(Washington State Department of Health’s BCHP & the Hutchinson Center’s Pacific NW Cancer Information Service)
A funding arrangement between the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) supports a 3-year demonstration project from October 1995 through 1998 in Washington State. The project's goal is to increase breast and cervical cancer screening and access to information on state-of-the-art diagnosis and treatment for low-income and minority women over fifty. This project is one of four CDC/NCI projects pairing CIS offices and Health Departments in the U.S. to assist the larger national effort, funded by CDC, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Each of the four projects has a different focus. Our project has two parts. One part integrates research on health information and behavior change in Native American tribes. The other part uses emerging technology to facilitate strategic discussion and provide access to state-of-the-art information on screening, diagnosis, and treatment for shared decision-support by health care providers, outreach workers, and low-income clients. Project staff reports jointly to directors of the Cancer Control Program of the Washington State Department of Health (WDOH), and of the PNW Cancer Information Service (PNWCIS). Staff are housed at the Fred Hutchinson Cancer Research Center in Seattle, the PNWCIS local sponsor.
This project blends the strengths of the Department of Health and the PNWCIS. The WDOH has contractual arrangements with, and intimate knowledge of, rural and underserved populations and their providers in their Breast & Cervical Health Program (BCHP) . The PNWCIS, with its 1-800-4-CANCER toll-free line, outreach, and research programs, has links to NCI technology and information and long-standing relationships with Native Americans. The PNWCIS’s parent institution, the Fred Hutchinson Cancer Research Center, has technology expertise and facilities (server, LAN), particularly for work on the Internet’s World Wide Web. Evaluation is conducted by the Survey Research Lab at the University of Chicago for process (assessing barriers and partnerships through data, site visits, and case studies), and for outcome (assessing effects of the educational initiatives and the integration of access to resources into the service delivery systems.) Partnerships are key for leveraging modest resources. The Indian tribes expanded in the 2nd year to include a consortium of 15+ tribes, and the initial 2 county health departments expanded to include interested parties from around the state. Two national projects with state presences at the University of Washington, the National Library of Medicine’s Regional Medical Library and the CDC’s INPHO project, provide Internet training to tribes and health departments and provide links to the growing health department infrastructure of Internet-linked computer networks and content/training programs. Other partners, private, non-profit, and academic, are being explored for further infrastructure links and new features, such as CD-ROM/Web interfaces, intelligent agents and push technology.
The Native American intervention builds on grounded field theory research done since 1988 by the PNWCIS Special Populations Liaison, June Strickland, Ph.D. (in combination with researchers at the University of Washington), as well as on focus groups conducted by the WDOH. Research revealed barriers to information and care and characteristics of provider/patient relationships. It concluded that interventions must focus on "staying healthy" rather than "avoiding illness,", emphasize self-care as motivated by regard for the community, not the individual, and show respect for ceremonial healing and the use of traditional Indian approaches. Strategies include direct outreach activities with tribes (such as health fairs and elder teas), BCHP outreach worker training, professional education and cultural sensitivity training for providers and staff on the BCHP program, partnership meetings with 15+ tribes involved with BCHP, and, in the 2nd and 3rd years, linking tribes with Internet information, training, and computer funding sources, and recommending and developing website materials and links.
The Technology intervention has the promise of addressing the "techno-gap" between the "haves" and the "have nots", building on the secular trend of exploding Internet use, and cultivating the resources of the empowered consumer - an often overlooked factor in health care cost containment - to change screening, diagnostic, and treatment patterns in underserved and rural areas. In the first three months, we moved from developing a spectrum of technology to focusing solely on the World Wide Web. The design of the emerging website at http://www.fhcrc.org/~bchp/cdc.htm, is determined by survey data and continual user feedback. It provides rich resources for shared decision-support in screening, detection, and treatment. Resources include highly pragmatic features such as eligibility criteria, patient/provider education, clinic street maps, and links to resources such as the PNWCIS, and NCI’s PDQ treatment database website. Multimedia features are being added to address literacy and cultural issues. Audiences are BCHP staff, outreach workers, and providers, and, now, clients/patients.
In summary, this project seeks to incorporate research-based interventions to help Native American partners address their screening needs, and to use emerging technology to empower underserved consumers, providers, and outreach workers in shared decision-support. *********************************************************
contacts:
Co-Directors:
Kelly K. Shaw, MPH,
Dir, Cancer Control Programs, WDOH,
PH: 360/586-8627
FX: 360/664-2619
EM: kks0303@hub.doh.wa.gov
Jean Wooldridge,
Prog.Dir., PNWCIS
PH: 206/667-4682
FX: 206/667-7792
E-M: jwooldri@fhcrc.org
Amer. Indian Outreach Coordinators:
Deb Everson,RN,MN,Penny Brewer, MN
PH:206/667-5471 FX:206/667-7792
EM: deverson@fhcrc.org EM: penbrewer@aol.com
Technology Outreach Coordinator:
Nigel Bush, PhD
PH: 206/667-5688
FX: 206/667-7792
EM: nbush@fhcrc.org
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Last updated on June 26, 2003
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