Academic journal article Social Work

Development of a Family Intervention for Native Hawaiian Women with Cancer: A Pilot Study

Academic journal article Social Work

Development of a Family Intervention for Native Hawaiian Women with Cancer: A Pilot Study

Article excerpt

Although cancer is the second leading cause of death in the United States (American Cancer Society [ACS], 2004), there have been notable reductions in deaths associated with this disease. In the 1930s, less than 20 percent of cancer patients were living five years after their treatment (ACS, 2003-2004). Today, however, improvements in the treatment of cancer have allowed more people to survive this devastating disease. Approximately 62 percent of cancer survivors are expected to live at least five years after their diagnosis (ACS, 2003), and it is projected that the number of survivors will increase steadily over the coming years (Centers for Disease Control and Prevention and Lance Armstrong Foundation [CDC & LAF], 2004).

Despite the decline in deaths from cancer, some groups have not fully benefited from the advances in medical technology and treatment. One such group is Native Hawaiians, a group indigenous to the islands of Hawai'i. Native Hawaiian women's health disparities are evidenced by their high cancer rates and low survival rates. In the state of Hawai'i, Native Hawaiian women, when compared with other ethnic and racial groups, have the highest death rates for all cancers combined (Tsark, 1998) and, in particular, are diagnosed at significantly younger ages and later stages for breast cancer (Braun, Fong, Gotay, Pagano, & Chong, 2005). When compared with other ethnic and racial groups in the United States, they have the second highest mortality rates for all cancers combined (Tsark, 1998). Their five-year survival rate from 1990 to 1995 was 53 percent (Tsark, 1998).

Numerous factors contribute to these rates for Native Hawaiians, including late detection and diagnoses at more advanced stages, high prevalence of behavioral risk factors, and genetic markers of tumor aggressiveness (Braun et al., 2005). However, one factor receiving increasing attention relates to the lack of culturally appropriate interventions, particularly those that focus on the family (Ka'opua, Gotay, Hannum, & Bunghanoy, 2005).

Native Hawaiian women, as with other women, typically experience their cancer in the context of their families. There is a growing body of literature that documents the effects of cancer not only on the patient, but also on the entire family (Baider, Cooper, & De-Nour, 2000;Veach, Nicholas, & Barton, 2002). The importance of family in dealing with cancer has led the National Cancer Institute to expand its definition of "cancer survivor" to include caregivers and family members as well as the person diagnosed with cancer (CDC & LAF, 2004).

The inclusion of the family in "survivorship" and the subsequent need to explore family support as a resource in dealing with cancer are of vital importance. Evidence demonstrates that family support as a resource can help the cancer patient cope with the illness and, in the best circumstances, reinforce the patient's efforts to stay healthy (Bloom, 2000; Keller, Henrich, Sellschopp, & Beutel, 1996; Lichtman & Taylor, 1986). The types of support that can be rendered by families include informational, tangible, and emotional support. Informational support refers to the provision of knowledge relevant to the cancer experience. Tangible support refers to specific assistance that others may provide to the cancer patient, such as child care and transportation to a medical appointment. Emotional support is the demonstration of caring and reassuring thoughts and behaviors. The body of literature on family support, unfortunately, excludes an examination of special populations such as Native Hawaiians.

NATIVE HAWAIIANS

As in other ethnic groups (Bloom, 2000; Keller et al., 1996), family ('ohana in the Hawaiian language) is a primary resource for Native Hawaiians who experience cancer. Consistent with the general literature, focus groups with Native Hawaiian female cancer patients and their 'ohana identified three key needs--easy access to information, tangible assistance with physical care, and emotional attention (Braun, Mokuau, Hunt, Ka'anoi, & Gotay, 2002). …

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