AI Cancer Support Circles

Transcription

1 Supported by: National Center for Minority Health and Health Disparities Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] Supported and Developed by: The original Native American Cancer Survivors Support Circles were: Supported by the California Community Foundation Developed and pretested by Terrie Restivo (Cherokee Nation of Oklahoma) The Cedar Circle Revisions and modifications were: Supported by Mayo Clinic s Spirit of E.A.G.L.E.S. SOE) [NCI U01 CA86098] Developed and modified by Lisa D. Harjo, (Choctaw) and Linda Burhansstipanov (Cherokee Nation of Oklahoma) 2 OBJECTIVES By the end of this segment, the community participant will be able to: 1. Describe unique features of the NACR Native American cancer support circles. 2. Identify three things that make a cancer support circle successful. 3. Describe how your Support Circle may be organized to be acceptable to your local community. OBJECTIVES By the end of this segment, the community participant will be able to: 4. Identify which resources are already in existence and are likely to be included within your local Circle. 5. Describe recruitment strategies specific to your local Circle. 6. Identify which topics are likely to be included as sessions within your local Circle. 3 4 What is an American Indian Cancer Survivor Support Circle? Overview of NACR Survivor Support Circles A place where American Indian cancer survivors can share their experiences with someone like them who has been there. A place where you can learn more about your cancer, your treatment, your recovery, and life after. A place your culture is respected and valued. 6 1

2 What is culture? A way of life that includes foods, clothing, language, music, beliefs, religion, lodging, customs and art. What is respect? To honor others, to treat others as you would like to treated. 7 What are definitions of a resource? An organization, literature, videos, media, etc. that you can get information from to use to learn about healthy life-skills, quality of care & end of life care information for physical, social, mental, emotional and/or spiritual support An organization that you can refer a client to An individual you can refer clients to 8 Examples of Available Native Specific Resources Native American Cancer Research (NACR) and the Survivors Network Mayo Clinic s Spirit of E.A.G.L.E.S., the Native C.I.R.C.L.E. and the Native WEB: Non-Native, Accurate Information Getting Started National Cancer Institute, Cancer Information Service CANCER 9 How Does A Support Circle Work? A series of 8-12 meetings are set up with dates, locations, and topics Meeting dates are posted around the tribal community, in newsletters, and flyers are shared with American Indian community members. How Did NACR s Circles Start? We learned from Terrie Restivo, consultant to NACR, who pretested the Native American Support Circles QUESTION: Where can you find materials for your support circle? Download them free off our webpage at

3 How Does the NACR Support Circle Work? NACR staff (Lisa Harjo) serves as the coordinator / facilitator Circle members tell NACR staff what they want, how often to meet, when, etc. She makes it happen NACR Staff Provides Meeting Handouts And Materials Provides a notebook (as funding allows) with materials for the participants Provides healthy foods Many groups do this as a potluck, but healthy food is the guideline Provides speakers on topics requested by the Circle members when feasible Most local speakers volunteer their time to talk with the Circle What are the benefits for members? Benefits for Participants Circle members receive support and caring from other members and the facilitator. Circle members learn more about their cancer, treatment, and recovery so they can improve their quality of life during and after cancer. 16 What are the benefits for members? Circle members learn how to handle the side effects of treatments through diet, herbal teas, and new behaviors. Circle members find out they are not alone. Circle members learn to have fun again and make plans for the future. What are the benefits for members? Circle members learn about resources in the community that can help them. Circle members build new relationships and friendships with other circle members. Circle members learn more about themselves and their strengths

4 How do NACR Native Circles differ from non-native support groups? How is an American Indian Support Circle different from another support circle? American Indian support circles respect the spiritual beliefs of the members and allow them to bring their spirituality in to the Circle. 20 How is an American Indian Support Circle different from another support circle? American Indian spiritual elders are invited into the Circle to guide members, council members, pray with members, and to share their understanding of the times. American Indian Cancer Support Circles Improve the Quality of Life for members Promote healing and wellness through the Medicine Wheel What Are Some of the Ways That the Circles Are Unique? Ranged from 4 to 12 (~2 hour) weekly sessions Tailored for Native cultures Spirituality incorporated throughout the sessions One of the few support programs that have been evaluated for effectiveness (both nationwide & multi-racial) Basics (food, typical agenda) 23 4

