The experience of treatment barriers and their influence on quality of life in American Indian/Alaska Native breast cancer survivors.

BACKGROUND: American Indian and Alaska Native (AI/AN) breast cancer survivors experience disparities in breast cancer incidence and age-adjusted mortality compared with non-Hispanic white (NHW) breast cancer survivors. In addition, mortality-to-incidence rates indicate that AI/ANs continue to have the poorest survival from breast cancer compared with other racial groups. "Native American Cancer Education for Survivors" (NACES) is a cultural education and support intervention for AI/AN patients with cancer that collects data from voluntary participants through the NACES quality-of-life (QOL) survey regarding their cancer experience and survivor journey. METHODS: Data from the NACES QOL survey were analyzed to determine whether barriers accessing and during initial cancer treatment impacted QOL domains for AI/AN cancer survivors. Exploratory analyses of selected variables were conducted and were followed by Kruskal-Wallis tests to determine whether these barriers influenced survivorship QOL for AI/AN breast cancer survivors. RESULTS: AI/AN breast cancer survivors' social QOL was significantly affected by barriers to accessing cancer treatment. Many respondents experienced barriers, including a lack of cancer care at local clinics and the distance traveled to receive cancer care. During treatment, too much paperwork and having to wait too long in the clinic for cancer care were the most frequently reported barriers. CONCLUSIONS: Treatment barriers influence AI/AN breast cancer survivors' social QOL. Mediating these barriers is crucial to ameliorating AI/AN survivors' disparities when accessing and completing cancer treatment and improving survivorship QOL. Cancer 2017;123:861-68. © 2016 American Cancer Society.

One Shot-One Kill: a culturally sensitive program for the warrior culture.

Despite efforts to reduce the stigma of mental health services across branches of the United States military, lasting change among this warrior culture remains an uphill battle. Difficulty affecting change can be attributed in part to stigma associated with psychological services and largely, mental health providers' difficulty tailoring traditional models of treatment to military personnel. We will discuss the development of One Shot - One Kill (OSOK), a culturally sensitive mental health prevention program piloted to reduce stigma and improve help seeking behaviors among the warrior culture. Three hundred and twenty military members completed the OSOK performance enhancement and resiliency program piloted at Tallil, Iraq in 2008. Pilot data were collected to assess military members' perceptions of the training program. Results indicated positive responses demonstrating the OSOK program as a culturally sound program that could increase help seeking behaviors among military members.