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D eveloping C ancer N avigation S upport for R ural A frican A merican E lders

D eveloping C ancer N avigation S upport for R ural A frican A merican E lders. J ennifer W enzel, PhD, RN, CCM* Rachel Klimmek , RN * *Johns Hopkins University, School of Nursing. Kenneth Muhammed 2001. Funsho Akerele -Ale, 2001. Leonard Evans 2001. Milbert O. Brown, Jr 2001.

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D eveloping C ancer N avigation S upport for R ural A frican A merican E lders

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  1. Developing Cancer Navigation Support for Rural African American Elders Jennifer Wenzel, PhD, RN, CCM* Rachel Klimmek, RN* *Johns Hopkins University, School of Nursing

  2. Kenneth Muhammed 2001 FunshoAkerele-Ale, 2001 Leonard Evans 2001 Milbert O. Brown, Jr 2001 Michael Bracy 2001 Devin Elmore: “Harbor Dock”, December 31, 2005

  3. Purpose To test a culturally appropriate patient navigation intervention designed to provide support for rural AAs undergoing cancer treatment. To assess treatment completion, stress, and economic and social outcomes among rural AA elderly cancer patients randomized to one of two groups (immediate intervention or waitlist control). & Voting Charles Moore, 1964 Family in CityscapeCharles Alston, 1966

  4. Methods • We will recruit 80 Medicare-enrolled AA patients residing in rural Virginia with a recent diagnosis (<60 days) of breast or prostate cancer who require & intend to pursue cancer treatment. • Inclusion criteria: • self-identify as AA • residing in a rural county • 65 years of age or older • newly diagnosed (<60 days) with eligible cancer (prostate or breast, histologically staged 0-III) • scheduled to receive surgery, chemotherapy, or radiation therapy as initial treatment • Exclusion criteria: • metastatic disease or concurrent cognitive problems/disabilities that would limit ability to participate • inability to identify a support person willing to participate in the intervention at study entry • Karnofsky score <80

  5. Goals of CPN Our goal is to facilitate timely access to cancer care in a culturally appropriate manner by: • 1) overcoming health system barriers, • 2) providing health education about cancer across the cancer continuum from prevention to treatment, • 3) addressing patient barriers to cancer care, and • 4) providing psychosocial support.

  6. CPN Services Servicesmay include but are not limited to: • (1) arranging various forms of financial support, • (2) arranging transportation to and from childcare during scheduled diagnosis and treatment appointments, • (3) identifying and scheduling appointments with caregivers, • (4) coordinating care among providers, • (5) addressing health literacy needs, • (6) ensuring coordination of services among health care personnel, • (7) ensuring that pertinent health records are available at scheduled appointments, • (8) providing other services to overcome access barriers encountered during the cancer care process.

  7. CPN Protocol Components Cancer Knowledge/Needs; Ability to Navigate Cancer Treatment • Address cultural beliefs/myths about cancer • Review needs/expectations/goals regarding the following: • -Potential stigma regarding diagnosis • -Prognosis • -Treatment strategies/minimization of related side effects • -Follow-up • Assess knowledge needs of participant/support individual; build educational plan

  8. CPN Protocol Components Support and Access to Cancer Care • Train identified support person(s) to assist in providing support through treatment • Incorporate designated support person into desired treatment monitoring/navigation (derived from Study 4 data, Table 1) • Review transportation, care coordination plans (appointments, scheduling, etc.)

  9. CPN Protocol Components Patient-Provider Communication • Acknowledge cultural issues regarding communication/health literacy • Discuss resource needs • Review effective strategies to facilitate better communications with care providers (e.g., commonly used cultural terms, documenting questions in advance of visits)

  10. CPN Protocol Components Finances • Acknowledge/discuss potential stress associated with cancer-related costs • Discuss priorities related to finances; personal plans • Provide culturally appropriate resources/strategies and other information to assist in controlling/decreasing cancer-related costs (i.e., transportation, medications)

  11. Questions? • Cultural tailoring will be applied to the intervention to increase its relevance to this rural population of AA Seniors The Builders, 1974Jacob Lawrence

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