COLDWATER CANCER RATES

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Community Project Proposal Investigation of Cancer Rates in Coldwater, British Columbia 9555093; 9555944; 9576304; T00044589 Thompson Rivers University

NURS3500 Section 01 M. Taylor February 11, 2013

COLDWATER CANCER RATES Table of Contents Introduction…………………………………………………………………………… 3 Purpose…………………………………………………………………………3 Importance of the Issue………………………………………………………...3 Assessment……………………………………………………………………...……...4 Determinants of Health ………………………………………………………………...5 Lifestyle Choices……………………………………………………………….5 Accessing Health Care………………………………………………………….6 Education ……………………………………………………………………….6 Literature Review……………………………………………………………………….6 Interventions……………………………………… …………………..………..………7 Creating Trusting Relationships……………………………………………….. 7 Increase Screening………………………………………………………………8 Education……………………………………..…………………………………9 Evaluation and Sustainability …………………………………………………………..9 References………………………………………………………………………………10

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COLDWATER CANCER RATES Investigation of Cancer Rates in Coldwater, British Columbia Introduction The target population for this project is the band members of the Coldwater First Nations

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Community (FNC), located 14 kilometers north of Merritt, British Columbia. There is a growing suspicion within the community that there is an increased prevalence of cancer which has been brought to the attention of the Scw’exmx Community Health Services Society (SCHSS). Purpose The purpose of this project is to collaborate with community members to develop trusting, caring relationships, and explore historical and present rates of cancer in the Coldwater reserve. Our group will interview members of the community to complete a health survey and the data collected will be presented to the key stakeholders of the SCHSS who will determine if further action needs to be taken. Importance of the issue
The Canadian Cancer Society estimated that 23,000 people in British Columbia would be diagnosed with cancer and 9,800 people would die from this disease in 2012 (Canadian Cancer Society, 2012). Although statistics are not readily available for specific FNCs in British Columbia, research has found that cancer rates in aboriginals have surpassed those of non-aboriginal Canadians (Health Canada, 2009). Statistics from 2008 state that 3% of members of the Scw’exmx community (which includes the Coldwater reserve) were diagnosed with cancer by a physician compared to the general Canadian population of 1.9% (Statistics Canada, 2006 & SCHSS, 2008). The members of the Scw’exmx community, Jim Adams, the executive director of the SCHHS, and Rena Jones, the Community Health nurse are the key stakeholders.

COLDWATER CANCER RATES Assessment Coldwater Demographics The Coldwater reserve has a population of approximately 740 residents living in a community of approximately 130 homes. Gender balance is approximately equal and there is a

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slight increase in the aging population (SCHSS, 2010). Homes are typically rented from the band and according to the most recent census 4% of the population live in homes where there is more than one person per room (Statistics Canada, 2006). The majority of the homes were constructed prior to 1991 and many are in need of repair. It is not uncommon to see several inoperable vehicles parked on a property that require significant repair (SCHSS, 2010). Many residents that do not have access to regular transportation gather at a common location on the reserve and hitchhike into town. The unemployment rate is high in Coldwater as only 47.6% of the work force is employed. The majority work in the service and agricultural industries earning an average annual income of $12,064 which is considerably lower when compared to the Canadian average of just over $20,000 (Statistics Canada, 2006 & Health Canada, 2008). First Nations communities generally have a higher incidence of chronic diseases such as diabetes and hypertension as well (Health Canada, 2008). Three quarters of the population of Coldwater are considered to be overweight and there are also some challenges in regards to mental health and addictions in this community (SCHSS, 2010). There is a variety of infrastructure within the community that includes the band hall, a church, fire hall, and the school that teaches culturally relevant programs for students from kindergarten to Grade 12. The Scw’exmx Community Health Society also provides Mental Health and Addictions programs, and Home and Community Care/Health. A satellite community health building provides general health services and employs a part-time social worker (SCHSS,

COLDWATER CANCER RATES 2008). The Merritt hospital is located 18 kilometers from the reserve and provides emergency services and general care. Patients that require specialized care are usually transferred to Royal Inland Hospital in Kamloops (SCHSS, 2008). Determinants of health Applying the health determinants to the people of the Coldwater shows disparities in virtually all areas within this community (Stamler & Yiu, 2012). The average level of education

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and household income are below the Canadian average, and a percentage of the population live in what is legally deemed as substandard housing (Health Canada, 2009). However cancer develops from various risk factors and the following appear to be prevalent in Coldwater. Lifestyle
Alcohol and tobacco use is very common in the Coldwater community (SCHSS, 2010). “Tobacco has a strong positive cultural context and a long tradition of use among many First Nations peoples” (Health Canada, 2009, p.25) and has proven to be a leading cause of several types of cancer. According to Health Canada (2009), 58% of First Nations people smoke occasionally, while those under the age of 50 tend to smoke on a regular basis. Alcohol consumption is also associated with the development of cancer and is understood to be a major health concern for First Nations. Some research suggests that aboriginals may under-report alcohol consumption which may explain statistics that indicate aboriginals drink less than the average Canadian (Health Canada, 2009). Obesity and sexual health are also areas that should receive attention in the community. Seventy – three percent of the population is considered obese which is significant as obesity can increase the risk of breast, colorectal or pancreatic cancer (SCHSS, 2010, Engelking & Cady, 2010). Health Canada (2009) found that only 10% of Aboriginals reported consistent use of a condom during sexual intercourse which is a concern as the human papillomavirus known for causing cervical cancer is contracted during unprotected sex (Health Canada, 2009).

