Spirit: a culturally grounded supportive care intervention for chickasaw nation patients with cancer

The National Institute of Nursing Research awarded the University of Oklahoma $653,357 on September 1, 2026, under the Nursing Research program (CFDA 93.361) to develop and pilot SPIRIT, a culturally grounded supportive care intervention for Chickasaw Nation patients with cancer.

SPIRIT (Supportive Palliative Intervention Respecting Indigenous Traditions) addresses culturally informed care needs of First American cancer patients through a collaboration between the Chickasaw Nation Department of Health and the Stephenson Cancer Center at the University of Oklahoma Health Sciences Center. The intervention integrates evidence from supportive and palliative care literature with guidance from a community advisory board comprising patients with cancer and staff from both organizations. The work responds to a documented gap: the Chickasaw Nation Department of Health, one of the largest tribally operated health systems in the United States, refers cancer patients to urban specialists who may lack understanding of tribal referral processes and indigenous knowledge and values. SPIRIT aims to streamline cancer care coordination across the rural tribal healthcare system and the cancer center while ensuring clinical rigor and cultural responsiveness.

Work is performed in Oklahoma City, Oklahoma. The period of performance runs from September 1, 2026, through August 31, 2029. This is a project grant mechanism under the Nursing Research program, which supports investigator-initiated and published funding opportunity research using nursing's holistic, patient and community-focused perspective.

Abstract

Our long-term goal is to enhance cancer care delivery and outcomes for first americans. The objective of this application is to develop and pilot a supportive care intervention called spirit (supportive palliative intervention respecting indigenous traditions) that addresses the culturally informed care needs and concerns of first american patients with cancer. Spirit is a collaboration between the chickasaw nation and the stephenson cancer center (SCC), an NCI-designated cancer center, at the university of oklahoma (OU) health. Our team has a long-standing and successful history of collaborative research to enhance care for first americans with cancer, including with the chickasaw nation department of health (cndh), which is one of the largest tribally operated health systems in the US. Cndh is a predominately rural tribal healthcare system that, like many tribal health systems, refers patients with cancer to specialists located in urban areas. These outside specialists may not understand the nuances of the cndh referral processes nor these patients' indigenous knowledge and values. Thus, interventions to streamline cancer care coordination across cndh and the SCC are urgently needed, particularly with regards to the unique supportive care needs of first americans. Spirit builds on a strong tribal-academic partnership, which fosters the CO-development of a culturally informed supportive care intervention for first american patients with cancer. The intervention integrates established evidence from the supportive and palliative care literature, facilitated by our team's experts in palliative care and supportive oncology, to ensure both clinical rigor and cultural responsiveness. Importantly, a community advisory board of patients with cancer and staff from cndh and SCC will guide spirit's refinement and implementation in collaboration with the tribal health system. With input from the community advisory board and key informants, the intervention will entail patient navigation, symptom monitoring, collaborative care, and personalized palliative care. We will conduct an open pilot (n=20) to demonstrate the feasibility and acceptability of delivering the spirit intervention for first american patients with cancer. Our hypothesis is that by developing a culturally informed supportive care intervention, we can feasibly deliver an intervention that addresses the unique needs of first american patients with cancer. We aim to 1) develop the spirit intervention to provide patient navigation, foster proactive symptom monitoring, ensure collaborative care, and personalize palliative care for first american patients with cancer, 2) assess feasibility and acceptability of delivering spirit for first american patients with cancer (n=20), and 3) identify facilitators and barriers to implementation of the spirit intervention.