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An Innovative Approach to Increasing Early Detection of Breast Cancer within Tribal Communities
Background: Native American women are experiencing an increasing incidence of breast cancer throughout the United States. Recent studies also demonstrate that American Indian women have the poorest breast cancer survival rates of any ethnic group in the United States. Furthermore, and perhaps most alarming, local statistics reveal strikingly low rates of breast cancer screening among women in regional Tribal communities. Objective/Hypothesis: The objective of this program is to improve breast cancer early detection practices among Native women in seven Tribal communities in the Southwest. Our hypothesis is that multidimensional provider-level training will significantly increase the observed rates of mammography and clinical breast exam among community women, and that provider training coupled with rigorous case management will even further improve breast cancer screening rates. Specific Aims: This proposed program aims to ensure that breast cancer becomes a priority in all seven of the Tribes served by the Albuquerque Area Indian Health Board. In addition, it seeks to increase the capacity of health care practitioners to respond to the needs of community women related to breast cancer. Lastly, the project aims to establish a sustainable breast health case management function in a pilot Tribal community. Study Design: The program will first gather current baseline data on the breast cancer screening practices (clinical breast exam and mammography) of Native women in each of the seven Tribes. Next, a host of trainings will be offered to a multidisciplinary group of health care workers from all seven Tribes, and will include, 1) cultural competency training for non-Indian providers, 2) clinical breast exam instruction for community nurses, 3) outreach skills training for field health workers, 4) cancer support workshops for behavioral health staff, and 5) chart review technical assistance for triage staff. In addition, an individual from the pilot community will be hired as the breast health case manager and trained to develop a database to monitor the early detection practices of community women and provide referrals and reminders as necessary. The case manager will also serve as the principal liaison between the Tribe and valuable outside resources such as referral hospitals and clinics, cancer support organizations, cancer researchers, universities, and related community based organizations. At the end of the three-year program, breast cancer screening data will once again be gathered in each Tribe to determine, 1) if provider specific training significantly improves breast cancer early detection practices among Native women, 2) if the combination of the provider training and case management even further bolsters breast cancer screening rates. All activities will be collaboratively designed and implemented with the input of Tribal community members to ensure cultural appropriateness and will be subject to the approval of Tribal leadership to respect lines of authority and honor Tribal sovereignty. Potential Outcomes and Benefits of the Research: The greatest benefit that can be achieved from this research is an improvement in breast cancer early detection practices, which will ultimately translate into improved survival rates for Native women. Additionally, the program has the potential to demonstrate the value of case management in Tribal communities, which are not often accustomed to providing and/or prioritizing preventative health services. Finally, this program can serve as a model for other Tribes to implement similar interventions to address breast cancer in their communities.
Background: Breast cancer is on the rise among Native Americans. To make matters worse, Native women are less likely to survive from breast cancer after they are diagnosed with it. This may be due to the fact that American Indian women are not having routine screening exams such as mammograms and clinical breast exams as often as is recommended. Objective/Hypothesis: The objective of this program is to increase breast cancer screening in Tribes. We believe that we can accomplish this by enhancing the skills of health care workers to better understand Native American cultures and improve breast cancer related services. We also think that having a case manager who encourages community women to go to their screening exams and follow-up appointments will have an even greater effect on improving breast cancer early detection. Specific Aims: This program has three aims: 1) to make breast cancer a priority among the seven Tribes served by our organization; 2) to build skills among health care workers to address breast cancer in their communities; and 3) to establish case management services in one Tribe, which is referred to as the pilot community of the program. Study Design: The first program activity will be to gather information on the current rates of breast cancer screening in all seven communities. Next, a series of trainings will be provided to a variety of community health workers. These will include: 1) cultural awareness training for non-Indian providers; 2) clinical breast exam instruction for nurses; 3) health education training for outreach workers; 4) cancer support workshops for social workers; and 5) chart review instruction for nursing and medical assistants. At the same time, program staff will hire a case manager in the pilot community who will develop a computer program to monitor breast cancer screening among community women. This individual will also be trained to provide information on breast cancer and local programs, which specialize in cancer. Once the three-year program is completed, program staff will again collect data on breast cancer screening rates in each community. This information will be compared to the same data that was collected at the beginning of the program to see: 1) if the health care worker trainings led to an increase in breast cancer screening; and 2) if the combination of case management and health care worker trainings (pilot community) led to an even greater increase in breast cancer screening. All of our program activities will be designed with input from Tribal community members to make sure that they are culturally appropriate. In addition, all components of the program will be presented to Tribal leaders to obtain their approval and support. Potential Outcomes and Benefits of the Research: The greatest benefit that can be achieved from this research project is an improvement in breast cancer screening among Tribal women. By increasing screening, we will be able to detect cancer earlier, which makes it much easier to treat and improves the chances of survival. This program also has the potential to convince other Tribes to create case management services in their communities. Lastly, all of the lessons learned through this program can be shared with other Tribes to build a widespread response to breast cancer among Tribal communities throughout the United States.