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Brant JM. Oncology Nurse Navigation in Underserved Communities: Opportunities and Future Directions. Semin Oncol Nurs 2024; 40:151586. [PMID: 38311537 DOI: 10.1016/j.soncn.2024.151586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVES Provide an overview of navigation in three disparate populations: rural, Native American/Alaska Native, and low- to middle-income countries. Discuss gaps in care and opportunities to improve cancer care. METHODS A literature search was conducted in PubMed and on Google Scholar using search terms, nurse navigation, cancer, disparit*, low- to middle-income countries, Native American, American Indian, and rural. Peer-reviewed research studies, review articles, databases and websites of professional organizations, and historical books were reviewed to provide an overview of oncology nurse navigation in underserved communities. Experiences in working with these populations over the past 30 years were also provided to support current literature. RESULTS Forty references were included in this overview of nurse navigation in underserved communities. Nurse navigation in these disparate areas is in its infancy. While some programs exist and outcomes have been positive, their dissemination is sparse. A need exists to expand nurse navigation into these areas to provide care for these underserved communities. CONCLUSION Oncology nursing navigation for each of these underserved communities requires a culturally sensitive approach. Many of these approaches are universal to cultural competency and can be applied to most disparate populations. IMPLICATIONS FOR NURSING PRACTICE Nurses comprise the largest workforce around the globe and are well-equipped to develop navigation programs in some of the most disparate communities around the world. To do so, it is important to use a foundation of building trust, embracing individual differences, providing culturally sensitive education and resources for growth, and good communication.
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Affiliation(s)
- Jeannine M Brant
- Executive Director, Clinical Science & Innovation, City of Hope National Medical Center, Duarte, CA.
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Champion VL, Monahan PO, Stump TE, Biederman EB, Vachon E, Katz ML, Rawl SM, Baltic RD, Kettler CD, Zaborski NL, Paskett ED. The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women. Cancers (Basel) 2022; 14:4354. [PMID: 36139515 PMCID: PMC9496655 DOI: 10.3390/cancers14184354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and the DVD plus patient navigation (PN) intervention vs. Usual Care (UC) for increasing the percentage of rural women (aged 50 to 74) UTD for breast cancer screening, as part of a larger study. Four hundred and two women who were not UTD for breast cancer screening, eligible, and between the ages of 50 to 74 were recruited from rural counties in Indiana and Ohio. Consented women were randomly assigned to one of three groups after baseline assessment of sociodemographic variables, health status, beliefs related to cancer screening tests, and history of receipt of guideline-based screening. The mean age of participants was 58.2 years with 97% reporting White race. After adjusting for covariates, 54% of women in the combined intervention (DVD + PN) had a mammogram within the 12-month window, over 5 times the rate of becoming UTD compared to UC (OR = 5.11; 95% CI = 2.57, 10.860; p < 0.001). Interactions of the intervention with other variables were not significant. Significant predictors of being UTD included: being in contemplation stage (intending to have a mammogram in the next 6 months), being UTD with other cancer screenings, having more disposable income and receiving a reminder for breast screening. Women who lived in areas with greater Area Deprivation Index scores (a measure of poverty) were less likely to become UTD with breast cancer screening. For rural women who were not UTD with mammography screening, the addition of PN to a tailored DVD significantly improved the uptake of mammography. Attention should be paid to certain groups of women most at risk for not receiving UTD breast screening to improve breast cancer outcomes in rural women.
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Affiliation(s)
- Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Patrick O. Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Timothy E. Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Erika B. Biederman
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Mira L. Katz
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH 43210, USA
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Ryan D. Baltic
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Carla D. Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Natalie L. Zaborski
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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How cancer programs identify and address the financial burdens of rural cancer patients. Support Care Cancer 2022; 30:2047-2058. [PMID: 34655327 PMCID: PMC9380718 DOI: 10.1007/s00520-021-06577-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs' perceptions of rural-urban differences in cancer patients' experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural-urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients. METHODS Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis. RESULTS We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients' experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients' financial concerns. CONCLUSIONS Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.
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Niranjan SJ, Hardy C, Bowman T, Bryant J, Richardson M, Tipre M, Baskin ML. Rural Cancer Health During the COVID-19 Pandemic. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:862-863. [PMID: 32860181 PMCID: PMC7455094 DOI: 10.1007/s13187-020-01858-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Soumya J Niranjan
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claudia Hardy
- Office of Community Outreach and Engagement, O'Neal Comprehensive Cancer Center University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- Office of Community Outreach and Engagement, O'Neal Comprehensive Cancer Center University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Bryant
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Molly Richardson
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA.
