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de Groot A, Brown B, Lindsay D, Gall A, Hewlett N, Hickman A, Garvey G. 'How Your Spirit Is Travelling'-Understanding First Nations Peoples' Experiences of Living Well with and after Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:798. [PMID: 38929044 PMCID: PMC11203506 DOI: 10.3390/ijerph21060798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
As the number of people living with cancer increases, it is important to understand how people can live well with and after cancer. First Nations people diagnosed with cancer in Australia experience survival disparities relating to health service accessibility and a lack of understanding of cultural needs and lived experiences. This study aimed to amplify the voices of First Nations individuals impacted by cancer and advance the development of a culturally informed care pathway. Indigenist research methodology guided the relational and transformative approach of this study. Participants included varied cancer experts, including First Nations people living well with and after cancer, health professionals, researchers, and policy makers. Data were collected through online Yarning circles and analysed according to an inductive thematic approach. The experience of First Nations people living well with and after cancer is inextricably connected with family. The overall themes encompass hope, family, and culture and the four priority areas included the following: strength-based understanding of cancer, cancer information, access to healthcare and support, and holistic cancer services. Respect for culture is interwoven throughout. Models of survivorship care need to integrate family-centred cancer care to holistically support First Nations people throughout and beyond their cancer journey.
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Affiliation(s)
- Anneliese de Groot
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- Australian Institute of Health Innovation, Macquarie University, Sydney 2113, Australia
| | - Bena Brown
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Brisbane 4077, Australia
| | - Daniel Lindsay
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Alana Gall
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
| | - Nicole Hewlett
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
| | - Amy Hickman
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Gail Garvey
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
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Paterson C, Roberts C, Blackburn J, Jojo N, Northam HL, Wallis E, Hind A, Caulfield R, Barratt M, Toohey K, Kavanagh PS, Bacon R, Wilson RL. Understanding the needs and preferences for cancer care among First Nations people: An integrative review. J Adv Nurs 2024; 80:1776-1812. [PMID: 38018290 DOI: 10.1111/jan.15968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
AIM This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. DESIGN Integrative review. DATA SOURCES An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. RESULTS Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs. CONCLUSION Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. PATIENT OR PUBLIC CONTRIBUTION Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. IMPLICATIONS FOR NURSING PRACTICE Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, UK
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - J Blackburn
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - N Jojo
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - H L Northam
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - E Wallis
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - A Hind
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - R Caulfield
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - M Barratt
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - P S Kavanagh
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - R L Wilson
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia
- School of Nursing, Massey University, Palmerston North, New Zealand
- Descendent of the Wiradjuri Nation (First Nations Person), New South Wales, Australia
- Department of Nursing, RMIT University, Melbourne, Victoria, Australia
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Henningham M, Gilroy J, McGlone J, Meehan D, Nila F, McAtamney A, Buchanan T. Utilising the CREATE quality appraisal tool to analyse Aboriginal and Torres Strait Islander peoples' involvement and reporting of cancer research in Australia. Aust N Z J Public Health 2024; 48:100142. [PMID: 38574430 DOI: 10.1016/j.anzjph.2024.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE We aimed to evaluate Aboriginal and Torres Strait Islander involvement in research focusing on cancer experiences using an Aboriginal and Torres Strait Islander quality appraisal tool (the QAT). METHODS We conducted a systematic review of the peer-reviewed literature on Aboriginal and Torres Strait Islander peoples' experiences associated with cancer, recently published elsewhere. We then appraised articles for the inclusion of Aboriginal and Torres Strait Islander-led research, community consultation, and involvement. RESULTS 91 articles were appraised. A lack of Aboriginal and Torres Strait Islander-led research and consultation was reported in the majority of articles, only 10 (11%) demonstrated success across seven (50%) or more questions of the QAT. CONCLUSIONS This review underscores the need for anti-racist research and publication practices that actively engage Aboriginal and Torres Strait Islander peoples and researchers. This approach is vital to enhance cancer outcomes within these communities. IMPLICATIONS FOR PUBLIC HEALTH To advance and prioritise appropriate involvement of Aboriginal and Torres Strait Islander peoples in cancer research, the onus must be on 'systems owners,' including academic journals and institutions, to require and report genuine engagement as standard practice. Researchers will produce higher-calibre research with a strengths-based focus, advancing the cause of equitable research.
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Affiliation(s)
- Mandy Henningham
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - John Gilroy
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | - Drew Meehan
- Cancer Council Australia, Sydney, NSW, 2000, Australia
| | - Farhana Nila
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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Lui PSC, Singh K, Nguyen T, Kurth B, Phan T, Nelson A, Danisevska R, De Ambrosis T. Determinants of cancer screenings participation in Queensland: a scoping review. J Prim Health Care 2024; 16:70-77. [PMID: 38546768 DOI: 10.1071/hc23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/29/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction Cancer screening programmes for cervical, breast, and colorectal cancer have successfully reduced mortality rates among target groups. However, a large proportion of women and men are unscreened. Aim This review aims to provide an overview of the literature regarding the determinants of cancer screening participation among target groups in Queensland. Methods Electronic databases were searched for studies on determinants of cancer screening participation in Queensland. Retrieved studies were screened, and eligible articles were selected for data extraction. Both peer-reviewed and grey literature studies were included. The determinants of cancer screening participation were classified according to the I-Change model. Results Sixteen out of 75 articles were selected and analysed. Information factors, such as the lack of tailored strategies, determined cancer screening participation. Age, gender, cultural beliefs, fear and past experiences were the most reported predisposing factors to cancer screening participation. Lack of knowledge, misconceptions, low awareness, timely access to service, privacy and confidentiality were mainly reported awareness and motivation factors. Encouragement from health professionals, providing more information and interactions with communities would result in different effects on cancer screening participation among the target groups. Discussion The I-Change model is a valuable tool in mapping the current determinants of cancer screening participation programs. Further research may be needed to fully understand the barriers and facilitators of cancer screening programs.
