Translation Is Not Enough: Translation Is Not Enough: Developing A Stress Developing A Stress

Management Tool Kit For Management Tool Kit For Latinas Coping With Latinas Coping With

Chemotherapy.Chemotherapy.

Dinorah Martinez, Cathy Meade, Dinorah Martinez, Cathy Meade, Jennifer Martinez, Paul JacobsenJennifer Martinez, Paul Jacobsen

American Cancer Society April 19, 2007American Cancer Society April 19, 2007

Supported by Susan G. Komen Breast Cancer FoundationSupported by Susan G. Komen Breast Cancer FoundationGrant # POP 131206Grant # POP 131206

ObjectivesObjectives

Identify the need for stress Identify the need for stress management tools for diverse management tools for diverse populations.populations.

Describe how qualitative methods Describe how qualitative methods can inform the development of can inform the development of culture, literacy and linguistically culture, literacy and linguistically relevant education tools.relevant education tools.

SignificanceSignificancePaucity of mental health professionals Paucity of mental health professionals

working in oncology settings (Even fewer working in oncology settings (Even fewer that are Hispanic/Spanish speaking)that are Hispanic/Spanish speaking)

English is not the primary language for English is not the primary language for many Hispanics many Hispanics

Language becomes barrier for accessing Language becomes barrier for accessing benefits, services, information, or benefits, services, information, or understanding and coping with medical understanding and coping with medical treatments, contributing to health treatments, contributing to health inequities. inequities.

Office of Minority Health/Office of Minority Health/CLASCLAS

Impact of Culture and Impact of Culture and literacy on Cancer Careliteracy on Cancer Care

The cancer experience cannot easily be The cancer experience cannot easily be separated from its cultural context. separated from its cultural context.

Illness and anxiety often reduce understandingIllness and anxiety often reduce understanding How we get and receive information and how it How we get and receive information and how it

is presented and by whom impacts what is done is presented and by whom impacts what is done with the information. with the information.

Affects the way people communicate, how they Affects the way people communicate, how they receive information and how they give receive information and how they give information. information.

It shapes your world view and how the world It shapes your world view and how the world sees you.sees you.

Builds on Evidence-Builds on Evidence-based Researchbased Research**

Patients receiving self-administered Patients receiving self-administered intervention reported significantly (P intervention reported significantly (P < or = .05) < or = .05) betterbetter physical physical functioning, greater vitality, fewer functioning, greater vitality, fewer role limitations because of emotional role limitations because of emotional problems, and better mental health. problems, and better mental health.

Favorable costs of SSMTFavorable costs of SSMT Enhances patient access to Enhances patient access to

psychosocial intervention during psychosocial intervention during chemotherapy.chemotherapy.

* * Jacobsen PB, , Meade CD, , Stein KD, , Chirikos TN, , Small BJ, , Ruckdeschel JC. . Efficacy and costs of two forms of stress management training for Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. cancer patients undergoing chemotherapy. J Clin Oncol. 2002 Jun J Clin Oncol. 2002 Jun 15;20(12):2851-62.15;20(12):2851-62.

The SSMT Teaches 3 The SSMT Teaches 3 techniquestechniques

Abdominal breathing, Abdominal breathing, Progressive muscle relaxation Progressive muscle relaxation

training with guided imagery, and training with guided imagery, and Positive coping self-statementsPositive coping self-statements

Pilot to Assess interest Pilot to Assess interest and Need (n=20)and Need (n=20)

Have you used any stress management Have you used any stress management techniques during chemotherapy?techniques during chemotherapy? – N=10 had used techniques to reduce stress N=10 had used techniques to reduce stress

(answers ranged from exercise to prayer)(answers ranged from exercise to prayer)– none had received any formal training none had received any formal training – none had received take-home materialsnone had received take-home materials

Would it have been useful to have stress Would it have been useful to have stress management materials in Spanish? management materials in Spanish? – 95%95% “ “very useful”very useful”– 95%95% “very interested”“very interested” in learning techniques in learning techniques

Reactions/responses to current Reactions/responses to current Coping with Coping with ChemotherapyChemotherapy (English SSMT). (English SSMT). – All women (100%) responded yesAll women (100%) responded yes

Study AimsStudy Aims Phase I AimsPhase I Aims

– 1. To conduct formative research (series of focus 1. To conduct formative research (series of focus groups, in-depth interviews) to explore the coping groups, in-depth interviews) to explore the coping and stress management needs of Latina breast and stress management needs of Latina breast cancer patients who undergo chemotherapy.cancer patients who undergo chemotherapy.

