Can American Indian and Alaska Native populations ever have a sufficient research base for best practices?

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Abstract text
Background:
Cancer disparities continue to increase for some small populations and current programs have little guidance. Only one Cochrane review exists relevant for United States (US) Indigenous populations such as American Indians and Alaska Natives (AIAN). Even the existing review notes the paucity of evidence available for making a recommendation for tobacco cessation. Given the small numbers of US AIAN in most urban areas and the lack of research infrastructure in rural areas, efforts to establish an evidence base may not be feasible under the current process.
Objectives:
To explore possibilities for building a knowledge base sufficient to make recommendations for small populations like US AIANs using cancer control and prevention as an example.
Methods:
A review of success stories and best practice documents was conducted using materials available from US federal agencies (National Cancer Institute, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Agency for Health Care Research and Quality and Indian Health Services).
Results:
Most cancer best practice documents are based on expert opinion and limited trials of programs. Success stories, especially for cancer screening programs, boast large numbers of patients served but rarely include comparison groups or communities. Existing studies are unique insofar as they do not share common outcome measures sufficient to conduct meta-analyses.
Conclusions:
A national database for federally funded programs needs to include consistent outcome data for small populations. Such a database should include intervention efforts and sufficient demographics so that comparisons can be made to substantiate effective programs and provide recommended best practices. With cancer rates dropping in other populations, health disparities for AIAN and other small populations will increase without new efforts and procedures for establishing program effectiveness and best practices. Federal agencies need to partner with tribal groups to prioritize addressing this gap.
Authors
Seals BF1, Marchionda PJ2
1 US Cochrane Center, Consumer Network, USA
2 US Cochrane Center, USA
Presenting author and contact person
Presenting author: 
Paula Marchionda
Contact person Affiliation Country
Paula Marchionda (Contact this person) US Cochrane USA