How community-based participatory outreach, education and research impacts American Indian breast cancer programs to address inequities

The majority of US public health professionals erroneously believe that American Indians have access to quality, comprehensive healthcare system. However, due to historical events that shaped Indian Health Service (IHS) and the continued underfunding of IHS by US Congress, this healthcare system is incredibly fragmented, particularly when dealing with a serious, chronic disease, like cancer. More than 400 American Indians who take part in the "Native American Cancer Education for Survivors" (NACES) program self-report multiple issues accessing health care programs. For example, although 55% of these participants live on Reservations, less than 15% use Indian Health Service to access cancer screening, diagnostic, treatment or supportive care services. More than half report significant problems accessing services and more than half continue to experience healthcare issues during their cancer care. NACES uses trained Native Patient Navigators (formerly called “Patient Advocates” or “Native Sisters”) to work with American Indian cancer survivors locally and nationally to address health inequities and cancer-related health issues (e.g., long-term side effects and late effects of cancer or cancer treatment). The Native Patient Navigators work in person with American Indian cancer patients to collect quality of life surveys that address psychosocial measures and access issues, and help the patients with the assistance of an online supportive care education and resource program. Through the assistance of the NACES website and Native Patient Navigators, many cancer-related health issues and healthcare system inequities are successfully addressed.