Phase II AimsPhase II Aims– 2a. To design, produce and adapt an educational 2a. To design, produce and adapt an educational

intervention about stress management for intervention about stress management for Hispanic breast cancer patients.Hispanic breast cancer patients.

– 2b. To evaluate the suitability of the intervention 2b. To evaluate the suitability of the intervention in terms of acceptability, attraction, in terms of acceptability, attraction, understanding, self-efficacy, persuasion, and understanding, self-efficacy, persuasion, and overall satisfaction.overall satisfaction.

Phase II AimsPhase II Aims– 3. To conduct a final evaluation of the Spanish 3. To conduct a final evaluation of the Spanish

language self-administered stress management language self-administered stress management intervention.intervention.

Project Overview/Timeline

OUTCOME: It is anticipated that this project will yield a cultural, linguistic and literacy relevant Spanish-language self-administered stress management training intervention that can then be pilot tested and evaluated for efficacy in a larger multi-site intervention study.

Phase I (Months 1-8)

Qualitative Methods

A. Formative Research

4 Focus Groups (FG)(n=48 participants)

Analysis

Key informant interviews (n=5-10) with health

providers that serve Latina cancer patients

In-depth interviews (n=10) with Latinas currently

receiving chemotherapy

Phase II (Months 9-18)

Infuse information obtained from the formative research

B. Adaptation and Development of SSMT

Cultural and linguistic adaptation and development of the SSMT

ABookletBVideo/DVDCAudio CD/CassetteDOverview card

Three pretesting iterations (n=30) to assess suitability-acceptability

-attraction understanding -self-efficacy-persuasion-Overall satisfaction

Spanish SSMT

Phase III (Months 19-24)

C. Final Evaluation

Dissemination of Findings - Present findings to local Latina breast cancer support groups, local and national conferences- Publications

Final reactions to the Spanish SSMT

2 Focus groups with Latina Breast cancer patients (n=24) and 1 focus group (n=12) with health providers- To evaluate Spanish SSMT in terms of final reactions and satisfaction with educational tools - To identify the best ways to disseminate

Qualitative Methods

Sample and RecruitmentSample and Recruitment Purposive and snowball sampling Purposive and snowball sampling

techniquestechniques Inclusion Criteria:Inclusion Criteria:

– self-identify as Hispanic/Latina; breast cancer self-identify as Hispanic/Latina; breast cancer diagnosis; speaks Spanish; 18 years of age or diagnosis; speaks Spanish; 18 years of age or older. older. In-depth interviews (n=10):In-depth interviews (n=10): are currently are currently

receiving chemotherapy or scheduled for receiving chemotherapy or scheduled for chemotherapychemotherapy

Focus Groups (n=4):Focus Groups (n=4): have received have received chemotherapy as a treatment modality chemotherapy as a treatment modality within the last 12 months; within the last 12 months;

Key informants:Key informants:– Health professionals, advocates Health professionals, advocates (n=5-10)(n=5-10) who who

work closely with Latina breast cancer survivorswork closely with Latina breast cancer survivors April 2007 – Procedure ModificationApril 2007 – Procedure Modification

Qualitative MethodsQualitative Methods

Exploratory natureExploratory nature Multiple Perspectives/ experiencesMultiple Perspectives/ experiences Allow us to develop the intervention in a way that Allow us to develop the intervention in a way that

that is culturally and literacy relevant. that is culturally and literacy relevant. ‘‘Truth’ lies in understanding actions, beliefs and Truth’ lies in understanding actions, beliefs and

values of others, from within the participant’s values of others, from within the participant’s frame of referenceframe of reference

Wanted to capture the spectrum of Latina Wanted to capture the spectrum of Latina experiences with chemotherapyexperiences with chemotherapy– coping and stress management needs coping and stress management needs – reactions to the existing English intervention reactions to the existing English intervention – ideas about the content, tone, character development, ideas about the content, tone, character development,

music and other elements of message design music and other elements of message design

MethodsMethods IRB approvalIRB approval To date we have conducted:To date we have conducted:

– 10 in-depth interviews10 in-depth interviews– 9 provider interviews9 provider interviews– 2 focus groups/discussions2 focus groups/discussions

Interview guides/questions done orallyInterview guides/questions done orally– Demographics, cancer and chemotherapy Demographics, cancer and chemotherapy

experience, coping, stress management experience, coping, stress management skills, review components of English SSMTskills, review components of English SSMT