5 Developing the Circles Decide on Circle healthy snacks, beverages, arts, crafts, keynote speakers, etc. Questions: Why would you want to have food & beverages? And why healthy food/drink? How might arts & crafts be used during the Circle? Why would keynote speakers be beneficial? 25 Example of the Typical Agenda Opening Prayer and Welcome Pre-session learning Topic or Guest Speaker Personal stories/progress since last week Sharing Healthy snacks Laughter Tears Affection and support 26 Example of the Typical Agenda continued Support for one another in the Circle Personal Goals / Contracts Journaling Post-Session Learning Closing Prayer Organizing the Circle Agenda for Southern California: Typically one (3-hour) session per week Topic Discussion (20-45 minutes) Artwork (throughout unless sad or angry stories being shared) Sharing personal stories of grief, joy, humor and information (1 to 1-1/2 hours) Evaluations, contract, journaling (1/2 hour) Organizing the Circle Agenda for Denver: Typically one (1½-2 hour) session per week Ranged from 5 week sessions to 12-week sessions Topic Discussion (15 minutes) Sharing personal stories of grief, joy, humor and information (1 to 1-1/2 hours) What topics does the group want for the next session (10 minutes) Evaluations (10 minutes) 29 Components (parts) of the Circle 1. Facilitators Checklist 2. Facilitators Outline 3. Ground Rules 4. Circle Prayer 5. Personal Inventory List 6. Topics Relevant to your Circle 30 5

6 Components (parts) of the Circle 7. Keynote Speakers 8. Literature 9. Arts & Crafts 10. Interactions through games or tribal stories 11. Journaling with Natural Mediums (e.g. stones, beads, etc) 12. Advertising / Recruitment Facilitator s Checklists 31 Facilitator Qualifications You cannot make someone serve as the facilitator who does not want to do it Native American (survivor of family member of survivor preferred Compassion Integrity / honesty / trusted Commitment Want to work with Cancer Survivors / Thrivers and their Loved Ones Facilitators Checklist Materials to bring to each session: Matches Cedar, Sage and/or Corn Pollen Abalone Shell and a holder for the shell Healthy Foods and Drinks (e.g. fruits, vegetables, juices) Water Cups Small Plates Facilitators Checklist Materials to bring to each session continued: Napkins Eating Utensils (if applicable) Name Tents or Badges Tissue/Kleenex Arts & Crafts Supplies and Accessories Pens, Pencils, Notebook Paper Facilitator s Notebook Medicine Wheel Forms Personal Contracts 35 Facilitators Checklist Materials to bring to each session continued: Journal Paper (My Circle Journey) Copies of 3-hole punched Handouts for each participant for next session Referral Form for the National Native American Cancer Survivors Network Business Cards with Business Card Holder Additional items requested by participants 36 6

7 Personal Inventory List for My Loved Ones Personal Inventory List Birth Certificate Driver s License Social Security Card Tribal Card/Roll # Military Papers/Military Doctor Name/Phone Medicine Person Herbalist 38 Personal Inventory List for My Loved Ones (continued) List of Prescriptions and dosage Hospital Name/Location Spiritual Advisor/Clergy ****Other Important Information**** Vehicle Registration and Ownership Slip Medical Insurance/Card Personal Inventory List for My Loved Ones (continued) Life and Accident Insurance/Card Durable Power of Attorney for Health Care & Living Will Credit Cards Real Estate or Rental Papers Burial Papers Developing the Circle Ground Rules Set your Circle Ground Rules Question: What is the definition of a ground rule? 42 7

