous experience designing opportunities to educate and build awareness regarding the unique needs of healthcare providers, community health workers, patient navigators, survivors, caregivers, family members, and friends

Applicants must label curricula vitae and organizational chart files as “CVs/Resumes” and “Organizational Charts” and upload it as a PDF to www.grants.gov.

d. Work Plan The work plan integrates and delineates more specifically how the recipient plans to carry out achieving the period of performance outcomes, strategies, and activities, evaluation and performance measurement, including key milestones. Applicants are required to provide a workplan for the first program year and a high-level work plan subsequent years which will serve as the foundation for annual workplans for selected cooperative agreement recipients. The workplan should not exceed 20 pages.

Applicants are strongly encouraged to organize period of performance outcomes, annual outcomes, and activities by the strategies under the Strategies and Activities section.

The work plan should provide a description of specific program strategies to be used during the first year of the period of performance that includes 1) specific, measurable, achievable, realistic, time-phased, inclusive, and equitable (SMARTIE) goals and objectives which are linked to and are consistent with the NOFO strategies and outcomes; 2) specific activities/interventions that will be undertaken to address each of the proposed short-term outcomes during the budget period; 3) staff responsible for completion of activities, including the level of effort and allocation of time for each proposed activity; and 4) key partners involved in the development, implementation and evaluation of proposed activities/strategies including a description of their role. At a minimum the work plan must include:

1. A description of the project period outcomes for the 5-year period of performance.

Applicants should use long-term outcomes that are specified in the logic model under the “Approach” section.

2. A description of Annual Objectives to be accomplished within year one of the budget period. Applicants should use short-term outcomes that are specified in the logic model under the “Approach” section.

a. Quantitative baselines should be provided for each outcome that leads to an increase, decrease, or maintenance over time.

b. Applicants should provide timelines for the first year of the period of performance.

3. A description of activities that are in alignment with the proposed objectives and the program strategies and, if applicable, should be based on cited evidence for the first year of the project.

Applicants must label this file “Work Plan” and upload it as a PDF file at www.grants.gov.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

• Tracking recipient progress in achieving the desired outcomes.

• Ensuring the adequacy of recipient systems that underlie and generate data reports.

• Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

• Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

• Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

• Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

• Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

f. CDC Program Support to Recipients

CDC will provide program guidance and technical assistance including:

• Coordinating quarterly teleconferences with the recipients and the directors of the CDC funded National Comprehensive Cancer Control Program (NCCCP) to share information, provide program updates, facilitate peer learning, and provide technical assistance.

• Leading/coordinating learning opportunities to build recipient capacity in the form of face-to-face trainings, webinars, and reverse site visits.

• Creating and disseminating program guidance documents that support the implementation of NOFO strategies that support YBCS, young women living with MBC, and their families, friends, caregivers, and providers.

• Facilitating information sharing and networking among recipients and CDC staff.

• Providing subject matter expertise on select interventions and program…