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Affiliation(s)
- Paraniala Silas C Lui
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia; and Centre for Health Research, University of Southern Queensland, Springfield Campus, 37 Sinnathambly Boulevard, QLD 4300, Australia
| | - Kamal Singh
- School of Health, Federation University, Brisbane Campus, PO Box 5274, Brisbane, QLD 4000, Australia
| | - Tam Nguyen
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Brian Kurth
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Thuc Phan
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Ashleigh Nelson
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Renata Danisevska
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Tony De Ambrosis
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
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Gilroy J, Henningham M, Meehan D, Nila F, McGlone J, McAtamney A, Whittaker K, Brown B, Varlow M, Buchanan T. Systematic review of Aboriginal and Torres Strait Islander peoples' experiences and supportive care needs associated with cancer. BMC Public Health 2024; 24:523. [PMID: 38378574 PMCID: PMC10877816 DOI: 10.1186/s12889-024-18070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Persistent disparities exist between Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) and non-Indigenous Australians associated with cancer, with Aboriginal and Torres Strait Islander peoples experiencing a longer time to treatment, higher morbidity rates, and higher mortality rates. This systematic review aimed to investigate findings and recommendations in the literature about the experiences and supportive care needs of Aboriginal and Torres Strait Islander peoples with cancer in Australia. METHODS A qualitative systematic review was conducted using thematic analysis. Database searches were conducted in CINAHL, Informit, MEDLINE, ProQuest, Scopus, and Web of Science for articles published between January 2000 and December 2021. There were 91 included studies which were appraised using the Mixed Methods Appraisal Tool. The included studies reported on the experiences of cancer and supportive care needs in Aboriginal and Torres Strait Islander populations. RESULTS Six key themes were determined: Culture, family, and community; cancer outcomes; psychological distress; access to health care; cancer education and awareness; and lack of appropriate data. Culture was seen as a potential facilitator to achieving optimal cancer care, with included studies highlighting the need for culturally safe cancer services and the routine collection of Aboriginal and Torres Strait Islander status in healthcare settings. CONCLUSION Future work should capitalize on these findings by encouraging the integration of culture in healthcare settings to increase treatment completion and provide a positive experience for Aboriginal and Torres Strait Islander peoples with cancer.
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Affiliation(s)
- John Gilroy
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mandy Henningham
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Drew Meehan
- Cancer Council Australia, Sydney, NSW, 2000, Australia.
| | - Farhana Nila
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | | | | | - Bena Brown
- Inala Indigenous Health Service, Metro South Health, Inala, QLD, 4077, Australia
| | - Megan Varlow
- Cancer Council Australia, Sydney, NSW, 2000, Australia
| | - Tanya Buchanan
- Cancer Council Australia, Sydney, NSW, 2000, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia
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Kinghorn M, Garvey G, Butler TL. Gynaecological cancer resources for Aboriginal and Torres Strait Islander women: A resource audit. Health Promot J Austr 2023. [PMID: 37883991 DOI: 10.1002/hpja.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
ISSUE ADDRESSED Aboriginal and Torres Strait Islander women experience considerable disparities in gynaecological cancer outcomes. Accessible and culturally appropriate health promotion resources about gynaecological cancers may support health literacy in this area. This study aimed to determine the understandability, actionability, readability, and cultural relevance of gynaecological cancer health literacy resources for Aboriginal and Torres Strait Islander consumers, families, and caregivers. METHODS We conducted a general Google search and targeted searches of Australian gynaecological cancer organisation websites in January and February 2022. Resources were assessed for understandability, actionability and cultural relevance to Aboriginal and Torres Strait Islander audiences. RESULTS We found 16 resources. The resources were generally understandable, actionable, readable, and culturally relevant, however, most resources were focused on cervical cancer prevention through vaccination and screening. Few resources focused other gynaecological cancer types or aspects of the cancer care continuum. While many resources contained elements that made them culturally relevant, areas for improvement were identified. These included: greater transparency relating to the Aboriginal and Torres Strait Islander leadership, governance, and involvement in the development of the resources as well as availability of different resource formats with an emphasis on visual aids. CONCLUSIONS This study highlighted a need for the development of resources relating to a wider range of gynaecological cancer types and different stages of the cancer care continuum for Aboriginal and Torres Strait Islander women. SO WHAT?: The development of a broader range of culturally appropriate gynaecological cancer health literacy resources, ideally developed through co-design with Aboriginal and Torres Strait Islander peoples, may contribute to addressing the disparities in gynaecological cancer outcomes for Aboriginal and Torres Strait Islander women.
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Affiliation(s)
- Mina Kinghorn
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Gail Garvey
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Tamara L Butler
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
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Johnston B, Dowling M. Qualitative Research and Cancer Nursing: A Guide for Novice Researchers. Semin Oncol Nurs 2023; 39:151397. [PMID: 36813627 DOI: 10.1016/j.soncn.2023.151397] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To introduce the cancer nurse to qualitative research. DATA SOURCES A search of published literature including articles and books was conducted to inform the article using University libraries (University of Galway and University of Glasgow) and CINAHL, Medline, and Google Scholar databases using broad terms, including qualitative research, qualitative methods, paradigm, qualitative, and cancer nursing. CONCLUSION It is important for cancer nurses wishing to read, critically appraise, or undertake qualitative research to understand the origins and different methods employed in qualitative research. IMPLICATIONS FOR NURSING PRACTICE The article is of relevance for cancer nurses globally who wish to read, critique, or undertake qualitative research.
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Affiliation(s)
- Bridget Johnston
- Clinical Professor of Nursing and Palliative Care, Director of Research School of Medicine, Dentistry & Nursing, University of Glasgow and Chief Nurse Research, NHS Greater Glasgow & Clyde, Glasgow, Scotland.
| | - Maura Dowling
- Associate Professor of Nursing, School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Basile VA, Dhillon HM, Spoelma MJ, Butow PN, May J, Depczynski J, Pendlebury S. Medical treatment decision-making in rural cancer patients: A qualitative systematic review and meta-synthesis. PATIENT EDUCATION AND COUNSELING 2022; 105:2693-2701. [PMID: 35430096 DOI: 10.1016/j.pec.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Rural cancer patients have unique care needs which may impact upon treatment decision-making. Our aim was to conduct a qualitative systematic review and meta-synthesis to understand their perspectives and experiences of making treatment decisions. METHODS A systematic search of MEDLINE, PsycINFO, CINAHL and RURAL was conducted for qualitative studies in rural cancer patients regarding treatment decision-making. Articles were screened for relevance, and data from the included articles were extracted and analysed using meta-thematic synthesis. RESULTS Twelve studies were included, with 4 themes and 9 subthemes identified. Many studies reported patients were not given a choice regarding their treatment. Choice, if given, was influenced by personal factors such as finances, proximity to social supports, convenience, and their personal values. Patients were also influenced by the opinions of others and cultural norms. Finally, it was reported that patients made choices in the context of seeking the best possible medical care and the patient-clinician relationship. CONCLUSIONS In the rural context, there are universal and unique factors that influence the treatment decisions of cancer patients. PRACTICAL IMPLICATIONS Our findings are an important consideration for clinicians when engaging in shared decision-making, as well as for policymakers, to understand and accommodate the unique rural perspective.
