**5.1 Building a cultural bridge through a competency-based approach**

Complementing other national efforts focused on the recruitment and retention of oncology health professionals, C-Change pursued the Cancer Core Competency Initiative to develop standards and tools for strengthening the cancer knowledge and skills of non-oncology health professionals, including generalist and other non-oncology specialists. Defining the core competencies needed by all members of the health workforce represents one important approach toward expanding the cancer workforce (Figure 2). A multi-disciplinary panel of national leaders and experts developed competency standards spanning the continuum of cancer care, basic cancer science, and communication and collaboration. Implementation tools included a logic model and curriculum validation template.(C-Change 2008; Smith, Tyus et al. 2009)

**Continuum of Care** Prevention | Early Detection | Treatment | Survivorship | Palliative Care **Basic Cancer Science** Etiology | Epidemiology | Clinical Trials | Cancer Surveillance **Communications & Collaboration** Inter-disciplinary Care | Psychosocial Communication Cross-Cultural Communication

Fig. 2. Scope of competency standards.

In an effort to test this approach, a grant program invited applicants from any academic, healthcare, cancer coalition, or voluntary/advocacy organization to apply the standards and tools to address a specific need in the professionals and, ultimately, the patients that they serve. Four grant-funded sites implemented the C-Change Cancer Core Competency Program in their organization by utilizing this rigorous set of competency standards, curriculum design tools, and evaluation methods to create their own programs. Each of the grant sites focused on a unique combination of a cancer topic, discipline, education/experience level, and practice setting.(C-Change 2008)

Creating a Sustainable Cancer Workforce: Focus on Disparities and Cultural Competence 413

As a continuation of this innovative program, C-Change invited grant applicants for a more focused purpose of strengthening the cancer pain and palliative care knowledge, skills, and attitudes of non-oncology health professionals. Program activities could focus on any relevant organization, discipline, or geographic area. This initiative was guided by a multidisciplinary, multi-sector advisory committee and managed by C-Change staff. Funding for the grant awards was provided through a generous donation from the Purdue

Through a collaborative process, four new grant sites worked with C-Change to plan and implement their programs. Again, the sites reported that the methods were flexible and useful when addressing various cancer topics, with a wide variety of disciplines, and within different organizational settings. Measurable gains in knowledge, skills, and attitudes were

One of the eight grant recipients, the South Puget Intertribal Planning Agency (SPIPA), indicated a specific cultural focus in meeting the needs of the population they serve. They recognized the need to understand cultural experiences and beliefs in order to equip health professionals with the most productive language, tools, and approach to reaching individuals at risk for and living with cancer.(C-Change 2010) The South Puget Intertribal Planning Agency (SPIPA), a Tribally-chartered nonprofit organization serves five Tribes, Chehalis, Nisqually, Shoalwater Bay, Skokomish, and Squaxin Island near Seattle, Washington. SPIPA's grant application described their aim to improve pain and palliative care management for community members.(C-Change 2010) They illustrated the existing

"According to the Washington State Cancer Registry, American Indians/Alaska Natives (AI/ANs) have the highest incidence and mortality rate of cancer incidence of any racial group in our state1. Geographically the SPIPA service population is located in the area of Washington that has had higher than expected total cancer deaths for each year individually and for all years combined. For 2000-2004 combined, the relative risk (rr) was 1.14, or 14% more cancer deaths than expected; this equals about *290 excess deaths* per year. Survival is poorer in small rural towns compared to urban and large rural cities/towns. 2 The reservations served by the Tribal clinics are considered to serve rural populations; the

cancer burden to their community in terms familiar to most health professionals:

majority is considered Health Professional Shortage Areas (HPSA)."(C-Change 2010)

The statistics alone were daunting, but as the planning process unfolded, cultural nuances emerged that made achieving their initial program goal more challenging. As part of the initial needs assessment process, the project leaders conducted a series of talking circles (focus groups) with each tribe. Initially, they gathered feedback that revealed some of the prevailing beliefs of the community, "[f]or Native Elders, pain is not discussed until it is severe, pain is believed to always accompany cancer, and it is not believed that it can be relieved, although traditional healers can help. Many have addiction concerns or concerns about being perceived as 'drug seekers'." This feedback was consistent with previous observations and reinforced the need to address myths in the competency training.(C-

Pharma L.P.

realized by all sites.

**5.2 Cultural competency focus** 

**5.3 Pre-assessment and program planning** 

Change 2010)


Table 1. Scope of pilot site competency initiatives.


Table 2. Scope of pain and palliative care grant site competency.

The pilot sites reported that the methods were flexible and useful when addressing various cancer topics, with a wide variety of disciplines, and within different organizational settings. Measureable gains in knowledge, skills, and attitudes were realized by all sites. In addition, all four pilot sites experienced benefits beyond those derived by the participant including positive effects such as professional development, institutional visibility, and community relations. A full description of the standards, tools, and pilot site results can be found at www.cancercorecompetency.org. (C-Change 2008)

As a continuation of this innovative program, C-Change invited grant applicants for a more focused purpose of strengthening the cancer pain and palliative care knowledge, skills, and attitudes of non-oncology health professionals. Program activities could focus on any relevant organization, discipline, or geographic area. This initiative was guided by a multidisciplinary, multi-sector advisory committee and managed by C-Change staff. Funding for the grant awards was provided through a generous donation from the Purdue Pharma L.P.

Through a collaborative process, four new grant sites worked with C-Change to plan and implement their programs. Again, the sites reported that the methods were flexible and useful when addressing various cancer topics, with a wide variety of disciplines, and within different organizational settings. Measurable gains in knowledge, skills, and attitudes were realized by all sites.
