**5.6 Conclusions**

416 Cancer Prevention – From Mechanisms to Translational Benefits

health system. In preparation for the workshop, two important tools were developed, video segments of cancer survivors discussing their discomfort and distress and a pain journal. The videos were an important way to convey the patient experience with familiar community members and reinforced the importance of expressing, rather than suppressing,

The pain journal was specially designed to provide a place for patients to record their symptoms and a tool to share their symptoms with their medical providers. The journal contains a variety of resources that prompt a patient to record onset, quality, intensity, duration, and the effect of relief interventions. The prompts included anatomical diagrams, vocabulary lists to describe the pain sensations, functional assessment of activities of daily living, and checklists to inventory other symptoms. In addition to addressing aspects of "discomfort," the journal also explored aspects of "distress" with functional and mood

The CCCP (Comprehensive Cancer Control Program) Advisory Council made a specific recommendation to create a customized pain barometer, mirroring the classic Wong-Baker faces (Figure 3). They commissioned a local artist, Peter Boome, to create a culturally meaningful rendition of this scale using traditional Salish faces. The scale provided a more culturally familiar image and more direct connection to their pain experience. In a broader sense, the knowledge and tools for expressing pain provided in the workshop gave participants "permission" to talk about a subject that was not a cultural norm. (C-Change

Evaluation methods for the workshop training including a pre- and post-tests for participants, which included questions assessing perceptions, knowledge, and skills. The perception questions assessed changes in confidence in knowledge, ability to recognize distress and discomfort, and ability to communicate symptoms. Knowledge questions assessed definitions of types of discomfort and distress and common interventions to address these symptoms. Skills questions assessed the ability to report symptoms clearly

In total, 102 people participated in one of the five workshops held for each of the tribes. This represents approximately 3.5% of the combine populations of these communities. Confidence scores increased dramatically from pre- to post test, ranging from 129-233% change on individual questions. Knowledge and skills questions showed modest improvements averaging a 7.4% change. Upon further reflection, the program leaders recognized the role that the timing, format, and reading skills of the participants may have played in these results. During the workshop, the faculty used interactive verbal true/false questions to assess comprehension which anecdotally reflected a much stronger gain in knowledge and skills. When asked about the impact of the training experience, 68% of respondents were "very" or "extremely likely" to change their caregiving as a result of the

pain symptoms.

2010)

Fig. 3. Pain Barometer.

and completely.

**5.5 Evaluation methods and outcomes** 

assessment tools.(C-Change 2010)

The impact of the workshop series has had a longer lasting and broader impact than expected. SPIPA has produced and distributed journals since the training within and beyond the SPIPA communities. In addition, they have received inquiries from other AI/AN communities interested in hosting a similar workshop. With these initial successes, they are turning back to their original goal of providing competency-based training for culturally appropriate pain management to western medical providers who serve the SPIPA community. The initial investment in the knowledge and skills of native healthcare workers and caregivers should provide an important cultural competency bridge for bringing patients and care providers together to improve patient outcomes