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Affiliation(s)
- Victoria A Basile
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Haryana M Dhillon
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-Making, School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia.
| | - Michael J Spoelma
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia; School of Psychiatry, University of New South Wales, Level 1, AGSM Building, Botany Street, Sydney, NSW 2052, Australia.
| | - Phyllis N Butow
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-Making, School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia.
| | - Jennifer May
- University of Newcastle Department of Rural Health, Faculty of Health and Medicine, 114-148 Johnston St, Tamworth, NSW 2340, Australia.
| | - Julie Depczynski
- University of Newcastle Department of Rural Health, Faculty of Health and Medicine, 114-148 Johnston St, Tamworth, NSW 2340, Australia.
| | - Susan Pendlebury
- Department of Radiation Oncology, North West Cancer Centre, Dean St, North Tamworth, NSW 2340, Australia.
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Taylor EV, Lyford M, Parsons L, Holloway M, Gough K, Sabesan S, Thompson SC. Putting Policy into Practice: How Three Cancer Services Perform against Indigenous Health and Cancer Frameworks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020633. [PMID: 35055464 PMCID: PMC8775789 DOI: 10.3390/ijerph19020633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
Abstract
Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.
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Affiliation(s)
- Emma V. Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
- Correspondence: ; Tel.: +61-8-9956-0232
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
| | - Lorraine Parsons
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sabe Sabesan
- Department of Medical Oncology, Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD 4814, Australia;
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
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Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. "The support has been brilliant": experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC Health Serv Res 2021; 21:493. [PMID: 34030670 PMCID: PMC8142293 DOI: 10.1186/s12913-021-06535-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improving health outcomes for Indigenous people by providing person-centred, culturally safe care is a crucial challenge for the health sector, both in Australia and internationally. Many cancer providers and support services are committed to providing high quality care, yet struggle with providing accessible, culturally safe cancer care to Indigenous Australians. Two Australian cancer services, one urban and one regional, were identified as particularly focused on providing culturally safe cancer care for Indigenous cancer patients and their families. The article explores the experiences of Indigenous cancer patients and their families within the cancer services and ascertains how their experiences of care matches with the cancer services' strategies to improve care. METHODS Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience. RESULTS Eight Indigenous people affected by cancer and 23 hospital staff (Indigenous and non-Indigenous) were interviewed. Three experiences were shared by the majority of Indigenous cancer patients and family members interviewed in this study: a positive experience while receiving treatment at the cancer service; a challenging time between receiving diagnosis and reaching the cancer centre; and the importance of family support, while acknowledging the burden on family and carers. CONCLUSIONS This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia.
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Lorraine Parsons
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Toni Mason
- Aboriginal Health Unit, Mission, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
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Chandanabhumma PP, Narasimhan S. Towards health equity and social justice: an applied framework of decolonization in health promotion. Health Promot Int 2021; 35:831-840. [PMID: 31236575 DOI: 10.1093/heapro/daz053] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The pursuit of health equity and social justice lie at the heart of community-empowered health promotion practice. However, there is a need to address the colonial legacy and its contributions to health inequities. The process of decolonization is essential to eliminating the mechanisms that contributed to such inequities. To this end, we propose an Applied Decolonial Framework for Health Promotion that integrates decolonial processes into health promotion practice. We present characteristics of the framework, its values for health promotion transformations and considerations for using the framework in health promotion practice. The framework will help health promotion stakeholders attend to colonizing structures within the field and engage with communities to achieve social justice and health equity.
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Affiliation(s)
| | - Subasri Narasimhan
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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12
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Anderson K, Diaz A, Parikh DR, Garvey G. Accessibility of cancer treatment services for Indigenous Australians in the Northern Territory: perspectives of patients and care providers. BMC Health Serv Res 2021; 21:95. [PMID: 33509170 PMCID: PMC7841038 DOI: 10.1186/s12913-021-06066-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Poorer cancer outcomes of Indigenous Australians in Australia's Northern Territory (NT) compared with their non-Indigenous counterparts are partially due to diminished access to cancer treatment services (CTS). Accessibility of health care is a multidimensional construct, including physical, logistical, psychosocial and cultural dimensions. While previous research has identified specific areas of reduced access to CTS for Indigenous Australians, the higher burden of cancer borne by Indigenous Australians warrants a more comprehensive understanding of access to CTS in the NT. The purpose of this study was to explore and map the accessibility of CTS for Indigenous Australians in the NT and to identify key access barriers. METHODS This predominantly qualitative study, complemented by a descriptive quantitative component, explored and mapped the accessibility of one CTS (CTS-NT) that services a large number of Indigenous Australians in the NT. Patient perspectives were obtained via secondary analysis of data from 75 face-to-face interviews with Indigenous Australian adults attending the CTS-NT. Care provider perspectives were obtained via primary analysis of data from 29 face-to-face interviews with care providers and staff working at CTS-NT. Data were analysed to identify issues of accessibility informed by Leveque and colleagues' conceptual framework of access to health care, which comprises five dimensions of accessibility of the health service and the ability of Indigenous patients to interact with these dimensions to generate access. Applied thematic analysis was conducted on the qualitative data and descriptive analysis was conducted on the quantitative data. RESULTS The analysis of the patient and care provider reports identified multiple access barriers across all dimensions including: inadequate preparation of Indigenous patients for treatment; delayed and complicated commencement of treatment; dislocation from home; competing priorities; scarcity of Indigenous care providers and staff; lack of culturally-relevant care; challenges associated with language, accommodation, transport and finance; and disjointed and fraught relationships with care providers. These barriers posed significant challenges to Indigenous patients maintaining their engagement with treatment. CONCLUSIONS This study provides a valuable snapshot of the barriers facing this population across the dimensions of health care access. Urgent action in addressing these issues is required at individual, service and state levels.
