title: Satisfaction with cancer care among American Indian and Alaska Natives in Oregon and Washington State: a qualitative study of survivor and caregiver perspectives.
abstract: To better understand satisfaction with care among American Indian and Alaska Native (AI/AN) persons with cancer, we explored dimensions of the provider relationship that contributed to satisfaction among caregivers and survivors who received cancer treatment in Oregon and Washington State.
  
  
  
  Between November 2011 and April 2013, the project team interviewed 11 caregivers and 71 AI/AN cancer survivors residing in Oregon and Washington State. Interview questions aimed to elicit participant experiences with care providers and factors associated with cancer care satisfaction. Interviews were analyzed using an inductive content analysis approach in which concepts were identified and themes derived from interview data.
  
  
  
  Three overarching themes, each with two sub-themes, emerged from the data: (1) universal factors: bolstering understanding, involvement, and empathy in care; (2) minority-specific factors: incorporating culture and community into care; and (3) AI/AN-unique factors: interacting with Indian health clinics and Indian Health Service (IHS).
  
  
  
  The results of our study suggest that satisfaction with care among survivors and their caregivers must be examined within the context of culture and community, particularly among minority patients. Our study demonstrates providers' critical role in ensuring AI/AN patients emerge satisfied with cancer treatment by honoring their AI/AN-specific needs, such as respect for integration of traditional healing modalities and navigation of specialty care coordination.
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Avenue N.M3-B232, Seattle, WA, 98109, USA. shohl@fredhutch.org.|School of Public Health, Department of Health Services, University of Washington, Seattle, WA, USA. shohl@fredhutch.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hohl
authors.affiliation: School of Public Health, Center for Research on Women and Gender, Cancer Center, University of Illinois-Chicago, Chicago, IL, USA.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Molina
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Avenue N.M3-B232, Seattle, WA, 98109, USA.
authors.forename: Lisel
authors.initials: L
authors.lastname: Koepl
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR, USA.
authors.forename: Kerri
authors.initials: K
authors.lastname: Lopez
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, OR, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vinson
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Avenue N.M3-B232, Seattle, WA, 98109, USA.|Seattle Cancer Care Alliance, Seattle, WA, USA.|School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Linden
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Avenue N.M3-B232, Seattle, WA, 98109, USA.|School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Ramsey
mesh_terms: D000413:Alaska; D000072957:Alaska Natives / Q000523:psychology*; D017028:Caregivers / Q000592:standards*; D004645:Empathy; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D009369:Neoplasms / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D009922:Oregon; D017060:Patient Satisfaction / Q000208:ethnology*; D036301:Qualitative Research; D017741:Survivors; D014481:United States; D014861:Washington
keywords: Cancer health disparities; Cultural competence; Patient-provider relationship; Race/ethnicity; Satisfaction with care; Survivorship