COLDWATER CANCER RATES Assessing Health Care

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Regular health exams can detect health problems early when treatment options are better (Center for Disease Control and Prevention, 2013). Seventy-three percent of Aboriginal women aged 50-59 reported having a mammogram (including 23 from Coldwater) which is lower than the Canadian average (Health Canada, 2009). More aboriginal women over the age of 18 reported having a regular Pap test than the general population (Health Canada, 2009). However this statistic was not reflected in a Coldwater study that found only one woman had a Pap test from the group of 30 that had an annual checkup (SCHSS, 2010). Colorectal and prostate cancer is also prevalent among aboriginal men although just 13% of this population report having undergone a rectal examination (Health Canada, 2009).

Education Thirty-nine percent of the Coldwater community has not completed a high school education compared to the national average of 12%. (SCHSS, 2008, Health Canada, 2009). Literature Review
Marrett and Chaudhry (2003) and Colquhoun et al, (2010) found that while cancer rates in FNCs have traditionally been lower than in the general population, the gap has closed over the past two decades. A Health Canada (2009) report found that cancer rates in FNCs have surpassed those in the general Canadian population (Health Canada). The top three types of cancers in FNCs tend to be lung, prostate and colorectal for men, and lung, breast and colorectal for women (Health Council of Canada, 2005). Rates of cervical cancer, once found to be significantly higher throughout FNCs across the country, are beginning to trend lower in many FNCs (National Aboriginal Health Organization, 2010). This trend is mainly due to increased education and the promotion and utilization of Pap tests in the community (Band et al., 1992, Colquhoun et al, 2010, Louchini & Beaupre, 2009).

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Cancer is the third leading cause of death in FNCs (Health Council of Canada, 2005). Members of FNCs must be educated on the importance of maintaining a healthy lifestyle and the significance of having regular screening tests to improve cancer prevention and early detection (Engelking & Cady, 2010). Increasing education and screening is difficult unless the members of the healthcare team are able to establish good relationships with the members of the FNC, making the establishment of trust and communication of utmost importance (Zeidler, 2011).These interventions strive to not only decrease the incidence of cancer diagnosis and mortality, but also to increase the health and well-being of all members of FNC in Canada.

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Interventions
The members of the Coldwater reserve live with several Determinants of Health that may place them at an increased risk for developing cancer. Barriers include a lack of education and awareness, availability of culturally appropriate screening services, and difficulty with transportation to health clinics (Assembly of First Nations, 2009). Multiple interventions should be implemented to encourage cancer prevention and early detection in the Coldwater community.

Creating Trusting Relationships
Building relationships that will help to set the foundation to deliver healthcare and increase the utilization of cancer prevention programs is perhaps the most important intervention when working in FNCs (National Aboriginal Health Organization, 2010). Nurses may not be aware of the difficulties they may encounter when trying to build relationships in FNCs. The community may be resistant to any interventions until trusting relationships are developed (Zeidler, 2011). Nurses need to be patient and remember that it “takes time to create connections that will lead to positive relationships” (Zeidler, 2011, p. 140). Being visible within the community by attending and participating in FNC functions such as traditional celebrations or sporting events has shown to significantly increase trust between community members and healthcare workers (Zeidler, 2011).

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Nurses that build trusting relationships also strive to develop collaborative partnerships with their community to drive successful healthcare programs (Gilles, Crewe, Granites, & Coppola, 1995). Research has shown that “a combination of community involvement, staff stability, teamwork, and

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cross cultural understanding can achieve a comprehensive and successful cervical screening service in a remote Aboriginal community"(Gilles et al., 1995, p. 479). Many FNCs have also experienced difficulty with the recruitment and retention of nurses in rural communities (Zeidler, 2011). This has been shown to have a negative impact on the level of trust between the community and the nurse (Zeidler, 2011). It is also important for the nurse to understand the impact that colonialism and the aftermath of the residential school system has had on FNCs as these issues may impact the creation of trusting relationships (Stamler & Yui 2012).

