title: Caregiving among American Indians and Alaska Natives with cancer.
abstract: OBJECTIVE
  Caregivers are an important source of support for oncology patients during cancer diagnosis and treatment, often helping patients manage barriers to care. Our study had three goals: to describe the characteristics of caregivers for American Indian and Alaska Native (AI/AN) oncology patients, to assess the similarities and differences between the perceptions of caregivers and patients regarding barriers to cancer care, and to compare AI/AN caregivers to non-AI/AN caregivers on perceived barriers to cancer care.
  
  
  METHODS
  We conducted a structured interview that assessed perceived barriers to cancer care with a paired sample of 98 adult caregivers and 98 AI/AN oncology patients and to assess the degree of agreement between these two groups. We also investigated whether AI/AN and non-AI/AN caregivers had differing perceptions of barriers to cancer care.
  
  
  RESULTS
  Caregivers reported that their role was very meaningful and not highly stressful. Caregivers and patients agreed 70 % of the time on specific barriers to cancer care. Both groups overwhelmingly reported financial and family or work issues as major barriers to care, whereas trust in providers was the least frequently endorsed barrier. A comparison of AI/AN and non-AI/AN caregivers revealed that AI/AN caregivers identified confidentiality among clinical staff as a significant barrier, whereas non-AI/AN caregivers perceived financial barriers as more significant.
  
  
  CONCLUSIONS
  Finances, family, and work are perceived as the largest barriers to the receipt of cancer care for AI/AN oncology patients. Both patients and caregivers trusted health-care providers. Assessing barriers to care early in the assessment process may result in better engagement with cancer treatment by patients and their caregivers.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA, sawchuk.craig@mayo.edu.
authors.forename: Craig N
authors.initials: CN
authors.lastname: Sawchuk
authors.forename: Emily
authors.initials: E
authors.lastname: Van Dyke
authors.forename: Adam
authors.initials: A
authors.lastname: Omidpanah
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: Ursula
authors.initials: U
authors.lastname: Tsosie
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D017028:Caregivers; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D035502:Trust; D055815:Young Adult