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Affiliation(s)
- Kate Anderson
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Abbey Diaz
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Darshit Rajeshkumar Parikh
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, Northern Territory, Australia
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McInerney-Leo AM, West J, Meiser B, West M, Brown MA, Duncan E. Causal Attributions in an Australian Aboriginal Family With Marfan Syndrome: A Qualitative Study. Front Genet 2020; 11:461. [PMID: 32457804 PMCID: PMC7221064 DOI: 10.3389/fgene.2020.00461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/14/2020] [Indexed: 12/02/2022] Open
Abstract
Causal attributions are important determinants of how health threats are processed and affect health-related behaviors. To date, there has been no research on causal attributions in genetic conditions in Aboriginal Australians. Forty members of a large Aboriginal Australian family with Marfan syndrome (MFS) were invited to participate in an ethically approved study exploring causal attributions, including perceived causes of phenotypic variability within the family. Eighteen individuals consented to conduct semi-structured qualitative interviews, which were recorded, transcribed verbatim and analyzed thematically. Most participants knew that MFS was genetic, but there were diverse theories about inheritance, including beliefs that it skipped generations, was affected by birth order and/or gender, and that it co-occurred with inheritance of blue eyes within this family. The mutation was thought to have been inherited from British settlers and initially triggered by disease or diet. Factors believed to modify disease severity included other genes and lifestyle factors, particularly alcohol and substance abuse and stress. Generally, this family did not endorse “blaming” chance or a higher power for phenotypic variability, though some felt that the spirits or a deity may have played a role. In conclusion, although participants knew MFS was a genetic condition, many speculated about the role of non-genetic causes in initiating the original mutation; and the gene-environment interaction was thought to affect severity. This study demonstrates a successful approach for exploring causal attributions in other genetic conditions in First Australians.
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Affiliation(s)
- Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Jennifer West
- Prince Charles Hospital Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Malcolm West
- Prince Charles Hospital Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew A Brown
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Guy's and St Thomas' NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, United Kingdom
| | - Emma Duncan
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Endocrinology, James Mayne Building, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Groot G, Waldron T, Barreno L, Cochran D, Carr T. Trust and world view in shared decision making with indigenous patients: A realist synthesis. J Eval Clin Pract 2020; 26:503-514. [PMID: 31750600 PMCID: PMC7154772 DOI: 10.1111/jep.13307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION How shared decision making (SDM) works with indigenous patient values and preferences is not well understood. Colonization has affected indigenous peoples' levels of trust with institutions, and their world view tends to be distinct from that of nonindigenous people. Building on a programme theory for SDM, the present research aims to refine the original programme theory to understand how the mechanisms of trust and world view might work differently for indigenous patients. DESIGN We used a six-step iterative process for realist synthesis: preliminary programme theory development, search strategy development, selection and appraisal of literature, data extraction, data analysis and synthesis, and formation of a revised programme theory. DATA SOURCES Searches were through Medline, CINAHL, and the University of Saskatchewan iPortal for grey literature. Medline and CINAHL searches included the University of Alberta Canada-wide indigenous peoples search filters. DATA SYNTHESIS Following screening 731 references, 90 documents were included for data extraction (53 peer reviewed and 37 grey literature). Documents from countries with similar colonization experiences were included. RESULTS A total of 518 context-mechanism-outcome (CMO) configurations were identified and synthesized into 21 CMOs for a revised programme theory. Demographics, indigenous world view, system and institutional support, language barriers, and the macro-context of discrimination and historical abuse provided the main contexts for the programme theory. These inspired mechanisms of reciprocal respect, perception of world view acceptance, and culturally appropriate knowledge translation. In turn, these mechanisms influenced the level of trust and anxiety experienced by indigenous patients. Trust and anxiety were both mechanisms and intermediate outcomes and determined the level of engagement in SDM. CONCLUSION This realist synthesis provides clinicians and policymakers a deeper understanding of the complex configurations that influence indigenous patient engagement in SDM and offers possible avenues for improvement.
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Affiliation(s)
- Gary Groot
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tamara Waldron
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Leonzo Barreno
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - David Cochran
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tracey Carr
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
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Marcusson-Rababi B, Anderson K, Whop LJ, Butler T, Whitson N, Garvey G. Does gynaecological cancer care meet the needs of Indigenous Australian women? Qualitative interviews with patients and care providers. BMC Health Serv Res 2019; 19:606. [PMID: 31464615 PMCID: PMC6716815 DOI: 10.1186/s12913-019-4455-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background There is a disparity in the burden of gynaecological cancer for Indigenous women compared with non-Indigenous women in Australia. Understanding how Indigenous women currently experience gynaecological cancer care services and factors that impact on their engagement with care is critical. This study explored Indigenous Australian women’s experience of gynaecological cancer care at a major metropolitan hospital in Queensland. Methods Indigenous women receiving care at a major metropolitan Queensland hospital for investigation or diagnosis of gynaecological cancer were invited to participate in a larger longitudinal study exploring women’s experiences of gynaecological cancer care. This component was an in-depth, qualitative interview exploring the women’s experiences of hospital care at approximately three-month post initial referral. A peer-approach was used to interview women. Hospital-based care providers involved in the care of Indigenous gynaecological cancer patients were invited to be interviewed. Interviews were transcribed and thematically analysed using an interpretative phenomenological approach enabling a multi-layered, contextualised understanding of the patients' experience and their interaction with tertiary cancer services. Results Eight Indigenous patients and 18 care providers were interviewed. Analysis of all interviews revealed four broad issues affecting Indigenous patients’ early experiences of care: (1) navigating the system, impacted by timely diagnosis, access to support services and follow up; (2) communication and decision-making, patients’ decision-making, efficacy of doctor-patient communication, and patients’ knowledge about cancer; (3) coping with treatment demands, was impacted by emotional stress, access to services and support by hospital staff; and (4) feeling welcome and safe in the hospital, impacted by patients’ relationship with care providers and their access to culturally-safe services. The combination of factors impacting these women’s’ experience of gynaecological care commonly left these women at breaking point, often with limited access to information, resources or support. Conclusions Our findings revealed that experiences of cancer care for Indigenous women are overlain by challenges associated with late referral, misdiagnosis, miscommunication, lack of information, logistics in accessing treatment and services and system cultural insensitivities. Our findings offer insights that can inform cancer care provision to more effectively support Indigenous women accessing gynaecological cancer services. Electronic supplementary material The online version of this article (10.1186/s12913-019-4455-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beverley Marcusson-Rababi
- Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, NT, 0811, Australia.
| | - Kate Anderson
- Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, NT, 0811, Australia
| | - Lisa J Whop
- Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, NT, 0811, Australia
| | - Tamara Butler
- Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, NT, 0811, Australia
| | - Nicole Whitson
- Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, NT, 0811, Australia
| | - Gail Garvey
- Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, NT, 0811, Australia
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Kaczmarek E. How to distinguish medicalization from over-medicalization? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:119-128. [PMID: 29951940 PMCID: PMC6394498 DOI: 10.1007/s11019-018-9850-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Is medicalization always harmful? When does medicine overstep its proper boundaries? The aim of this article is to outline the pragmatic criteria for distinguishing between medicalization and over-medicalization. The consequences of considering a phenomenon to be a medical problem may take radically different forms depending on whether the problem in question is correctly or incorrectly perceived as a medical issue. Neither indiscriminate acceptance of medicalization of subsequent areas of human existence, nor criticizing new medicalization cases just because they are medicalization can be justified. The article: (i) identifies various consequences of both well-founded medicalization and over-medicalization; (ii) demonstrates that the issue of defining appropriate limits of medicine cannot be solved by creating an optimum model of health; (iii) proposes four guiding questions to help distinguish medicalization from over-medicalization. The article should foster a normative analysis of the phenomenon of medicalization and contribute to the bioethical reflection on the boundaries of medicine.