Increase Screening Screening programs are a vital key to the early detection of many types of cancer (Engelking & Cady, 2010). A recent study found that a “lack of awareness of screening, shyness and discomfort in discussing and undergoing the procedure, feelings of anxiousness or embarrassment, fear of cancer and cancer diagnosis, or lack of access to culturally sensitive healthcare professionals” as factors that negatively impacted participation in screening programs (National Aboriginal Health Organization, 2010, p. 1). By creating trusting relationships and collaborating with the community, the healthcare team is more able to provide education that aims to increase the number of people in FNCs that take part in cancer related testing. Education
Education programs should include information regarding lifestyle choices such as exercise, nutrition, and substance abuse. It is important to explain the risks of alcohol and tobacco use as they relate to the development of several types of cancer (Engelking & Cady, 2010). The nurse should also provide education regarding cancer prevention and early detection with the use of screening tests such

COLDWATER CANCER RATES as a Pap test, mammograms, and colonoscopies. Prevention measures and healthy lifestyle choices may reduce cancer rates up to 35 % (Assembly of First Nations, 2009).

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Evaluation and Sustainability
The success of our interventions must be evaluated in both the short and long term. Short term evaluation would look for outcomes such as positive changes in lifestyle and an increase in community access to various health prevention programs. These outcomes could be recognized by health assessments and determined by the number of people who access healthcare services and utilize cancer screening tests. We would also hope that our interventions would have a positive impact in the long term by decreasing the incidence and mortality rates of cancer while improving community health. We would continue to encourage the community to access healthcare programs on a regular basis to sustain positive change. We would provide regular health education programs with topics that are specific to the needs of the community. Information would also be provided indirectly by way of posters and pamphlets that promote health prevention and remind the community of the services that are available to them. We would also continue to follow up to ensure community members are able to attend their health care appointments and provide assistance with transportation when necessary. Improving the health of the members of the FNCs must always be our top priority.

COLDWATER CANCER RATES References

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Assembly of First Nations. (2009). Access to cancer screening and first nations. Retrieved from http://64.26.129.156/cmslib/general/AFN Cancer Screening Review-final-ENG.pdf Band, P., Gallagher, R., Threlfall, W., Hislop, T., Deschamps, M., & Smith, J. (1992). Rate of death from cervical cancer among native Indian women in British Columbia. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 147(12), 1802-1804. Canadian Cancer Society (2012). Canadian Cancer Statistics 2012. Retrieved on February 9, 2013 from http://www.cancer.ca/~/media/CCS/Canadawide/Files List/English files heading/PDF-Policy-Canadian Cancer Statistics-English/Canadian Cancer Statistics 2012-English.ashx
Centers for Disease Control and Prevention (n.d.). National breast and cervical cancer early detection program. Retrieved from http://www.cdc.gov/cancer/nbccedp/

Colquhoun, A., Jiang, Z, Maiangowi, G., Ashbury, F., Chen, Y., Drobina, W., McLeod, L., Panaro, L., Sihota, S., Tustin, J., Yacoub, W. (2010). An investigation of cancer incidence in a First Nations community in Alberta, Canada,1995–2006. Engelking, C. & Cady, J. (2010). Cancer. In M. Barry, S. Goldsworthy, & D. Goodridge (Eds.). Medical surgical nursing in Canada: Assessment and management of clinical problems (2nd Canadian ed., pp.322 - 361).Toronto, ON: Elsevier Mosby. Gilles, M., Crewe, S., Granites, I., & Coppola, A. (1995). A community-based cervical screening program in a remote Aboriginal community in the Northern Territory. Australian Journal Of Public Health, 19(5), 477-481. Health Canada. (2009). A statistical profile on the health of first nations in Canada: Determinants of health, 1999 to 2003. Retrieved from Health Canada website:

COLDWATER CANCER RATES http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/fnihb-dgspni/pdf/pubs/aborigautoch/2009-stats-profil-eng.pdf Health Council of Canada. (2005). The health status of Canada’s First Nations, Inuit and Metis Peoples. Retrieved from http://www.healthcouncilcanada.ca/tree/2.03BkgrdHealthyCdnsENG.pdf Louchini, R., Beaupre, M. (2009). Cancer among Aboriginal people living on reserves and in Northern villages in Québec,1984-2004. Retrieve from http://www.inspq.qc.ca/pdf/publications/981_CancerAutochtonesVAng.pdf Marrett , L.D. & Chaudry, M. (2003). Cancer incidence and mortality in Ontario First Nations, 1968-1991 (Canada). Cancer Causes and Control. 14(3), 259-268. National Aboriginal Health Organization. (2010). Cervical cancer in First Nations women: Information for health care providers. Retrieved from http://www.naho.ca/documents/fnc/english/cervicalcancer_000.pdf Scw’exmx Community Health Services Society. (2008). Health plan survey results [Print]. Scw'exmx Community Health Services Society. (2010). Survey results [Print]. Stamler, L.L. & Yiu, L. (2012). Community health nursing: A Canadian perspective (3rd ed.). Toronto: Pearson Prentice Hall. Statistics Canada. (2006). 2006 Coldwater aboriginal community data initiative: Coldwater indian band. Retrieved from

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http://www.bcstats.gov.bc.ca/applications/aborprofile/Reports/Coldwater_Indian_Band.p df Zeidler, D. (2011). Building A Relationship: Perspectives From One First Nations Community. Canadian Journal Of Speech-Language Pathology &Audi