Data AnalysisData Analysis Interviews were tape-recorded, transcribed Interviews were tape-recorded, transcribed

verbatim, verbatim, Manually coded and then reviewed by Manually coded and then reviewed by

members of the research team members of the research team Content analysis used to assess emergent Content analysis used to assess emergent

themetheme Presenting findings from the 10 in-depth Presenting findings from the 10 in-depth

interviewsinterviews Preliminary results of Health Professional Preliminary results of Health Professional

interviewsinterviews

* In-depth Interview* In-depth InterviewPreliminary ResultsPreliminary Results

Demographics (n=10)Demographics (n=10) AgeAge

– Range: 30-59 yrsRange: 30-59 yrs Place of BirthPlace of Birth

– 10% USA, 10% 10% USA, 10% Ecuador, 10% Ecuador, 10% Mexico, 10% Mexico, 10% Cuba, 10% Puerto Cuba, 10% Puerto Rico, 10% Rico, 10% Panama, 30% Panama, 30% Columbia. Columbia.

Average number of Average number of yrs in US (n=9)yrs in US (n=9)– 40% (1-10 yrs)40% (1-10 yrs)– 60% (11-30 yrs60% (11-30 yrs

Travel back/forth to Travel back/forth to homeland frequentlyhomeland frequently– 40% yes40% yes

EducationEducation– 10% 610% 6thth or less or less– 40% some HS/ HS40% some HS/ HS– 50% Some College/ 50% Some College/

CollegeCollege Marital StatusMarital Status

– 60% Married60% Married EmploymentEmployment

– 40% Unemployed40% Unemployed– 60% Employed60% Employed

Demographics (Cont)Demographics (Cont) Language spokenLanguage spoken

– 40% Spanish only40% Spanish only– 60% Bilingual60% Bilingual

Language readLanguage read– 10% English only10% English only– 30% Spanish only30% Spanish only– 60% Bilingual60% Bilingual

Language preference Language preference for health/cancer for health/cancer informationinformation– 10% English10% English– 90% Spanish90% Spanish

Year diagnosedYear diagnosed– 20% in 200520% in 2005– 80% in 200680% in 2006

Stage at diagnosisStage at diagnosis– 30% did not 30% did not

knowknow 60% did not know 60% did not know

what kind of what kind of cancer they hadcancer they had

What are the most What are the most important things in your important things in your

life?life? 1. Children, 1. Children, 2. Family, 2. Family, 3. Health and getting better, 3. Health and getting better, 4. Life4. Life

– ““My children… And now my health.”My children… And now my health.”~ Puerto Rican 34 ~ Puerto Rican 34

yrs oldyrs old

– ““For me, it is that they cure me as soon as For me, it is that they cure me as soon as possible, so that I can go back to work. I need to possible, so that I can go back to work. I need to pay my bills, I don’t have the means to even pay pay my bills, I don’t have the means to even pay for my rent. To persevere.”for my rent. To persevere.”

~ Mexican 54 yrs ~ Mexican 54 yrs oldold

Q: Tell me about your cancer Q: Tell me about your cancer experienceexperience

1.1. Saw cancer as an opportunity for change Saw cancer as an opportunity for change and personal growthand personal growth

2.2. Feeling fear, anguished, aloneFeeling fear, anguished, alone3.3. Turning to God, enhanced spiritualityTurning to God, enhanced spirituality

– ““I see it as a lesson to make positve changes in I see it as a lesson to make positve changes in my life, and a chance to be closer to God, to be my life, and a chance to be closer to God, to be more... to undertsand that God is taking care of more... to undertsand that God is taking care of me. Stress is produced by anguish and the first me. Stress is produced by anguish and the first minute you are told you have cancer, but it minute you are told you have cancer, but it [cancer] has been more of a life lesson than [cancer] has been more of a life lesson than anything else. You have to surpass it and you anything else. You have to surpass it and you need to manage your stress, becasue if not it need to manage your stress, becasue if not it manages you and that can also affect other manages you and that can also affect other aspects of your health.”aspects of your health.”

~ Columbian, 39 ~ Columbian, 39 yrs oldyrs old

Q: Tell me about your Q: Tell me about your chemotherapy experience chemotherapy experience

1. Physical side effects:1. Physical side effects:1. nausea, 2. vomiting, 3. loosing hair, 4. heat 1. nausea, 2. vomiting, 3. loosing hair, 4. heat

flashesflashes““By hard I mean it’s like I mean, you know, you throw By hard I mean it’s like I mean, you know, you throw up, you get nauseated, you can’t even get up in bed. up, you get nauseated, you can’t even get up in bed. You feel horrible… Like the whole world just slaps you You feel horrible… Like the whole world just slaps you and just left you there. You go through a whole lot of and just left you there. You go through a whole lot of different emotions. …Losing my hair was pretty hard… different emotions. …Losing my hair was pretty hard… It’s like you don’t know who you are anymore. It’s like you don’t know who you are anymore.

