These results indicate that the primary problem with accrual is not the attitudes of patients, but rather that the loss of potential participants is the result of the unavailability of an appropriate clinical trial and the disqualification of large numbers of patients. The pool of willing patients is further reduced by the reluctance of some physicians to engage in accrual.

This information provides insight into the complex survivorship relationships between QOL and sequelae of cervical cancer for women diagnosed during childbearing years. Therefore, it is important for health care professionals to recognize that aspects of cancer survivorship continue to require attention and possible follow-up care.

Medically underserved women in the Greater Denver Metropolitan Area had low rates of routine repeat mammograms in the latter 1990s. “Increasing Mammography Adherence among Medically Underserved Women” was designed to increase annual rescreening among medically underserved populations living in this area. Four community-based organizations collaborated to implement this 5-year study. A culturally modified navigator model including both face-to-face and telephone formats was used to facilitate mammography for African Americans, Latinas, Native Americans, and poor White women who had not been rescreened in more than 18 months. The navigator-implemented intervention was statistically significant at the 0.05 level for increasing rescreening.

Native Navigators and the Cancer Continuum (NNACC) was a community based participatory research study among Native American Cancer Research Corporation, CO; Inter-Tribal Council of Michigan, MI; Rapid City Regional Hospital's Walking Forward, SD; Great Plains Tribal Chairman's' Health Board, SD; and Muscogee (Creek) Nation, OK. The project goal was to collaborate, refine, expand and adapt navigator/community education programs to address American Indian communities' and patients' needs across the continuum of cancer care (prevention through end-of-life). The intervention consisted of 4 to 6 site-specific education workshop series at all 5 sites. Each series encompassed 24 hours of community education. The Social Ecology Theory guided intervention development; community members from each site helped refine education materials. Following extensive education, Native Patient Navigators (NPNs) implemented the workshops, referred participants to cancer screenings, helped participants access local programs and resources and assisted those with cancer to access quality cancer care in a timely manner. The intervention was highly successful; 1,964 community participants took part. Participants were primarily American Indians (83%), female (70%) and between 18 and 95 years of age. The education programs increased community knowledge by 28%, facilitated referral to local services, and, through site-specific navigation services, improved access to care for 77 participants diagnosed with cancer during the intervention. Approximately 90% of participants evaluated workshop content as useful and 92.3% said they would recommend the workshop to others. The intervention successfully increased community members' knowledge and raised the visibility of the NPNs in all 5 sites.

Objective To identify the role of patient navigation in decreasing healthcare disparities through an exemplar of a successful patient navigation program for American Indian populations living in the Northern and Southern Plains of the US. Data Sources Published literature and data from the Native Navigators and the Cancer Continuum study. Conclusion Native Patient Navigators successfully collaborated with local American Indian organizations to provide cancer education through a series of 24-hour workshops. These workshops increased community knowledge about cancer, influenced cancer screening behaviors and increased the visibility and availability of the navigators to provide navigation services. Implications for nursing practice Reaching those with healthcare disparities requires multiple strategies. Collaborating with patient navigators who are embedded within and trusted by their communities helps to bridge the gap between patients and providers, increases adherence to care recommendations and improves quality of life and survival.

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These themes are a reminder for health care professionals to spend time looking at, listening to and trying to understand how cancer and its treatments affect the everyday lives of people and families we treat and how this should guide our overall management plan. They teach us the importance of taking time to listen to the stories, responding to the cultural needs of every patient and family member and honoring teach the cancer journeys of all people.

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