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Affiliation(s)
- Emilia Kaczmarek
- Ethics Department, Center for Bioethics and Biolaw, Institute of Philosophy, University of Warsaw, ul. Krakowskie Przedmieście 3, 00-097, Warsaw, Poland.
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Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliat Care 2019; 18:21. [PMID: 30764810 PMCID: PMC6376644 DOI: 10.1186/s12904-019-0404-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. Methods We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts. Results The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. Discussion Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. Conclusions Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.
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Affiliation(s)
- Kaela Schill
- Cumming School of Medicine, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Susana Caxaj
- School of Nursing, Faculty of Health and Social Development, Okanagan Campus, University of British Columbia, Kelowna, British Columbia, Canada
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19
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Taylor EV, Haigh MM, Shahid S, Garvey G, Cunningham J, Holloway M, Thompson SC. Australian cancer services: a survey of providers’ efforts to meet the needs of Indigenous patients. Aust N Z J Public Health 2018; 42:547-552. [DOI: 10.1111/1753-6405.12843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Emma V. Taylor
- Western Australian Centre for Rural Health, The University of Western Australia
| | - Margaret M. Haigh
- Western Australian Centre for Rural Health, The University of Western Australia
- School of Nursing and Midwifery, Trinity College, The University of Dublin, Ireland
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, The University of Western Australia
- Centre for Aboriginal Studies, Curtin University, Western Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia
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20
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Thewes B, McCaffery K, Davis E, Garvey G. Insufficient evidence on health literacy amongst Indigenous people with cancer: a systematic literature review. Health Promot Int 2018; 33:195-218. [PMID: 27543930 DOI: 10.1093/heapro/daw066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Indigenous people experience poorer cancer survival outcomes compared with non-Indigenous people. Currently, there is growing awareness of poor health literacy as a determinant of cancer outcomes. However, little attention has been given to researching cancer-related health literacy amongst Indigenous people. Objectives To systematically review empirical studies of cancer health literacy amongst Indigenous people worldwide. Methods Articles were identified in Medline (1946-2013); Pre-Medline; CINAHL; PsycINFO (1967-2013); PubMed; Current Contents/All Editions (1993-2013); Allied Health and Complimentary Medicine (1985-2013), and in the reference lists of retrieved articles and by expert consultation. 64 abstracts were screened for inclusion and 16 articles were retained. Results There is a paucity of high-quality research concerning of health literacy amongst Indigenous cancer patients. No articles used formal measures of health literacy and data on the prevalence of health literacy was not reported. Of the 7 articles describing interventions only one included a control group and the remainder employed quasi-experimental methods. Conclusions Research is needed to explore the cultural relevance of existing measures of health literacy and to document the prevalence of health literacy amongst Indigenous people with cancer. A better understanding of Indigenous cancer patients' health literacy is required before health literacy interventions can be designed to improve Indigenous cancer outcomes.
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Affiliation(s)
- Belinda Thewes
- Menzies School of Health Research, Brisbane, Australia.,Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Esther Davis
- Menzies School of Health Research, Brisbane, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Australia
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21
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Gall A, Leske S, Adams J, Matthews V, Anderson K, Lawler S, Garvey G. Traditional and Complementary Medicine Use Among Indigenous Cancer Patients in Australia, Canada, New Zealand, and the United States: A Systematic Review. Integr Cancer Ther 2018; 17:568-581. [PMID: 29779402 PMCID: PMC6142081 DOI: 10.1177/1534735418775821] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer 'patients' are increasingly using traditional indigenous and complementary medicines (T&CM) alongside conventional medical treatments to both cure and cope with their cancer diagnoses. To date T&CM use among Indigenous cancer patients from Australia, Canada, New Zealand, and the United States has not been systematically reviewed. METHODS We systematically searched bibliographic databases to identify original research published between January 2000 and October 2017 regarding T&CM use by Indigenous cancer patients in Australia, Canada, New Zealand, and the United States. Data from records meeting eligibility criteria were extracted and appraised for quality by 2 independent reviewers. RESULTS Twenty-one journal articles from 18 studies across all 4 countries met our inclusion criteria. T&CM use ranged from 19% to 57.7% (differing across countries). T&CM was mostly used concurrently with conventional cancer treatments to meet their spiritual, emotional, social, and cultural needs; however, bush, traditional, and herbal medicines were used in a minority of cases as an alternative. CONCLUSIONS Our findings highlight the importance of T&CM use to Indigenous cancer patients across these 4 countries; we identified multiple perceived spiritual, emotional and cultural benefits to its use. The patient's perception of their health professional's attitudes toward T&CM in some cases hindered or encouraged the patient's disclosure. Additional research is required to further explore the use and disclosure of T&CM among Indigenous cancer patients to help inform and ensure effective, safe, coordinated care for Indigenous cancer patients that relies on shared open decision making and communication across patients, communities, and providers.
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Affiliation(s)
- Alana Gall
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | - Stuart Leske
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | - Jon Adams
- 2 University of Technology Sydney, Sydney, New South Wales, Australia
| | - Veronica Matthews
- 3 University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Kate Anderson
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | | | - Gail Garvey
- 1 Charles Darwin University, Brisbane, Queensland, Australia
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22
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Taylor EV, Haigh MM, Shahid S, Garvey G, Cunningham J, Thompson SC. Cancer Services and Their Initiatives to Improve the Care of Indigenous Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040717. [PMID: 29641441 PMCID: PMC5923759 DOI: 10.3390/ijerph15040717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 02/02/2023]
Abstract
Indigenous Australians continue to experience significantly poorer outcomes from cancer than non-Indigenous Australians. Despite the importance of culturally appropriate cancer services in improving outcomes, there is a lack of awareness of current programs and initiatives that are aimed at meeting the needs of Indigenous patients. Telephone interviews were used to identify and describe the Indigenous-specific programs and initiatives that are implemented in a subset of the services that participated in a larger national online survey of cancer treatment services. Fourteen services located across Australia participated in the interviews. Participants identified a number of factors that were seen as critical to delivering culturally appropriate treatment and support, including having a trained workforce with effective cross-cultural communication skills, providing best practice care, and improving the knowledge, attitudes, and understanding of cancer by Indigenous people. However, over a third of participants were not sure how their service compared with others, indicating that they were not aware of how other services are doing in this field. There are currently many Indigenous-specific programs and initiatives that are aimed at providing culturally appropriate treatment and supporting Indigenous people affected by cancer across Australia. However, details of these initiatives are not widely known and barriers to information sharing exist. Further research in this area is needed to evaluate programs and initiatives and showcase the effective approaches to Indigenous cancer care.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
| | - Margaret M Haigh
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
- Centre for Aboriginal Studies, Curtin University, Kent Street, Perth, WA 6102, Australia.
