Filipina Breast Cancer Support: What Model is Meaningful?

Institution: University of California, San Francisco
Investigator(s): Edwin Jocson, BA - Nancy Burke, Ph.D. -
Award Cycle: 2006 (Cycle 12) Grant #: 12AB-1800 Award: $10,000
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2006)
The proposal described below was awarded a $10,000 planning grant to enable the applicants to strengthen the scientific and community elements of their project, as detailed in the scientific review evaluation document, and incorporate these elements into a new application for the 2007 funding cycle.

Introduction to the research topics: Breast cancer among Filipina American women represents a major but largely neglected cancer disparity. First, though not as highly visible as other Asian subgroups, the Filipino population in the US is large, second among Asians only to the Chinese. Second, Filipinos suffer a disproportionate burden of breast cancer compared with most other Asian subgroups. Third, resources for and data regarding Filipina women with breast cancer are almost non-existent. In a 2004 collaboration between West Bay Pilipino Multi-Service Center (West Bay), the UCSF Comprehensive Cancer Center, and the San Francisco General Breast Care Program, the first Filipina breast cancer support group (Sinag Tala) was started in San Francisco. However, group attendance is uneven and the little research available on Filipino Americans suggests that a “one size fits all” approach to support group design would not be effective in this highly relational (collectivist-oriented) culture. Our study seeks to illuminate the meanings of survivorship and breast cancer support in this community, and how to design culturally appropriate support services building upon existing community resources (social networks).

The question(s) or central hypotheses of the research: We propose an 18-month pilot study to prepare for a 3-year trial. The pilot study will answer these questions: What are Filipina women’s beliefs and values around cancer, survivorship, and social support? What are the strengths and weaknesses of the existing Sinag Tala Breast Cancer Support Group? What keeps women from participating in the existing group?; What other resources do women access for support?; How does this support influence their quality of life?; and What are other possible, culturally resonant, configurations of support services (e.g. one-on-one support; church, exercise, or mahjong groups)?

The general methodology: In this pilot study we will identify existing support resources within the Filipino community and incorporate these into a culturally resonant support model in order to test this model in a full CRC trial. We will participate in the current Sinag Tala support group meetings and interview the people who know the most about breast cancer survivorship support resources and needs in the Filipino community: women and their families who take part in the support group, and breast cancer survivors who have never gone to the support group. After review of findings from interviews and observations in the support groups, we will pretest a culturally appropriate support model in small group interviews with breast cancer survivors and their families. These interviews and analyses of the information that results will be conducted in accordance with qualitative research methods. Staff of West Bay Pilipino Multiservice Center will be trained to conduct interviews by UCSF researchers, and analyses will be conducted jointly. This systematic identification of key issues related to our research questions is called “formative research” and precedes an intervention trial.

Innovative elements of the project: Rather than assuming that a facilitator-run support group is the most appropriate model for Filipina breast cancer survivors, we will question this, and explore other possible configurations of support services with current members of the support group, as well as those survivors who have not participated in the group. For example, it might be more appropriate to invite survivors to play mahjong than to participate in a support group. The conversation around the mahjong tables could be infused with culturally appropriate approaches to survivorship issues. Or women might prefer one-on-one counseling. Possibilities such as these will emerge from our qualitative study, which will enable us to begin to illuminate ways in which the nature and structure of services should differ by culture and social context. Lastly, we seek to increase the capacity of West Bay, an organization based in and trusted by the Filipino community since they are best positioned to reduce the breast cancer burden in their community.

Community involvement: The community is involved in three ways in this project. First, the community partner is a long-standing trusted community-based organization. The impetus for the study came from this group. Second, representatives of organizations serving the Filipino community, including Pilipino Mental Health Resource Group, Philippines Nurses’ Association of Northern California, Stanford Geriatric Education Center, Seton Medical Center, South of Market Health Center, and Maxine Hall Health Center will be involved in review, interpretation and dissemination of findings through their participation in the Sinag Tala Advisory Council. Third, breast cancer survivors are involved as members of the Sinag Tala Advisory Council and as interview participants, providing insight into the meanings of support in their community and appropriate models for its delivery.

Final Report (2007)
The aims of this planning grant were to address reviewer concerns about our previous submission through ongoing discussion and collaboration between the scientific and community partners. Such discussions between the UCSF PI, the West Bay PI, the West Bay Executive Committee and members of the Sinag Tala Breast Cancer Support Group resulted in a change in research focus from formative ethnographic research to understand support processes and social capital within the Filipino community to a focus on peer education and raising breast cancer awareness. The revised aims built upon the commitment and interest of breast cancer support group members and West Bay as a whole. In addition, this change reflects the community partner's desire to work on a study which would quickly become a workable program, rather than an in-depth study of cultural processes and meanings. As a result the application that emerged from this collaborative process was entitled: "Filipina Breast Cancer Survivors as Peer Educators."

Throughout the course of the grant year the partners met and worked together closely to write the revised proposal which was submitted in 2006 for review. (3) Challenges/barriers: Staffing changes in West Bay resulted in a transition of leadership for the grant application.

Or accomplishments during this period include: commitment to breast cancer outreach and awareness raising at West Bay; procurement of funding for, a related study from Susan G. Komen Foundation Breast Cancer Disparities Program.

As a result of this planning grant we feel confident in our ability to carry out the proposed project and we intend to resubmit our collaborative proposal for funding, should we be successful, beginning July 1, 2008.

5 Filipina, Survivor or Both?