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Richman AR, Torres E, Wu Q, Kampschroeder AP. Evaluating a Community-Based Breast Cancer Prevention Program for Rural Underserved Latina and Black Women. J Community Health 2020; 45:1205-1210. [PMID: 32529466 DOI: 10.1007/s10900-020-00856-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Persistent racial and ethnic disparities and rural-urban disparities in breast cancer mortality in North Carolina require attention. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provided culturally tailored breast cancer education and navigation to age-appropriate screening services (mammography and clinical breast exams) for uninsured and underinsured Black and Latina women age 25 and older in two rural counties in North Carolina (Pitt and Edgecombe Counties). Using a lay health model, the PCBWI-E trained 23 community members and public health undergraduate students as lay breast health educators. Breast health educators educated 735 women across the 2-year program. Baseline knowledge about breast health was low at year 1 and 2 (mean knowledge score = 59%, SD = 0.21 and 57%, SD = 0.22, respectively) and was higher at follow-up post-intervention for both years 1 and 2 (mean knowledge score = 78%, SD = 0.18 and 75%, SD = 0.19, respectively) (p < 0.001). In terms of navigation, almost three-quarters (72%) of those recommended to receive a mammogram, received one. Of the population served by the PCBWI-E who were aged 40 and above, 34% had never received a mammogram. Of those women who had never received a mammogram, 68% received one through the PCBWI-E program. The PCBWI-E was successful in increasing both breast health knowledge and access to age-appropriate breast cancer screening among uninsured and underserved Latina and Black women in rural eastern North Carolina. Future efforts should support the large-scale implementation of successful evidence-based culturally appropriate models like this one in the reduction of racial, ethnic, and rural breast cancer disparities.
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Affiliation(s)
- Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3107 Carol Belk Building, Greenville, NC, 27858, USA.
| | - Essie Torres
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3107 Carol Belk Building, Greenville, NC, 27858, USA
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Health Sciences Building, Greenville, NC, USA
| | - Amy P Kampschroeder
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3107 Carol Belk Building, Greenville, NC, 27858, USA
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Kamaraju S, Olson J, DeNomie M, Visotcky A, Banerjee A, Asan O, Tavares E, Rao A, LaCroix M, Krause K, Neuner J, Stolley M. Community Breast Health Education for Immigrants and Refugees: Lessons Learned in Outreach Efforts to Reduce Cancer Disparities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1092-1096. [PMID: 30091014 DOI: 10.1007/s13187-018-1412-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Community-academic partnerships are vital to address cancer disparities in geographic areas with diverse socioeconomic, language, and cultural barriers. Regarding breast health, immigrant and refugee women are a particularly vulnerable population, with considerably lower mammography rates than most communities, including racial and ethnic minorities. To promote health care equity in this high-risk population, we developed a community-academic partnership (CAP) model to promote breast health education at community faith-based centers in the city of Milwaukee, WI. In this paper, we describe the success of our partnerships, our lessons learned, and future directions.
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Affiliation(s)
- Sailaja Kamaraju
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Jessica Olson
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melissa DeNomie
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alexis Visotcky
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anjishnu Banerjee
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Onur Asan
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emmanuel Tavares
- Medical School, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amrita Rao
- Medical School, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Megan LaCroix
- Medical School, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate Krause
- Massachusettes General Hospital, Boston, MA, USA
| | - Joan Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melinda Stolley
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Drake BF, Lewis-Thames MW, Brown A, Rancilio D, Hicks V. An Evaluation of Follow-Up Activities of Participants From an Urban Prostate Cancer Screening Event. Am J Mens Health 2019; 13:1557988319844353. [PMID: 30982387 PMCID: PMC6463237 DOI: 10.1177/1557988319844353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aims to evaluate follow-up activities completed by participants attending community prostate cancer (PCa) screening events. On-site surveys were collected from participants of 17 free PCa screening events from 2007 to 2011 in the St. Louis, MO metropolitan area. Follow-up action surveys were mailed to all on-site participants to assess medical (i.e., made an appointment with a doctor, got additional testing for PCa, made an appointment to be screened) and nonmedical activities (i.e., sought social support, health information-seeking, health behavior modifications) completed after the PCa screening event. Further, t tests and chi-square tests characterized participant information from the on-site survey and within each follow-up activity category for the mailed surveys. Among 1,088 on-site community PCa screening participants, the mean age was 50 years old, 94% were Black, and 30% responded to the mailed follow-up action survey. For the recorded follow-up activities, 65% of participants reported medically reported activities, of which “made an appointment to get a yearly physical” was the most common action (29%). Health behavior modifications were the most common nonmedically related activities (44%). Health information-seeking behaviors were the least reported follow-up action (22%). Men with higher incomes, married, with health insurance, and a primary care physician, most often participated in post-PSA screening activities, namely medically-related and social support activities. Understanding the most common activities completed by participants of a community PCa screening suggests the effectiveness of community events to re-engage underserved populations in the health-care system and provides insight on acceptable health promotion opportunities.
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Affiliation(s)
- Bettina F Drake
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Marquita W Lewis-Thames
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | | | - Danielle Rancilio
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Veronica Hicks
- 1 Department of Surgery, Washington University in St. Louis School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
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