8 Ground Rules A Ground Rule is: A set of directions for conduct and processes throughout your Circle. Ground Rules refer to how participants should behave with one another during and after the support circle. Ground Rules Please form small groups of about 5 people each. Discuss possible ground rules that you would suggest for a support circle in your community. Groups will be asked to share their ideas and possible ground rules Ground Rules No one talks when someone else is talking. Whatever is said in the circle stays in the circle. No cussing or bad words used during the Circle. Examples of Cedar Circle s Ground Rules 1. Every session begins with the same Circle spiritual blessing or prayer. 2. Show respect for others...allow them to tell their story without interruptions. 3. Family members and loved ones are welcomed to the group 4. Positive supportive comments should take place while arts & crafts are being worked on (i.e., no negativity toward others or ourselves; spiritual pain could feed into our and others= artwork) Examples of Cedar Circle s Ground Rules 5. No Smoking in the building or during the Circles. 6. Nutritious foods & beverages only (i.e., fruits, vegetables, juices, occasionally sandwiches and other healthy snacks to promote health, healing and good tastes. Please do not bring sodas, burgers, fast-foods, etc. (Remind diabetics to watch their exchanges) 7. Circle participants, or their designee, determine whether or not to invite a speaker to stay for the rest of the Circle. 47 Organizing the Circles for Southern California: The first (2) sessions are open for anyone to attend. Session #3 and beyond is closed to new participants Newly diagnosed people are referred to one-on-one telephone counseling until the next Circle begins to insure bonding between the current Circle participants 48 8

9 Benefits/Drawbacks to Including New People Each Circle Session Some communities feel uneasy with not allowing new people into the Circle after Session #2. Question: Why do you think this may have been important to the Circle participants to do this? Benefits/Drawbacks to Including New People Each Circle Session Question: What do you think may happen if new people joined the Circle each Session? Based on discussion with Native survivors in your local Circles, you will need to decide whether or not you should allow new people to join in each week especially in smaller communities Opinion: Do you think your local Circles should be closed to allow for bonding and healing after the first few session? 1. No 2. Yes 3. Don t know / not sure Opinion: Do you think men and women should be in the same Circle? 1. No, they should have their own Circle (i.e., Men s Circle, Women s Circle) 2. Yes, they should be together EXCEPT when sexual or intimate issues are discussed 3. Yes, they should be together for ALL topics 4. Don t know / not sure 0 / / Opinion: Do you think family (or loved ones) who are the caregivers should take part in the Circles? 1. No, they should have their own Circle (i.e., Caregivers Circle) 2. Yes, they should be with the survivors EXCEPT when caregiver issues are discussed 3. Yes, they should be together for ALL topics 4. Don t know / not sure Benefits/Drawbacks to Including New People Each Circle Session Question: If your Circle participants want to keep the Circle private after the 2 nd session, how can your community provide support to someone who is newly diagnosed? Question: Will your Circle participants be willing to do this? 0 /

10 Benefits/Drawbacks to Including New People Each Circle Session Benefits/Drawbacks to Including New People Each Circle Session Those who do not have the opportunity to evolve in their recovery tend to not complete the healing process Terrie Restivo Question: If new people continue to join how will you help the group participants bond and move forward in their own recovery? Ground Rules: Groups Report 1. List local AIAN community rules here Prayer or Blessing to start and end all sessions Developing the Circles Create a prayer or a spiritual opening that is respectful to your local community Circle participants compose or write thoughts, feelings and drawings, or what they would want included in a prayer Excerpt from the Cedar Circle s Prayer Creator...thank you for bringing the women and men of the Circle back once more. Special prayers for all who were not able to make it here. Keep them safe in their travels and strong in heart. Special prayers that we remain in good heart and good mind throughout the session. Special prayers for the People of this land that they may continue in their quest to bring back their culture, their heritage, their traditions

