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Purpose/Objectives: To obtain experiential data regarding
African American older adult survivors’ perceptions of and
recommendations on the role of community health workers
(CHWs) in providing a cancer navigation intervention.
Research?Approach: Focus groups.
Setting:?Rural Virginia and urban Maryland.
Participants:?48 African American solid-tumor cancer survi-
vors, aged 65 years or older, with Medicare insurance.
Methodologic?Approach: Analysis was accomplished
through a reflexive process of transcript review, categoriza-
tion, and interpretation.
Findings: Themes and accompanying categories identified
were uneasiness surrounding the CHW role (disconnect
between identified support needs and CHW role, essential
CHW characteristics, and potential application of CHWs),
recommendations to adequately address cancer needs (co-
ordinating cancer treatment and unmet needs during cancer),
and the importance of individualized interventions. Partici-
pants provided specific recommendations regarding the role
of the CHW and how to develop supportive interventions.
Conclusions: Study participants had surprisingly limited prior
exposure to the CHW role. However, they stated that, in cer-
tain circumstances, CHWs could effectively assist older adult
African Americans undergoing cancer diagnosis or treatment.
Interpretation: Study findings can be helpful to researchers
and to healthcare providers engaged in assisting older Afri-
can Americans during cancer diagnosis and treatment. The
results lay a foundation for developing culturally appropriate
interventions to assist this at-risk population.
families, and caregivers (Chang et al., 2004; Halbert et
al., 2002). The risk for poor outcomes is additive in the
presence of comorbidities and decreased economic, psy-
chological, and social resources (Aday, Begley, Lairson, &
Slater, 1998), in addition to aging (Schneider, Zaslavsky,
& Epstein, 2002). In fact, cancer-related disparities are
projected to notably worsen among ethnic minorities
and older adults (Smith, Smith, Hurria, Hortobagyi, &
Cancer outcomes are unequally distributed across
racial and ethnic groups, with minorities experienc-
ing worse outcomes, particularly in overall survival
(American Cancer Society, 2010; Hayes & Smedley,
2004; Ries et al., 2005). Cancer generally occurs later in
life, with more than half of cancer diagnoses occurring
among individuals aged 55 years or older (American
Cancer Society, 2010), thus increasing the vulnerability
of older African Americans. African American older
adults enrolled in Medicare are more likely to report
poor health than their Caucasian counterparts (42%
versus 25%) and are much less likely to have supple-
mental insurance (Chang et al., 2004).
Several groups (Brandeis University, 2003; Institute
of Medicine, 2002) have recommended employing
community health workers (CHWs) to help eliminate
disparities. CHWs have been described as serving in
areas of community outreach and follow-up by helping
patients to access health-related services. They also have
revious studies have shown that African
Americans may experience more barriers to
quality cancer care than Caucasian Ameri-
cans (Gornick, 2000). Those barriers include
issues related to the high cost burden of can-
cer treatment and lack of support resources for patients,
Jennifer Wenzela, PhD, RN, CCM, Randy Jonesa, PhD, RN, Rachel Klimmek, BSN, RN, OCN®,
Sarah Szanton, PhD, CRNP, and Sharon Krumm, PhD, RN
a Joint first author
provided informal counseling, social support, health
education, screening, detection, and basic emergency care
(Rosenthal et al., 1998; Witmer, Seifer, Finocchio, Leslie, &