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O’Grady JR, Ferdus J, Leylachian S, Bolarinwa Y, Wagamese J, Ellison LK, Siedule C, Batista R, Sheppard AJ. Lung cancer in First Nations, Inuit, and Métis peoples in Canada - a scoping review. Int J Circumpolar Health 2024; 83:2381879. [PMID: 39074244 PMCID: PMC11288199 DOI: 10.1080/22423982.2024.2381879] [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: 03/07/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Lung cancer is one of the most commonly diagnosed cancers in Canada and a leading cause of cancer mortality. Lung cancer also affects First Nations, Inuit and Métis peoples significantly in Canada, which deserves further investigation as there is a literature gap on this topic. We sought to develop a deeper understanding of lung cancer diagnosis, incidence, mortality, and survival in First Nations, Inuit, and Métis peoples in Canada. A systematic search was conducted in bibliographic databases to identify relevant studies published between January 2000 and March 2023. Articles were screened and assessed for relevance using the Population/ Concept/ Context (PCC) framework. A total of 22 articles were included in the final analysis, of which 13 were Inuit-specific, 7 were First Nations-specific, and 2 were Métis-specific. The literature suggests that comparative incidence, mortality, and relative risk of lung cancer is higher and survival is poorer in First Nations, Inuit and Métis peoples. Lung cancer also has varying impact on these population depending on sex, age, location and other factors. This review illustrates that more comprehensive quantitative and qualitative lung cancer research is essential to further identify the structural causes for the high incidence of the disease.
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Affiliation(s)
| | - Jannatul Ferdus
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Sayna Leylachian
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Yinka Bolarinwa
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Joshua Wagamese
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Lisa K Ellison
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Connie Siedule
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Ricardo Batista
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Amanda J Sheppard
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Groot G, Marques Santos JD, Witham S, Leeder E, Carr T. "Somebody That can Meet you on Your Level:" Cancer Survivors' Perspectives on the Role of Indigenous Patient Navigators in Cancer Care. Can J Nurs Res 2024; 56:178-188. [PMID: 38373404 PMCID: PMC11032001 DOI: 10.1177/08445621241230099] [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] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer incidence has increased for First Nations and Métis Peoples in Canada over recent years. Despite a growing cancer burden, there remain challenges to accessing culturally appropriate and quality care in Saskatchewan. OBJECTIVE The study aimed to explore, from cancer survivors' perspectives, the potential of Indigenous patient navigators to enhance the healthcare experiences of First Nations and Métis cancer survivors in Saskatchewan. METHODS We conducted semi-structured interviews with 19 First Nations and Métis cancer survivors. Participants were interviewed by phone between May 2022 to March 2023. Thematic analysis was conducted to generate themes, categories, and codes reflecting participants' experiences with patient navigators. RESULTS Participants reported several supports to help patients with cancer through their cancer journey, including family, community, traditional ways, and First Nations and Métis health support services. Challenges to accessing care included language and communication barriers, logistical challenges, cultural differences, financial challenges, and gaps in care. Indigenous patient navigators may play a critical role in overcoming barriers by providing communication, translation, coordination, education, advocacy, and guidance to Indigenous cancer survivors. In participants' view, the tasks of Indigenous patient navigators could vary, ranging from helping schedule appointments to advocating for the patient's treatment preferences. In addition, Indigenous patient navigators could be helpful bridging Western medicine with traditional medicine when supporting patients seeking cancer care. CONCLUSION According to study participants, Indigenous patient navigators could be beneficial to Indigenous cancer survivors in Saskatchewan.
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Affiliation(s)
- Gary Groot
- Department of Community Health and Epidemiology and Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | | | - Stephanie Witham
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Erin Leeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Bourgeois A, Horrill T, Mollison A, Stringer E, Lambert LK, Stajduhar K. Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review. BMC Health Serv Res 2024; 24:670. [PMID: 38807237 PMCID: PMC11134650 DOI: 10.1186/s12913-024-11129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite advances in cancer research and treatment, the burden of cancer is not evenly distributed. People experiencing socioeconomic disadvantage have higher rates of cancer, later stage at diagnoses, and are dying of cancers that are preventable and screen-detectable. However, less is known about barriers to accessing cancer treatment. METHODS We conducted a scoping review of studies examining barriers to accessing cancer treatment for populations experiencing socioeconomic disadvantage in high-income countries, searched across four biomedical databases. Studies published in English between 2008 and 2021 in high-income countries, as defined by the World Bank, and reporting on barriers to cancer treatment were included. RESULTS A total of 20 studies were identified. Most (n = 16) reported data from the United States, and the remaining included publications were from Canada (n = 1), Ireland (n = 1), United Kingdom (n = 1), and a scoping review (n = 1). The majority of studies (n = 9) focused on barriers to breast cancer treatment. The most common barriers included: inadequate insurance and financial constraints (n = 16); unstable housing (n = 5); geographical distribution of services and transportation challenges (n = 4); limited resources for social care needs (n = 7); communication challenges (n = 9); system disintegration (n = 5); implicit bias (n = 4); advanced diagnosis and comorbidities (n = 8); psychosocial dimensions and contexts (n = 6); and limited social support networks (n = 3). The compounding effect of multiple barriers exacerbated poor access to cancer treatment, with relevance across many social locations. CONCLUSION This review highlights barriers to cancer treatment across multiple levels, and underscores the importance of identifying patients at risk for socioeconomic disadvantage to improve access to treatment and cancer outcomes. Findings provide an understanding of barriers that can inform future, equity-oriented policy, practice, and service innovation.