11 Excerpt from the Cedar Circle s Prayer Special prayers that we can clear our minds, calm our hearts, strengthen our determination to work for the health of ourselves, Mother Earth and all of Her inhabitants. And, Creator, special prayers for patience to stop and listen to others; for the wisdom to understand them both inside and outside of our situations; for eyes to see around us the beauty and ugliness...and to take from that experience information to pass onto the next Circle. Excerpt from the Cedar Circle s Prayer Special prayers that we have the strength to accept the stories of experiences shared by the women or men here; strength to accept the reality of a situation...both real or imagined; and ears to listen to the stories and to hear the joy or sadness in them. Thank you, Creator, for each breath we take; for the air; the water; the rain; the sun; the win; all that are on Mother Earth; all that is Above and all that is Below. Thank you for another day of living Facilitator Outline ~ Session #1 Facilitator s Outline for Each Session OBJECTIVES: 1. Participants can briefly share their personal experience with cancer 2. Participants can identify unique characteristics of cancer in Native Americans 3. Participants can start the Circle opening prayer Facilitator Outline ~ Continued Facilitator Outline continued B. MATERIALS FACILITATOR needs to bring to this lesson, in addition to normal meeting supplies: 1. Notebook for each participant 2. Video tape machine and monitor 3. Video #1, #2, #6 4. Handouts: a) Seascape Referral Form & Consent Form b) Introduction to Native American Cancer Survivors / Thrivers Support Circles c) Circle Ground Rules

12 Facilitator Outline continued d) Personal Inventory List for Family & Other Loved Ones e) Personal Contract f) Circle Journal Paper g) Session Topics Ranking h) Medicine Wheel Evaluation Answer Sheet i) Blank paper and a pen or pencil for each participant (for note taking) 67 Facilitator Outline ~ continued C. AGENDA: 1. Blessing 2. Self-Introductions, including information such as a) Tribal Affiliation b) Are you a Survivor/Thriver, or are you a Loved One of a cancer patient c) Type of cancer & when diagnosed 68 Facilitator Outline ~ continued d) What you want to get from the Circles 3. The Native Survivors Support Circles [Distribute Notebooks with Intro Section included] a) Introduction (see program hand-out) Facilitator Outline ~ continued b) Review Topics 1) Topic Survey is for participants to rank thetopics of Interest 2) Participants may write in additional Topics of Interest 3) The first two (2) sessions of the Circle are open to anyone, but will be closed from Session #3 on Facilitator Outline ~ continued c) Review the format for each session (see handout) d) Review the Circle Ground Rules. Ask for revisions and/or other changes. (see handout) 71 Facilitator Outline ~ continued 4. Ranking of Discussion Topics a. Ask the participants to complete the ranking of Topics of Interest to them and remind them they can add new items to the list. b. Collect those forms at the end of the session. New items added to the list will be shared with all participants of the group to determine if they are topics of high interest

13 Facilitator Outline ~ continued 5. *Sharing Stories (ask for volunteer/s who is/are willing to share his/her experiences) *Keep this time approx 1 hour* 6. Personal Contract for next session ~ Each participant identifies at least one thing s/he will do between tonight and the next session that is focused to HER/HIS needs. 73 Facilitator Outline ~ continued 7. Distribute Handouts for next session: which will be Dietary Concerns [you will finish Dietary Concerns ~ Traditional Food Session 10] 8. Evaluation ~ Using the Medicine Wheel Answer Sheet, ask participants to respond to questions 9. Closing Prayer 74 Sample Topic List Examples of Topics and Handouts from NACR Survivor Support Circles 75 Dietary Concerns Chemotherapy Radiation Therapy Surgery Pain Control Intimacy and Sexuality Outlook on Life 76 Dorcas Bloom Siberian Yupik Dx 1998 Breast Cancer had really changed my life around for the betterment

