title: Developing the Native People for Cancer Control Telehealth Network.
abstract: OBJECTIVE
  We aimed to develop a telehealth network to deliver postdiagnosis cancer care clinical services and education to American Indian and Alaska Native patients, their families, and their healthcare providers. We also sought to identify the challenges and opportunities of implementing such a telehealth-based application for this rural and underserved population.
  
  
  METHODS
  We followed a participatory formative evaluation approach to engage all stakeholders in the telehealth network design and implementation. This approach allowed us to identify and address technical and infrastructure barriers, lack of previous experience with telehealth, and political, legal, and historical challenges.
  
  
  RESULTS
  Between September 2006 and August 2009, nine tribal clinics in Washington and 26 clinical sites in Alaska had participated in the telehealth network activities. Network programming included cancer education presentations, case conferences, and cancer survivor support groups. Twenty-seven cancer education presentations were held, with a total provider attendance of 369. Forty-four case conferences were held, with a total of 129 cases discussed. In total, 513 patient encounters took place. Keys to success included gaining provider and community acceptance, working closely with respected tribal members, understanding tribal sovereignty and governance, and working in partnership with cultural liaisons.
  
  
  CONCLUSIONS
  The telehealth network exceeded expectations in terms of the number of participating sites and the number of patients served. Following a participatory formative evaluation approach contributed to the success of this telehealth network and demonstrated the importance of community involvement in all stages of telehealth system design and implementation.
authors.affiliation: Biobehavioral Nursing & Health Systems, School of Nursing, University of Washington, Seattle, Washington 98195, USA. doorenbo@uw.edu
authors.forename: Ardith Z
authors.initials: AZ
authors.lastname: Doorenbos
authors.forename: George
authors.initials: G
authors.lastname: Demiris
authors.forename: Cara
authors.initials: C
authors.lastname: Towle
authors.forename: Anjana
authors.initials: A
authors.lastname: Kundu
authors.forename: Laura
authors.initials: L
authors.lastname: Revels
authors.forename: Roy
authors.initials: R
authors.lastname: Colven
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Norris
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000413:Alaska; D002983:Clinical Competence; D055812:Community-Based Participatory Research; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000175:diagnosis*; D010353:Patient Education as Topic; D016730:Program Development; D015397:Program Evaluation; D012657:Self-Help Groups; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States; D014861:Washington