title: Caring for Alaska Native prostate cancer survivors in primary care: a survey of Alaska Tribal Health System providers.
abstract: BACKGROUND
  Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care.
  
  
  OBJECTIVE
  To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors.
  
  
  METHODS
  In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items.
  
  
  RESULTS
  Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice.
  
  
  CONCLUSIONS
  These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA ; Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA ; Knowledge & Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA ; Robert D. and Patrician E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.affiliation: Clinical and Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Kelley
authors.affiliation: Clinical and Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: DeCourtney
authors.affiliation: Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Humeniuk
authors.affiliation: Department of Urology, Alaska Native Medical Center, Anchorage, AK, USA.
authors.forename: Jerilyn
authors.initials: J
authors.lastname: Latini
authors.affiliation: Department of Urology, Yale University, New Haven, CT, USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
mesh_terms: D000368:Aged; D000413:Alaska; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000208:ethnology*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D044382:Population Groups; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*
keywords: Alaska Native; cancer survivorship; prostate cancer