Cancer Prevention in Diverse Populations: Cultural Implications for the Multidisciplinary Team

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Preface

The first edition of this book was based on a series of federally funded grants for ethnically and culturally diverse nurses. These grants would not have been possible without the assistance of Barnie Lepovetsky, PhD, JD, of the National Cancer Institute (NCI).

In the early 1980s, Dr. Lepovetsky met with several nurses in leadership positions in the Oncology Nursing Society (ONS) and urged them to write a training grant to promote the education of minority nurses on cancer prevention and detection. As the result of Dr. Lepovetsky's support, Marilyn Frank-Stromborg, EdD, JD, FAAN, Judi Johnson, RN, PhD, and Ruth McCorkle, RN, PhD, wrote a relatively small grant proposal for a one-day workshop on cancer prevention for 30 African American nurses, to be held the day before the start of the 1985 ONS Annual Congress in Houston, TX.

At the time, few African American nurses traditionally attended the annual ONS Congresses, so the investigators were apprehensive about whether enough nurses would apply to fill this small workshop. The tremendous response to the call for applications-more than 500 African American nurses applied-quickly dispelled any doubts. The investigators were impressed with these nurses' commitment to improving the health of people of color and with their involvement in community activities. In unsolicited comments, the applicants poignantly documented the need for cancer prevention/screening programs in their communities. They also recognized their need for greater knowledge and skills in conducting cancer prevention activities.

The 560 applicants, hailing from 40 states, Canada, Puerto Rico, and Germany, represented all nursing specialties. Many regularly provided health care to African Americans in food pantries, low-income housing projects, homeless shelters, churches, public health departments, jails and federal correction facilities, hospitals, clinics, physicians' offices, family planning programs, inner-city high schools, community organizations in remote rural areas, and the military.

Selecting just 30 participants from this stellar pool was a formidable task. The culmination of this process was a workshop involving 30 outstanding, socially committed African American nurse clinicians who also were leaders of African American nursing organizations and sororities in this country.

To evaluate the success of this type of educational intervention, workshop developers tested participants before and after the workshop in three areas. Improvement was observed in knowledge and attitudes about cancer prevention and early detection, and participation in community-based cancer prevention and early detection activities increased.

In response to feedback from workshop participants and encouragement from Dr. Lepovetsky, Dr. Frank-Stromborg designed a grant for a series of five regional two-day workshops for African American nurses. Claudette Varricchio, RN, DNS, was the co-project director on this grant. NCI funded the grant (1T14CA90554001) from 1986 to 1988. For each workshop, 30 African American nurses were recruited.

Material from the initial workshop was expanded, and content concerning planning community-based programs was added. Faculty for this series of regional workshops primarily consisted of prior attendees of the 1985 workshop. Each had a strong interest in oncology and was actively involved in community-based prevention programs. Diverse geographical representation enabled ONS to hold regional workshops.

The ONS National Office received more than 1,200 requests for applications for the two-day courses. By the entry deadline, ONS had received and processed 744 applications. Applicants hailed from 40 states, Puerto Rico, and the Virgin Islands. Eighty applicants were chosen for each regional workshop and then assigned to one of two groups: one that actually attended the workshop or one that served as a matched control group for purposes of evaluating the success of the workshops. Once the workshops were over, the project directors used a cross-sectional, repeated measures design to test the two groups for knowledge of and attitudes about cancer prevention and involvement in community-based cancer prevention activities.

The investigators were able to conclude that 1. The workshops significantly increased participants' knowledge about cancer prevention/early detection as measured by the Cancer Prevention/Early Detection Cognitive Test. 2. Participants increased their involvement in cancer prevention/early detection activities to a greater extent than did nonparticipants as measured by the Cancer Prevention/Early Detection Activities Survey. 3. Workshop participants' attitudes about cancer were more positive than the attitudes of nonparticipants.

Sandra Millon Underwood, PhD, RN, FAAN, ultimately assumed responsibility for continuation of these grants in 1991 and received funding from NCI for a series of similar workshops for nurses working with African Americans. Based on the educational model used successfully with African American nurses, Frank-Stromborg and coinvestigator Sharon J. Olsen, MS, RN, AOCN^®, obtained a new grant from NCI (5R25CA09554-03) to offer a series of regional workshops for 180 nurses working with Hispanic, Asian American, and Native American populations. The response was as strong as it had been for the previous African American nurses workshops: 218 Hispanic nurses, 131 Native American nurses, and 73 Asian American nurses aplied.

The following statement from an applicant typifies reasons for wanting to attend the course: "It has been my experience, especially in the Native American populations, that though the cancer rate is apparently low, when people finally are diagnosed, the cancer is already quite advanced and often beyond cure. I need ideas for how to make this population more aware of symptoms and less afraid to come in for examinations or screenings, plus I want to hone my own skills in early cancer detection." -Family Nurse Practitioner, U.S. Public Health Service, Red Lake IHS Hospital.

Before beginning the regional workshops, an extended three-day workshop was held. Ten stellar applicants for each of the three ethnic groups were selected to attend. Culturally specific seminars were presented during the first two days; on the third day, three culturally specific focus group interview sessions were held. Study questions and work assignments previously sent to the participants allowed them to prepare to share information about the unique health beliefs and practices of their ethnic group and how these influenced cancer prevention and early detection. Participants also were asked to bring and share patient-education materials designed specifically for the ethnic groups with whom they worked. The focus groups generated information on health beliefs, medical practices, physical factors, and psychosocial issues to consider when assessing cancer risk and health status. Sessions were tape-recorded and transcribed. The faculty for each of the five subsequent regional workshops used the information gained from this three-day workshop and actively sought additional input from their participants. The result was a large body of practical, practice-oriented, culturally sensitive information concerning Native Americans, Alaska Natives, Hispanics, and Asians and Pacific Islanders.

In the first edition of the book, the chapters on Asian Americans, Hispanics, and Native Americans contained much of the information that emerged from the focus groups and ensuing regional workshops. Each chapter was based not only on academic sources but also on focus group and clinician information provided by members of the particular ethnic group. Participants in the focus group interview sessions reviewed each chapter. The book was unique in terms of the information it provided on each racial/ethnic group. Federal funding enabled the editors and each author to generate a comprehensive and geographically representative book. The extensive reviews by ethnic nurses from across the United States helped to ensure that the information in each chapter was culturally relevant, timely, and of practical assistance to healthcare professionals working with members of the Native American/Alaska Native, Hispanic, Asian/Pacific Islander, Native Hawaiian, and African American cultures.

The first edition of the book got positive reviews and was well-received by all segments of the nursing profession. It was acknowledged to be a landmark contribution to the nursing literature in terms of translating the qualitative data gathered from intensive focus groups into practical, clinically relevant information that all nurses could use in their own clinical setting. The success of the first edition supported updating and writing a second edition. As with the first edition, the goal is to provide comprehensive, culturally relevant, and practical information for healthcare professionals. Each chapter has been rewritten and expanded by many of the original contributors and reviewed by an expert oncology nurse of the chapter's ethnic/racial group. The expert was asked to evaluate the chapter in terms of cultural correctness and completeness. After revisions, a nationally recognized healthcare professional from each chapter's ethnic/racial group contributed the chapter's foreword.

It is hoped that the information in this second edition is clinically useful for all healthcare professionals dedicated to the provision of culturally relevant cancer prevention and early detection for men and women of minority populations.

Marilyn Frank-Stromborg, EdD, JD, FAAN