~ Puerto Rican, 34 yrs old~ Puerto Rican, 34 yrs old

2. Cleansing2. Cleansing– ““I don’t see it as a drug. I feel it is like the blood of I don’t see it as a drug. I feel it is like the blood of

Christ, going inside and cleansing me, because Christ, going inside and cleansing me, because everything is changing for me.”everything is changing for me.”

~ Ecuadorian, 48 yrs old~ Ecuadorian, 48 yrs old

Cont.Cont.3. “Getting” chemo was not as bad as expected3. “Getting” chemo was not as bad as expected

– ““Y’ know, I had heard about many bad experiences, like my Y’ know, I had heard about many bad experiences, like my freind who came back really sick … Well, When I saw they were freind who came back really sick … Well, When I saw they were sticking all that stuff there [port] and nothing was happening to sticking all that stuff there [port] and nothing was happening to me, I did not feal anything. The experience was completely me, I did not feal anything. The experience was completely different to what I expected. ... And then when it was over, different to what I expected. ... And then when it was over, they took it out and said “ok you can go now” I said “that’s it?” they took it out and said “ok you can go now” I said “that’s it?” I got up, did not get dizzy, nothing happened, I walked and said I got up, did not get dizzy, nothing happened, I walked and said “Pedro, Let’s go!” and he said “ah Dios, How can that be?”“Pedro, Let’s go!” and he said “ah Dios, How can that be?”

~ Puerto Rican, 56 yrs old~ Puerto Rican, 56 yrs old

– “ “ Look at yesterday… I graduated with chemo and was there Look at yesterday… I graduated with chemo and was there with cap and gown. (Laughter) I sure did. I wore a cap and with cap and gown. (Laughter) I sure did. I wore a cap and gown,… People were looking at me like…they thought I was gown,… People were looking at me like…they thought I was graduating from college. I said, ‘no, chemotherapy’. And I’m graduating from college. I said, ‘no, chemotherapy’. And I’m like, ‘where’s my diploma?’ (Laughter) You know? And I took like, ‘where’s my diploma?’ (Laughter) You know? And I took a picture with my gown.”a picture with my gown.”

~ Puerto Rican, 34 yrs old~ Puerto Rican, 34 yrs old

Words used to describe Words used to describe stressstress

Described as something pyschological and Described as something pyschological and physicalphysical– ““Stress is something, it is like the world falls Stress is something, it is like the world falls

on top of you and you don’t know what to on top of you and you don’t know what to do. And you try to react and do something...” do. And you try to react and do something...”

– Being constantly worried, always thinkingBeing constantly worried, always thinking– ““Nervios”/ NervesNervios”/ Nerves– ““It makes you tremble, shake. It makes you It makes you tremble, shake. It makes you

susceptible, sensitive, you cry, it can make susceptible, sensitive, you cry, it can make you irritable and angry.”you irritable and angry.”

– ““Well, it riles up your body, your whole Well, it riles up your body, your whole system. system.

– ““Stuff falling all on you.”Stuff falling all on you.”

Q: What was stressful during Q: What was stressful during treatmenttreatment

Not knowing / lack of information about the drugs they were Not knowing / lack of information about the drugs they were given/the secondary side effectsgiven/the secondary side effects– ““I, for example, I don’t know the names of the drugs that they I, for example, I don’t know the names of the drugs that they

are giving me. I tried to get them yesterday from the are giving me. I tried to get them yesterday from the oncologists during my appointment, but since there is such oncologists during my appointment, but since there is such little time I can not talk too much. She almost did not have little time I can not talk too much. She almost did not have enough time to give me the info about the tumor, I have not enough time to give me the info about the tumor, I have not been able to ask about the rest of the stuff yet. For example, been able to ask about the rest of the stuff yet. For example, the chemo combinations they are giving me, if they have the chemo combinations they are giving me, if they have changed them...for the second or third time. I have not been changed them...for the second or third time. I have not been able to ask.”able to ask.”