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
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Worrall-Carter L, Daws K, Rahman MA, MacLean S, Rowley K, Andrews S, MacIsaac A, Lau PM, McEvedy S, Willis J, Arabena K. Exploring Aboriginal patients' experiences of cardiac care at a major metropolitan hospital in Melbourne. AUST HEALTH REV 2018; 40:696-704. [PMID: 26954753 DOI: 10.1071/ah15175] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/08/2016] [Indexed: 01/03/2023]
Abstract
Objectives The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne. Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data. Results Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences. Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community. What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system. What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care. What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.
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Affiliation(s)
| | - Karen Daws
- St. Vincent's Hospital Melbourne, Fitzroy, Vic. 3065, Australia.
| | - Muhammad Aziz Rahman
- St. Vincent's Centre for Nursing Research, Australian Catholic University, East Melbourne, Vic. 3002, Australia. Email
| | - Sarah MacLean
- Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia.
| | - Kevin Rowley
- Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia.
| | - Shawana Andrews
- School of Health Sciences, The University of Melbourne, Carlton South, Vic. 3053, Australia
| | - Andrew MacIsaac
- The Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Vic. 3002, Australia
| | - Phyllis M Lau
- Department of General Practice, The University of Melbourne, Carlton, Vic. 3053, Australia. Email
| | - Samantha McEvedy
- St. Vincent's Centre for Nursing Research, Australian Catholic University, East Melbourne, Vic. 3002, Australia. Email
| | - John Willis
- St. Vincent's Hospital Melbourne, Fitzroy, Vic. 3065, Australia.
| | - Kerry Arabena
- Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia.
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Self-reported health-related quality-of-life issues for Aboriginal and Torres Strait Islander patients with experience of cancer in Australia: a review of literature. INT J EVID-BASED HEA 2016; 13:233-53. [PMID: 26126000 DOI: 10.1097/xeb.0000000000000051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aboriginal peoples and Torres Strait Islander peoples (who comprise the indigenous people or the original inhabitants of Australia before colonization) are more likely to experience cancers with poorer prognoses, are more likely to be diagnosed with cancer at a later stage of disease progression, are less likely to receive adequate cancer treatment and are more likely to pass away due to cancer, compared with other Australians. Cancer and biomedical therapies for cancer often have significant, ongoing effects on patient health-related quality of life (HRQL). Therefore, consideration of HRQL for Aboriginal and Torres Strait Islander peoples with experience of cancer in Australia is imperative. This article examines the literature for HRQL issues self-reported by Aboriginal and/or Torres Strait Islander people with experience of cancer in Australia. METHODS A search of peer-reviewed journal articles, government reports, and other literature was undertaken using electronic databases and citation snowballing. Self-reports from Aboriginal and/or Torres Strait Islander people with experience of cancer were examined. HRQL issues were determined utilizing the Australian Psycho-Oncology Co-operative Research Group's definition of HRQL. RESULTS Fifty-two documents were found with original data from Aboriginal and/or Torres Strait Islander people who self-reported their experiences of cancer. No published reports were found that specifically examined self-reports from Aboriginal and/or Torres Strait Islander people on the impact of cancer and biomedical treatment on their HRQL. CONCLUSION Previous literature suggests that there is urgency for improved communication and cultural competency in cancer care for Aboriginal and Torres Strait Islander patients in Australia, with a stronger focus on meeting patient needs and improving HRQL. This review has provided insight into HRQL issues for Aboriginal and Torres Strait Islander patients with cancer in Australia. Further work using patient-reported outcomes measures would provide greater insight into the impact of cancer and biomedical treatments on Aboriginal and Torres Strait Islander patients' HRQL.
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"I Had a Little Bit of a Bloke Meltdown…But the Next Day, I Was Up": Understanding Cancer Experiences Among Aboriginal Men. Cancer Nurs 2016; 40:E1-E8. [PMID: 27271367 DOI: 10.1097/ncc.0000000000000399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although cancer in indigenous populations is receiving increased research attention, there is a gap in understanding the particular experiences of Aboriginal men. OBJECTIVE The aim of this study is to integrate a range of primary and secondary accounts of the experiences of Aboriginal men in engaging with a cancer diagnosis and treatment in Australia. METHODS Secondary analysis of qualitative interviews (n = 54) conducted between 2008 and 2011 revealed recurrent themes regarding the cancer experiences of Aboriginal men in a subset of participant interviews (n = 23). The analysis reports themes that spanned the accounts of Aboriginal men with cancer (n = 6) and those of their carers (n = 12) and clinicians (n = 5). RESULTS Recurrent beliefs about the cancer experiences of Aboriginal men included that they "avoid seeking help" for health matters, including cancer symptoms, and to "get on with it," "not talk about it," and "manage without fuss" after a cancer diagnosis. Although some men described having to "accept vulnerability," emphasis was placed on appreciating men's desire to "protect cultural roles" and "connect with family and culture" throughout care and treatment, including through humor. CONCLUSIONS Men's accounts of the experiences of cancer diagnosis and care reveal more than simply individual challenge, extending to encompass the very real social and economic implications of illness and vulnerability for Aboriginal men today. IMPLICATIONS FOR PRACTICE Aboriginal men could be better engaged with cancer diagnosis and treatment if greater attention was paid to recognizing preferred approaches, including pragmatism and humor, and supporting connections to family and culture throughout the cancer journey.