14 IHS Age-adjusted Malignant Neoplasm Death Rates 79 IHS Trends, 1999, Chart 4.33, p AI/AN cancer rates for all cancers, by region, both sexes, compared to US all race rates, Alaska US N. Plains East P. Coast Southwest Special thanks to David Espey, AI Cancer MD Support and Circles Roberta Paisano, MHSA, IHS 81 National Epidemiology Program Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research 14

15 Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Haverkamp D, Espey D, Paisano R, Cobb N., Cancer Mortality among AIAN: Regional Differences, , IHS, Rockville, MD

16 Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) Excerpt from Spiritual Healing George Hogan III Crow Diagnosed: 1992 lung cancer Oh, my spiritual life. I do a lot of spiritual work before my cancer and even after I had the surgery, I kept on with my spiritual work with the church, and it takes me along and helps me, and I look at it in a positive way. Spiritually I didn't have nothing to worry about, because I still have my life in the hands of God, go on living. Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) 96 16

17 Excerpt from Healing / Spirituality / Recovery -- All Cancer Sites Native American Cancer Survivors Stories about Healing Katherine Big Hail Crow Dx 1993 Breast [translated by daughter]... a lot of people were praying for her and she was in prayer and she even had a dream, a vision that the Lord showed her that she was already healed you know. While she, this happened while she was still real sick and uh and then uh once she seen this vision or dream and then she said well I know I m gonna be all-right. She said to the other cancer patients, people that have cancer, she said if you re willing to get healed she said you re gonna get healed. Even from the help of your doctor, pray for your doctor, you know, work with him, like work with your doctor. (Native tongue) Ya, and then she said just go ahead with the treatment they re helping you too so work with them, work with the doctor Excerpt from Personal Reaction to Cancer Bonnie Heavy Runner Craig Blackfoot Diagnosed: 1991 ovarian cancer It was just an amazing experience to sit there and be totally alert, feel good, and have a doctor tell you that that you can't see because it came over the phone. How can this be? Why is this happening to me? What do we do? Excerpt from Personal Reaction to Cancer Abe Conklin Ponca-Osage Diagnosed: 1987 prostate cancer When you first hear about it, to me it was kind of a scary situation, because I never did ever believe that I would ever come to the point where I would have cancer. It kind of put fear into me. I knew then that I should have gone earlier Excerpt from Personal Reaction to Cancer Sarah S. Allman Oglala Sioux Diagnosed: 1970 cervix cancer I thought it was a killer, you know. I was always so scared of that word cancer

18 Excerpt from Dietary Control during and following Treatment Angela Russell Crow Diagnosed: 1987 breast cancer I changed my diet, I didn't eat red meat. I cut out all kinds of fats, didn't use chocolate or eat fruits that weren't grown in this climate, a very strict regiment. No coffee, so I tried to stick with that for the full year, half of that year of course I was on chemo, I think that made a difference to my body Frank Mercer Tlinqit-Raven Clan Diagnosed: 1992 colon cancer Excerpt from Chemotherapy Well, I don't think I got really used to it, but it didn't bother me that much. I think the only discomfort I had from chemotherapy was when they.. inserted a needle but as time went on, I got a little sensitive, but I got kind of used to it some cases like my colon cancer, since it was caught in time, it is preventive measures that I went through that therapy. It was just to make sure there was no more cancer cells left in my system so, that is why on early detection, because the quicker they find the cancer in your body and isolate it, the less time you will spend in treatment. Like with me, I spent a little over a year, about 14 months, of chemotherapy. It didn't affect me that much. 105 Excerpt from Chemotherapy -- All Cancer Sites Native American Cancer Survivors Stories Jennie R. Joe Navajo Diagnosed: 1988 breast cancer Chemotherapy consisted of probably three different types of drugs. My treatment took almost a year, because with chemotherapy, they always give you time for your body to re build your blood cells, so I think you know the treatment isn't something that you can go in and have it done within two or three days. My particular cancer had spread through my lymph nodes at least one of them was positive, so I didn't have a choice, I had to have the chemotherapy. 106 Inactive Activity: Which topics do you feel are of most interest or need for local Native survivors? 1.In groups, please discuss which of the following topics you think your local community may want to have included 2.What additional topics do you feel need to be added to be of most relevance to your survivors community? 107 Examples of Session Topics Interactive Activity Dietary Concerns Benefits of Breast/Body Self-exams Chemotherapy Radiation Therapy Hormonal Therapy Surgery