~ Ecuadorian, 48 ~ Ecuadorian, 48 yrs oldyrs old

Time waiting for the infusion to be overTime waiting for the infusion to be over Not being able to care for their family (e.g., younger children)Not being able to care for their family (e.g., younger children)

– ““I was stressed out when I was diagnosed as far as who was I was stressed out when I was diagnosed as far as who was going to watch my children when in chemotherapy… Who is going to watch my children when in chemotherapy… Who is going to watch my children and be there in the night? Even going to watch my children and be there in the night? Even when my mother-in-law watches my children it’s not the same when my mother-in-law watches my children it’s not the same because you’re there in bed and when they cry you feel because you’re there in bed and when they cry you feel hopeless, you can’t do nothing. It’s hard. … hopeless, you can’t do nothing. It’s hard. … It’s the most It’s the most stressful thing for me.stressful thing for me.

~ Puerto Rican, 38 yrs old~ Puerto Rican, 38 yrs old

Cont.Cont. Immigration-related, being away from family, need of Immigration-related, being away from family, need of

supportsupport– ““I have lost a lot of time and miss my family very much.... In I have lost a lot of time and miss my family very much.... In

my country I had a good job, but you keep going, living and my country I had a good job, but you keep going, living and don’t value the resource and support you have when your don’t value the resource and support you have when your family is near. ... You really value them when you are far away family is near. ... You really value them when you are far away and it is even worse in this situation...”and it is even worse in this situation...”

~ Columbian, 53 yrs old~ Columbian, 53 yrs old

– ““He [son] is alone. We are both alone. That worries me. May He [son] is alone. We are both alone. That worries me. May God help me get better and... Lets see what I can do, how I God help me get better and... Lets see what I can do, how I can get him here or... I don’t know. What ever God wants. But can get him here or... I don’t know. What ever God wants. But he is my priority and my mom too. he is my priority and my mom too. ~ Ecuadorian, 54 yrs old~ Ecuadorian, 54 yrs old

Financial aspects, not being able to work during Financial aspects, not being able to work during treatment treatment – ““Well, what casues me the most stress is for example not Well, what casues me the most stress is for example not

being able to work. They approved food stamps and medicaid being able to work. They approved food stamps and medicaid but not until February, I don’t have anything till then (Speaking but not until February, I don’t have anything till then (Speaking in tears).in tears).

~ Cuban, 35 yrs old~ Cuban, 35 yrs old

Learning needs during Learning needs during chemotherapychemotherapy

Nutrition – what to eat.Nutrition – what to eat.– ““About Nutrition. Because there are lots of About Nutrition. Because there are lots of

opinions, that say for example, you need to eat opinions, that say for example, you need to eat more carefully. Well, more healthy, like eating less more carefully. Well, more healthy, like eating less fat. Well, some say you should not eat any fat at fat. Well, some say you should not eat any fat at all. Yesterday, I asked my doctor, “Doctor, they all. Yesterday, I asked my doctor, “Doctor, they have told me that the first thing chemo attacks is have told me that the first thing chemo attacks is fat, it takes the fat and that you have to try and fat, it takes the fat and that you have to try and maintain the fat, right?” and I asked, “Well, what maintain the fat, right?” and I asked, “Well, what does that mean, what is included? What should I does that mean, what is included? What should I eat?” I have doubts. I am not convinced..”eat?” I have doubts. I am not convinced..”

~ Panama, 47 yrs ~ Panama, 47 yrs oldold

Information about the drugs they are given and how Information about the drugs they are given and how to manage side effectsto manage side effects

Exercise and ways to relieve stressExercise and ways to relieve stress

Methods to reduce stress Methods to reduce stress during treatmentduring treatment

Writing/ReadingWriting/Reading – Bible, spiritual psalmsBible, spiritual psalms

Exercise Exercise – Walking, Relaxation on beach and in the waterWalking, Relaxation on beach and in the water

Positive ThinkingPositive Thinking– ““That you are one and the same, take care of yourself and That you are one and the same, take care of yourself and

always fight to live... Do not have negative thoughts, if not always fight to live... Do not have negative thoughts, if not the opposite, try to be positive, say “I am going to get the opposite, try to be positive, say “I am going to get through this, I am going to get cured? And that is a great through this, I am going to get cured? And that is a great help. Being positive.”help. Being positive.”