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Sinclair C, Stokes A, Jeffries-Stokes C, Daly J. Positive community responses to an arts-health program designed to tackle diabetes and kidney disease in remote Aboriginal communities in Australia: a qualitative study. Aust N Z J Public Health 2016; 40:307-12. [PMID: 27197563 DOI: 10.1111/1753-6405.12522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/01/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The Western Desert Kidney Health Project (WDKHP) is an innovative clinical screening, arts-health and community development program, staffed by Aboriginal health workers. The WDKHP is aimed at prevention and early detection, improving the chance of better management of kidney disease among people in 10 predominantly Aboriginal communities in rural Western Australia. This paper aimed to understand community responses to the WDKHP in three of these communities. METHODS Interviews were undertaken with 26 Aboriginal people living in three remote communities. Community responses were analysed with attention to the social organisation of participants in each community and a focus on the perspectives of key groups, identified here as 'Community Leaders', 'Homelanders', 'Refuge Seekers' and 'Dislocated'. RESULTS Participants from all groups reported that the WDKHP was highly acceptable, and an effective means of drawing attention to the need for prevention, early detection and management of diabetes and kidney disease. The integration of Aboriginal health workers to explain the project contributed to the high rates of participation in clinical screening. CONCLUSIONS Outreach clinical services can be an appropriate method of engaging people in remote communities in addressing diabetes and kidney disease. IMPLICATIONS The remote community setting can act as an 'enabler' of healthy lifestyle for Aboriginal people, particularly when augmented by well-designed outreach programs.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia
| | - Annette Stokes
- Rural Clinical School of Western Australia, University of Western Australia
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Diaz A, Bernardes CM, Garvey G, Valery PC. Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need. Eur J Cancer Care (Engl) 2016; 25:242-53. [PMID: 26918689 DOI: 10.1111/ecc.12471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/28/2022]
Abstract
Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey.
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Affiliation(s)
- A Diaz
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia
| | - C M Bernardes
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia.,QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia
| | - P C Valery
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia.,QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
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Tranberg R, Alexander S, Hatcher D, Mackey S, Shahid S, Holden L, Kwok C. Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review. Psychooncology 2015; 25:131-41. [PMID: 26152813 DOI: 10.1002/pon.3900] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples. METHODS Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies. RESULTS Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures. CONCLUSION Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples.
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Affiliation(s)
- Rona Tranberg
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Susan Alexander
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Deborah Hatcher
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Sandra Mackey
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Shaouli Shahid
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, Perth, Australia.,School of Nursing, Midwifery and Para Medicine, Curtin University, Perth, Australia
| | - Lynda Holden
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Cannas Kwok
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
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Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer. Cancer Nurs 2014; 36:484-92. [PMID: 23047804 DOI: 10.1097/ncc.0b013e31826fc9b4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment. OBJECTIVE The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer. METHODS An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. RESULTS Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age). CONCLUSIONS Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning. IMPLICATIONS FOR PRACTICE Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.
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McGrath P, Rawson N. The experience of relocation for specialist treatment for Indigenous women diagnosed with vulvar cancer in East Arnhem Land. J Psychosoc Oncol 2013; 31:540-55. [PMID: 24010531 DOI: 10.1080/07347332.2013.822051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Vulvar cancer is a serious condition that requires a range of specialist treatments including surgery, chemotherapy, and radiation. In Australia, such treatments are only available in major metropolitan hospitals. Thus, women diagnosed with this condition in rural and remote areas must relocate to the metropolitan specialist centers for treatment. The focus of this article is on the experience of relocation for specialist care for Indigenous women diagnosed with vulvar cancer from East Arnhem Land, Northern Territory, Australia. The findings presented in this article explore a range of issues that affect the experience of relocation such as community concerns, cultural distress, loneliness, fear, worry, and physical concerns associated with the condition.
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Affiliation(s)
- Pam McGrath
- a Population & Social Health Program , Griffith Health Institute, Griffith University , Meadowbrook , Australia
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Treloar C, Gray R, Brener L, Jackson C, Saunders V, Johnson P, Harris M, Butow P, Newman C. Health literacy in relation to cancer: addressing the silence about and absence of cancer discussion among Aboriginal people, communities and health services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:655-664. [PMID: 23692557 DOI: 10.1111/hsc.12054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2013] [Indexed: 06/02/2023]
Abstract
Cancer outcomes for Aboriginal Australians are poorer when compared with cancer outcomes for non-Aboriginal Australians despite overall improvements in cancer outcomes. One concept used to examine inequities in health outcomes between groups is health literacy. Recent research and advocacy have pointed to the importance of increasing health literacy as it relates to cancer among Aboriginal people. This study examined individual, social and cultural aspects of health literacy relevant to cancer among Aboriginal patients, carers and their health workers in New South Wales. Qualitative interviews were conducted with 22 Aboriginal people who had been diagnosed with cancer, 18 people who were carers of Aboriginal people with cancer and 16 healthcare workers (eight Aboriginal and eight non-Aboriginal health workers). Awareness, knowledge and experience of cancer were largely absent from people's lives and experiences until they were diagnosed, illustrating the need for cancer awareness raising among Aboriginal people, communities and services. Some beliefs about cancer (particularly equating cancer to death) differed from mainstream Western biomedical views of the body and cancer and this served to silence discussion on cancer. As such, these beliefs can be used to inform communication and help illuminate how beliefs can shape responses to cancer. Participants proposed some practical strategies that could work to fill absences in knowledge and build on beliefs about cancer. These results were characterised by a silence about cancer, an absence of discussions of cancer and an acknowledgement of an already full health agenda for Aboriginal communities. To promote health literacy in relation to cancer would require a multi-layered programme of work involving grass-roots community education, workers and Board members of Aboriginal community-controlled health organisations and speciality cancer services, with a particular focus on programmes to bridge community-based primary care and tertiary level cancer services.
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Affiliation(s)
- Carla Treloar
- National Centre in HIV Social Research, The University of New South Wales, Sydney, NSW, Australia
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Stagg-Taylor J. No need for ‘yes’: Australian Pap Smear Registers, consent and the (re-)creation of gendered identities. WOMENS STUDIES INTERNATIONAL FORUM 2013. [DOI: 10.1016/j.wsif.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McGrath P, Rawson N. Key factors impacting on diagnosis and treatment for vulvar cancer for Indigenous women: findings from Australia. Support Care Cancer 2013; 21:2769-75. [PMID: 23720063 DOI: 10.1007/s00520-013-1859-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To date, there has been limited research on the topic of vulvar cancer. This paper provides findings from a qualitative study conducted with Indigenous women in East Arnhem Land, Northern Territory, Australia on the psychosocial impact of diagnosis and treatment for vulvar cancer. The insights from the study outlined in this paper not only make a contribution to deepening our understanding of the experience of vulvar cancer for Indigenous women, but provide practical recommendations to ensure effective and early engagement for diagnosis and treatment. METHODS A qualitative research method was employed through in-depth, open-ended interviews. The participants of the study were a purposive sample of Indigenous women with the condition, health professionals, and Aboriginal health workers. There were a total of 40 participants; with twelve (n = 12) Indigenous women affected with the condition, fourteen (n = 14) Aboriginal Health Workers, ten (n = 10) nurses, three (n = 3) doctors, and one (n = 1) community member. RESULTS This paper addresses three key issues highlighted by the participants which include the fact that the private nature of the disease makes the condition 'women's business', that there is a sense of shame associated with the condition, and that there is fear and worry generated by the seriousness of the condition. CONCLUSION The private nature of the disease and the sense of shame associated with the condition impact upon the diagnosis and treatment for many Indigenous women. In addition, the limitation of resources for health service delivery for East Arnhem Land exacerbates the problems faced by these communities. This paper puts forward suggestions to facilitate early diagnosis and treatment for women affected with the condition.