19 Examples of Session Topics continued Pain Control Economic Issues Benefits of Physical Therapy Intimacy and Sexuality Outlook on Life Examples of Session Topics continued Emotional Purging Follow-up Care Managing Home & Family During Care Incorporating Traditional Healing with Modern Medicine Closing Ceremony & Celebration Advertising & Recruitment Recruitment Strategies for NACR Survivor Support Circles How would you let people know about your upcoming Circles? Question: What tribal or Health Board approvals do you need to have in place before you advertise or recruit to your Circles? How do patients learn about the support circle? How do patients learn about the support circle? Circle Members invite others who have or have had cancer. Doctors and clinics who provide care for American Indian cancer patients refer circle members. Organizations, both Indian and non- Indian, refer individuals to the Circle. Family members of cancer survivors are also invited to join in the meeting

20 Advertising the California Circle: An example Fliers posted in the market Exhibit booth during Pow Wows and Health fairs Information in community newsletter Visit elder s weekly craft gatherings to share information Recruitment of Survivors NACR Website Native Wellness Conferences Community News Medical Center/Doctor/Clinic/I.H.S. Word of Mouth ( Moccasin Telegraph ) Telephone Inactive Activity: For your local Native community, what strategies do you are most likely to spread the word about your Circles? 1. In small groups of about 5 people, please brain storm an additional survivors recruitment strategy that would be acceptable to your community. Personal Contracts 2. Now, identify an additional way to advertise the existence of these Circles My Circle Journey Interactive Activity Write thoughts, feelings, poems Draw, cut or paste pictures Compose a song Group art using stones, shells, beads Personal Health Contract (Weekly Activity) Focus on his / her needs at least 15 minutes per week American Indian people always take care of their community / family before themselves Contract is between the participant and his or her God / Creator Contract is a weekly commitment

21 Weaving a Healthy Life Survivors Contract I,, do hereby promise my God/Creator that I will take 15 minutes strictly for myself this next week; I will take a few minutes to watch a butterfly dance or listen to the beautiful songs of a bird, or look up and see the stars looking down on me. Tips for Successful Circles Tips for Successful Circles Tips for Successful Circles Begin each session with a prayer or silent time for members. Allow members to share their experiences during the week. Hold sessions at times that are convenient for members, for example evenings, weekends. Be flexible with the topics and modify agenda as the needs of the members demand. Survey members to see which topics they want to cover and in what order. 123 Have tissues handy for members. Help to lighten the mood when necessary. 124 Tips for Successful Circles Tips for Successful Circles Have healthy and appropriate food available for meetings. Encourage circle members to establish rules for interaction and to follow them. Utilize the Medicine Wheel to address the physical, mental, emotional and spiritual aspects of life and survival. Hold meetings in a private, safe place. 125 Be patient. Successful Circles take time to establish (Sometimes even a year or more.) Be persistent. Set meeting dates, hold meetings, even if only one person comes. And do it again and again. People will come

22 Tips for Successful Circles Keep the size of Circles reasonable members is a good number for interaction and trust. NACR has had groups as small as 2 people. Local Artists Donate Artwork A superb way you can acknowledge your local talent is to seek artists from your community that will donate their artwork to your Circles Remember to list your artists in your print materials Evaluation Conclusion Medicine Wheel evaluations (pre and post-session questions used during development of the Circles) Overall session evaluations (every 4 sessions) Recommend these still be used The hardest work in holding Support Circles is that they are hard to keep Continuing the Circle Question: If or when you have this challenge, what are 3 things you can do to increase the likelihood of the group succeeding? Thank you very much