Prayer/MeditationPrayer/Meditation Deep breathingDeep breathing Crafts (drawing, knitting)Crafts (drawing, knitting) Talking with family and friendsTalking with family and friends Learning EnglishLearning English

Stress ManagementStress Management Did anyone talk to you about any ways to Did anyone talk to you about any ways to

reduce stress during your chemotherapy?reduce stress during your chemotherapy?– All answered All answered NONO

Is there any relaxation or stress management Is there any relaxation or stress management technique you would like to learn about?technique you would like to learn about?– Breathing exercises, Reiki, Positive Thinking, Breathing exercises, Reiki, Positive Thinking,

Pain Management, Relaxation methodsPain Management, Relaxation methods Would you do these by yourself or with Would you do these by yourself or with

someone else?someone else?– Alone:Alone: Exercise, Prayer, Reading, Crafts Exercise, Prayer, Reading, Crafts– Group:Group: (with spouse/family/friends) Exercise (with spouse/family/friends) Exercise

Do you think that this will be useful for Latinas Do you think that this will be useful for Latinas undergoing chemotherapy?undergoing chemotherapy?– All said All said YESYES

Suggestions for Spanish Suggestions for Spanish SSMTSSMT

Who should teach women these Who should teach women these techniques in the video?techniques in the video?– Someone who has gone through it, who Someone who has gone through it, who

know what it is like, that can speak from know what it is like, that can speak from experienceexperience

– Doctors/ health professional/ well educated Doctors/ health professional/ well educated = who know what he/she is talking about= who know what he/she is talking about

– All said it should be a native Spanish All said it should be a native Spanish speaker speaker

– Majority said it should be a womanMajority said it should be a woman When and where would you like to When and where would you like to

receive these materials?receive these materials?– Before women start chemotherapyBefore women start chemotherapy

Do you have any suggestions for our Do you have any suggestions for our project?project?– The overwhelming response was The overwhelming response was

changing the color and making it more changing the color and making it more “lively” use vibrant colors (yellow, red, “lively” use vibrant colors (yellow, red, orange), some said “not pink”orange), some said “not pink”

– They also mentioned making the video as They also mentioned making the video as if it were following a true story so that the if it were following a true story so that the women can relate. Some suggested women can relate. Some suggested following one woman through chemo, following one woman through chemo, before, during and after… before, during and after…

Suggestions for Spanish Suggestions for Spanish SSMTSSMT

Preliminary Results: Health Preliminary Results: Health Professional Interviews Professional Interviews

(n=9)(n=9) Verified that the lack of mental health, Verified that the lack of mental health,

stress management, support programs in stress management, support programs in SpanishSpanish

Experiences with Latina cancer survivorsExperiences with Latina cancer survivors– Socio-economic barriers, patient/provider Socio-economic barriers, patient/provider

communication issues communication issues – Differences between Latina and non-Latina Differences between Latina and non-Latina

patientspatients Differences between Hispanics by Differences between Hispanics by

region/nationalityregion/nationality Differences between older/younger womenDifferences between older/younger women

A Spanish SSMT would be very useful and A Spanish SSMT would be very useful and they would be willing to disseminatethey would be willing to disseminate

Next stepsNext steps

Conduct 10 additional in-depth Conduct 10 additional in-depth interviewsinterviews

Conduct 1 more Focus groupConduct 1 more Focus group Qualitative analysisQualitative analysis Infuse information from Phase IInfuse information from Phase I Begin Phase II : Adaptation and Begin Phase II : Adaptation and

development of Spanish SSMTdevelopment of Spanish SSMT

Lessons learnedLessons learned Participant Observation Participant Observation

– Attended Latina support group meetingsAttended Latina support group meetings– Observations at the infusion center at Observations at the infusion center at

MoffittMoffitt Need for information in SpanishNeed for information in Spanish Need for mental health, stress management Need for mental health, stress management

programs that are culturally and programs that are culturally and linguistically relevantlinguistically relevant

Patient/provider communication issuesPatient/provider communication issues The importance of family and spiritualityThe importance of family and spirituality Need to consider added stressors related to Need to consider added stressors related to

the immigration contextthe immigration context FlexibilityFlexibility

AcknowledgementsAcknowledgements

Susan G. Komen for the CureSusan G. Komen for the Cure H. Lee Moffitt Cancer CenterH. Lee Moffitt Cancer Center LUNA, IncLUNA, Inc FE (Fortaleza y Esperanza)FE (Fortaleza y Esperanza) LUNA de PinellasLUNA de Pinellas Melba Martinez, RNMelba Martinez, RN Centers for Radiation OncologyCenters for Radiation Oncology TBCCN (Tampa Bay Community Cancer TBCCN (Tampa Bay Community Cancer

Network)Network)

Together we can make a difference… Together we can make a difference… We need more hands, we need yours.We need more hands, we need yours.