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Affiliation(s)
- Pam McGrath
- Population & Social Health Program, Griffith Health Institute, LO5, Level 1, Logan Campus, Logan, Australia,
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Newman CE, Gray R, Brener L, Jackson LC, Johnson P, Saunders V, Harris M, Butow P, Treloar C. One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people. ETHNICITY & HEALTH 2013; 18:433-447. [PMID: 23297651 DOI: 10.1080/13557858.2012.754408] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. DESIGN Our team--which includes both Aboriginal and non-Aboriginal researchers--conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of 'discursive framing' in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what 'cultural difference' means for the design and delivery of cancer care services to Aboriginal people. RESULTS Despite geographical, organisational, disciplinary and cultural diversity, these interview participants consistently drew upon six discursive frames, which we have interpreted as either eliding a discussion of difference ('everyone is the same' and 'everyone is different') or facilitating that discussion ('different priorities,' 'different practices' and 'making difference safe'). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. CONCLUSIONS While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the 'taken for granted' assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer.
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Affiliation(s)
- Christy E Newman
- National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia.
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MILLER J, KNOTT V, WILSON C, RODER D. A review of community engagement in cancer control studies among Indigenous people of Australia, New Zealand, Canada and the USA. Eur J Cancer Care (Engl) 2012; 21:283-95. [DOI: 10.1111/j.1365-2354.2012.01325.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A study of head and neck cancer treatment and survival among indigenous and non-indigenous people in Queensland, Australia, 1998 to 2004. BMC Cancer 2011; 11:460. [PMID: 22026423 PMCID: PMC3213195 DOI: 10.1186/1471-2407-11-460] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 10/25/2011] [Indexed: 12/02/2022] Open
Abstract
Background Overall, Indigenous Australians with cancer are diagnosed with more advanced disease, receive less cancer treatment and have poorer cancer survival than non-Indigenous Australians. The prognosis for Indigenous people with specific cancers varies however, and their prognosis for cancers of the head and neck is largely unknown. We therefore have compared clinical characteristics, treatment and survival between Indigenous and non-Indigenous people diagnosed with head and neck cancer in Queensland, Australia. Methods Rates were based on a cohort of Indigenous people (n = 67), treated in public hospitals between 1998 and 2004 and frequency-matched on age and location to non-Indigenous cases (n = 62) also treated in the public health system. Data were obtained from hospital records and the National Death Index. We used Pearson's Chi-squared analysis to compare categorical data (proportions) and Cox proportional hazard models to assess survival differences. Results There were no significant differences in socioeconomic status, stage at diagnosis or number and severity of comorbidities between Indigenous and non-Indigenous patients, although Indigenous patients were more likely to have diabetes. Indigenous people were significantly less likely to receive any cancer treatment (75% vs. 95%, P = 0.005) and, when cancer stage, socioeconomic status, comorbidities and cancer treatment were taken into account, they experienced greater risk of death from head and neck cancer (HR 1.88, 1.10, 3.22) and from all other causes (HR 5.83, 95% CI 1.09, 31.04). Conclusion These findings show for the first time that Indigenous Australians with head and neck cancer receive less cancer treatment and suggest survival disparity could be reduced if treatment uptake was improved. There is a need for a greater understanding of the reasons for such treatment and survival disparities, including the impact of the poorer overall health on cancer outcomes for Indigenous Australians.
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Thomson MD, Hoffman-Goetz L. Cancer information comprehension by English-as-a-second-language immigrant women. JOURNAL OF HEALTH COMMUNICATION 2011; 16:17-33. [PMID: 21120740 DOI: 10.1080/10810730.2010.529496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Limited acculturation and socioeconomic factors have been associated with lower participation in cancer screening. Limited comprehension of cancer prevention information may contribute to this association. The authors used a stepwise linear regression to model acculturation and socioeconomic factors as predictors of comprehension (colon cancer and general health information) and screening intention in a sample of 78 Spanish-speaking immigrant women in Canada. The authors used the McNemar test to look for changes in women's screening intention. They used the Bidimensional Acculturation Scale, a language-based scale, to assess acculturation. Among English-as-a-second-language immigrant women, acculturation, television and Internet use, age, and Spanish-language education predicted comprehension of cancer prevention information, F(3, 69) = 6.76, p < .001, R(2) = .23. These variables also predicted comprehension of general health information, via the short form of the Test of Functional Health Literacy in Adults, F(4, 68) = 12.13, p < .001, R(2) = .42; and the Rapid Estimate of Adult Literacy in Medicine, F(2, 70) = 7.54, p = .001, R(2) = .17. However, the variables did not predict screening intention. More women expressed intention to be screened after reading the cancer prevention information than expected by chance alone, p = .002. Acculturation is an important influence on the comprehension of health information by older English-as-a-second-language immigrant women. However, other culture-related factors not measured by the Bidimensional Acculturation Scale likely influence their exposure to and understanding of health and cancer prevention information.
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Affiliation(s)
- M D Thomson
- Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Christou A, Katzenellenbogen JM, Thompson SC. Australia's national bowel cancer screening program: does it work for indigenous Australians? BMC Public Health 2010; 10:373. [PMID: 20579344 PMCID: PMC2915957 DOI: 10.1186/1471-2458-10-373] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/25/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups. METHODS A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions. RESULTS The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening. CONCLUSIONS Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.
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Affiliation(s)
- Aliki Christou
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
| | - Judith M Katzenellenbogen
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
| | - Sandra C Thompson
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
- Combined Universities Centre for Rural Health, University of Western Australia PO Box 109 Geraldton WA 6531, Australia
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