The Partnership for Native American Cancer Prevention (U54)

Transcription

1 The Partnership for Native American Cancer Prevention (U54) David S. Alberts, MD - Principal Investigator, AZCC/UA Laura Foster Huenneke, PhD - Principal Investigator, NAU Jesse Martinez, PhD - Research PI, AZCC/UA Diane Stearns, PhD - Research PI, NAU Francisco Garcia, MD, MPH; Jesse Nodora, DrPH - Outreach, AZCC/UA William Wiist, DrPH - Outreach, NAU Teshia Solomon, PhD (Choctaw); Margaret Briehl, PhD -Training, AZCC/UA Jani Ingram, PhD - Training, NAU

2 Community Outreach Program Aims 1. A Native American tribal liaison will increase cancer prevention and control programs and research in Hopi, Navajo and Tohono O odham communities. 2. A Native American tribal community expert network will expedite the cultural adaptation of cancer prevention and control programs and research in the Hopi, Navajo and Tohono O odham communities. 3. Educational preparation for Native American tribal community lay health workers will result in an increased provision of culturally appropriate cancer education programs for their respective Hopi, Navajo and Tohono O odham communities. 4.Delivery of clinical education programs tailored to Indian Health Service (IHS) physicians, nurses and health education staff of the Hopi, Navajo and Tohono O odham communities will increase compliance with ageappropriate breast, cervix and colon cancer screening, and documentation of smoking cessation, nutritional and physical activity counseling.

3 As an example - Tohono O odham Cancer Partnership (Francisco Garcia, MD and Jesse Nodora, DrPH) Established in 2008, the Tohono O odham Nation Division of Health addresses the problem of cancer on the Nation Tohono O odham Nation s first comprehensive cancer plan was ratified by the Council on June 18, 2010 (Resolution No ) Partners include; Arizona Cancer Center Partnership for Native American Cancer Prevention Arizona Department of Health Services Tucson Area Indian Health Services Leukemia and Lymphoma Society University of Arizona College of Public Health and the Center of Excellence in Women s Health Southwest American Indian Collaborative Network Partially funded by the Centers for Disease Control

4 Tohono O odham Cancer Plan & Implementation Priorities Prevention- Obesity, Tobacco Control Early Detection- Breast, Cervical, Colorectal, Prostate Quality of Life- Case Management, Palliative Care

5 Tohono O odham Nation Capacity Development Cancer Health Promotion Program Implementation Cultural Integration Evaluation Program Sustainability

6 Tohono O odham Cancer Report Card

7 Meaningful Outcome Metrics: Tucson Area IHS GPRA Indicators Tucson Area IHS (3Qs) NHW SWAI BRFSS BRFSS Mammography 45% 60% 76% 66% Colorectal Screening 13% 35% 54% 38% Pap Smear 59% 52% 84% 80% IHS-Indian Health Service; GPRA-Govt. Performance & Results Act NHW-non-Hispanic white; BRFSS-Behavioral Risk Factor and Surveillance System; SWAI-Southwest American Indian

8 Summary of Outreach Activities Conducted clinically oriented CME/CNE presentations for 190 physicians, CNMs, NPs, nurses and outreach staff in partner communities. Events reaching 117 additional providers scheduled for the next 12 months Perspective Navajo Area IHS 384 providers Tucson Area IHS 30 providers Hopi Health Center 12 providers

9 Sustainability of Cancer Center- University-Native American Partnerships EXTREME CHALLENGES Sustainability is especially important, because most tribes lack infrastructure (i.e., trained personnel, etc) for grant writing, publishing, and, most importantly, research Sustainability is especially important, because without consistent, long term resources, cancer-related research cannot be conducted with active community involvement Much of the distrust, and current moratoriums on research among Native American tribes stem from past failures on the part of the university researchers

10 Sustainability of Cancer Center- University-Native American Partnerships EXTREME CHALLENGES (continued) Sustained efforts that support and produce capacity building among local tribal leaders is critical This capacity spans understanding of key concepts related to cancer s natural history and management to partnering with non-tribal collaborators and the logistics of grants management. It takes decades to develop such research capacity and the trust needed to work together effectively

11 Short and long term commitments of the Arizona Cancer Center and Northern Arizona University The Arizona Cancer Center has developed a Cancer Health Disparities Institute (CHDI), co-directed by two of the strongest research faculty in the U.S. (Elena Martinez, PhD and Francisco Garcia, MD, MPH) Northern Arizona University and the University of Arizona have pushed the boundaries in valuing and supporting these partnerships Full scholarships for Native American undergraduate and graduate students Tenure track faculty slots for Native American scholars Direct involvement of upper Administration in our U54 project (e.g., Laura Huenneke, VP Research as NAU s Lead PI and UA President participates in Retreats) Arizona Cancer Center Director serves as UA s Lead PI

12 The Cancer Health Disparities Institute: The AZCC s Plan to Address Cancer Disparities Francisco Garcia, M.D. Elena Martinez, Ph.D. Co-Directors

13 Education/Training Build educational programs to train students and faculty from underserved populations as well as those who are committed to conducting research in underserved populations Community Outreach Establish sustainable relationships with the communities served Research Bring together teams of investigators engaged in peer-reviewed collaborative research in cancer disparities

14 CHDI Board of Community Advocates Frank Valenzuela (co-chair) Jacob Bernal Peter Chan Dr. Nelba Chavez Richard Elias Dr. Nancy Johnson Dr. Tsianina Lomawaima Richard Miranda Ned Norris Francisco Romero JoAnn Sayre Andrew Pacheco (co-chair) Hirsch Handmaker Dr. William Chavira Larry Halvorson Doug Hirano Nancy Jordan Sandy McClendon Bill Rosenfeld Kendra Sabol Dr. Kent Scribner Fred Taylor

15 CHDI adds long term value to the AZCC Community Partnerships Enhance ability to serve Arizona s racial/ethnic minority and other under-served populations. Improve integration of efforts with state-wide networks. Foster binational and international studies to understand the etiology of cancer in Hispanic/Latino populations. Foster inter-programmatic collaborations.

16 Sustainability for Native American Outreach & Education Activities Cancer disparities in Native American communities require long term multi-sector investments with Tribal government Academic partners Cancer advocacy organizations State government Federal government Priorities must be determined by communities themselves which requires ownership and capacity building Metrics must be evidence-based and relevant to the communities Research is a secondary priority, but must be an extremely important component of any interaction

17 Sustainability - What can NCI do? NCI can provide support for existing (U54) grant recipients by partnering with key agencies that are either funding related efforts (e.g., CDC Cancer Control program that funds cancer planning and screening) or can impact key cancer control initiatives (e.g., Indian Health Service cancer screening measured via GPRA-Government Performance and Requirements Act) and supporting policies/recommendations for sustainability. NCI can identify and acknowledge (e.g., via certificate) community/tribal health entities that have reached key cancerrelated milestones (e.g., have comprehensive cancer plan) lending credibility and support to these efforts. Cancer Centers funded by NCI, like AZCC, can designate one or two fundraising events to hire and maintain a tribal liaison