Cultural roles of native patient navigators for american Indian cancer patients.

Abstract

The purpose of this opinion article is to clarify cultural roles Native Patient Navigators (NPNs) perform in providing cancer support. NPNs, who are American Indian (AI), provide many unique services to indigenous patients who are undergoing treatment (radiation, chemotherapy, surgery, adjuvant therapy) for cancer. AIs experiences of cancer often are complex, requiring a team that not only provides comprehensive, quality cancer care, but also provides care that incorporates cultural norms and beliefs. NPNs are an essential component of AI cancer patients’ recovery and healing. American Indians in the USA have distinct and significant geographic rates of cancer incidence and mortality, whereas White rates remain homogeneous (1–5). Indigenous people living in Alaska and the Northern (e.g., ND, SD, NE, WI, MT, MI) and Southern Plains (e.g., OK, TX, KS) typically have elevated age-adjusted cancer incidence and mortality rates. The substantial progress in reducing cancer death rates experienced by Whites over the past two decades has not been experienced by AIs (6); cancer mortality rates remain the same or more commonly are increased from previous data (1–5). AIs continue to have the poorest 5-year relative survival from cancer in comparison to all other ethnic and minority groups in the US (66.7% for non-Hispanic Whites vs. 59.0% for AIs) (7, 8). Anecdotal data from Canadian First Nations or Aboriginals, New Zealand Maoris, and Australian Aboriginals report similar geographic variability in their respective countries. According to Harold Freeman, MD, the “father” of patient navigation, navigators guide patients through and around barriers in the complex health care system, to help ensure timely diagnosis and treatment (9) of cancer and other illnesses. However, the term “navigator” has varied meanings within healthcare systems, resulting in some confusion. As an example, the federal Affordable Care Act (H.R. 3590) (10) refers to navigators as trained individuals who “establish relationships with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be qualified to enroll in a qualified health plan” (11). Thus, under the Act, a navigator functions mainly as an insurance broker rather than one who helps patients overcome barriers to accessing and using a specific healthcare system or treatment plan/program. Within many settings, Community Health Workers, who are culturally, well-respected members of underserved populations, help bring these community members to the doors of the clinic or healthcare facility. NPNs function similarly to Community Health Workers; however, they cross the threshold of the clinic and continue providing cultural support within clinical departments (i.e., they cross boundaries). NPNs are familiar with varying tribal beliefs about health and illness and can establish a rapport and trust with patients that allow them to share their fears and spiritual practices necessary to achieve health and healing. NPNs provide services and support that are unlikely to be addressed by other hospital staff and they need to be paid lay professional positions. Ideally, the NPN and the hospital collaborate to provide the optimal healing environment for the AI patients.