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Affiliation(s)
- Amber Bourgeois
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada.
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada.
| | - Tara Horrill
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Ashley Mollison
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
| | - Eleah Stringer
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
| | - Leah K Lambert
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall T201, Vancouver, BC, V6T 2B5, Canada
| | - Kelli Stajduhar
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
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Moodley J, Unger-Saldaña K. The role of racial and ethnic discrimination in breast cancer disparities. Lancet 2024; 403:1827-1830. [PMID: 38636534 DOI: 10.1016/s0140-6736(24)00699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative and School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa.
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Donkin L, Bidois-Putt MC, Wilson H, Hayward P, Chan AHY. An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups. JMIR Form Res 2024; 8:e50385. [PMID: 38696236 PMCID: PMC11099811 DOI: 10.2196/50385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. OBJECTIVE This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. METHODS We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. RESULTS Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. CONCLUSIONS While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations' world views.
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Affiliation(s)
- Liesje Donkin
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | - Holly Wilson
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Penelope Hayward
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
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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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Saldaña-Téllez M, Meneses-Navarro S, Cano-Garduño L, Unger-Saldaña K. Barriers and facilitators for breast cancer early diagnosis in an indigenous community in Mexico: voices of otomí women. BMC Womens Health 2024; 24:33. [PMID: 38218790 PMCID: PMC10787990 DOI: 10.1186/s12905-023-02875-2] [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: 03/08/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Literature on barriers and facilitators for early detection of Breast Cancer (BC) among indigenous women is very scarce. This study aimed to identify barriers and facilitators for BC early diagnosis as perceived by women of the otomí ethnic group in Mexico. METHODS We performed an exploratory qualitative study. Data was collected in 2021 through three focus group interviews with 19 otomí women. The interview transcripts were analyzed using the constant comparison method and guided by a conceptual framework that integrates the Social Ecological Model (SEM), the Health Belief Model and the Institute of Medicine's Healthcare Quality Framework. RESULTS Barriers and facilitators were identified at several levels of the SEM. Among the main barriers reported by the study participants were: beliefs about illness, cancer stigma, cultural gender norms, access barriers to medical care, and mistreatment and discrimination by health care personnel. Our participants perceived as facilitators: information provided by doctors, social support, perceived severity of the disease and perceived benefits of seeking care for breast symptoms. CONCLUSIONS Healthcare policies need to be responsive to the particular barriers faced by indigenous women in order to improve their participation in early detection and early help-seeking of care for breast symptoms. Measures to prevent and eradicate all forms of discrimination in healthcare are required to improve the quality of healthcare provided and the trust of the indigenous population in healthcare practitioners.
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Affiliation(s)
| | - Sergio Meneses-Navarro
- CONAHCYT (National Council of Science and Technology)-Center for Research in Health Systems, National Institute of Public Health, Mexico City, Mexico
| | - Leonor Cano-Garduño
- CEDIPIEM (Center for the Development of the Indigenous People of the State of Mexico), Mexico City, Mexico
| | - Karla Unger-Saldaña
- CONAHCYT (National Council of Science, Humanities and Technology), National Cancer Institute, Mexico City, Mexico.
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Huang WQ(M, Gifford W, Phillips JC, Coburn V. Examining structural factors influencing cancer care experienced by Inuit in Canada: a scoping review. Int J Circumpolar Health 2023; 82:2253604. [PMID: 37677103 PMCID: PMC10486290 DOI: 10.1080/22423982.2023.2253604] [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: 05/29/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
Inuit face worse cancer survival rates and outcomes than the general Canadian population. Persistent health disparities cannot be understood without examining the structural factors that create inequities and continue to impact the health and well-being of Inuit. This scoping review aims to synthesise the available published and grey literature on the structural factors that influence cancer care experienced by Inuit in Canada. Guided by Inuit input from Pauktuutit Inuit Women of Canada as well as the Joanna Briggs Institute scoping review methodology, a comprehensive electronic search along with hand-searching of grey literature and relevant journals was conducted. A total of 30 papers were included for analysis and assessment of relevance. Findings were organised into five categories as defined in the a priori framework related to colonisation, as well as health systems, social, economic, and political structures. The study results highlight interconnections between racism and colonialism, the lack of health service information on urban Inuit, as well as the need for system-wide efforts to address the structural barriers in cancer care.
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Affiliation(s)
| | - Wendy Gifford
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Veldon Coburn
- School of Political Studies, University of Ottawa, Ottawa, Ontario, Canada
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Bourgeois A, Horrill TC, Mollison A, Lambert LK, Stajduhar KI. Barriers to cancer treatment and care for people experiencing structural vulnerability: a secondary analysis of ethnographic data. Int J Equity Health 2023; 22:58. [PMID: 36998035 PMCID: PMC10064679 DOI: 10.1186/s12939-023-01860-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND A key pillar of Canada's healthcare system is universal access, yet significant barriers to cancer services remain for people impacted by structural vulnerability (e.g., poverty, homelessness, racism). For this reason, cancer is diagnosed at a later stage, resulting in worse patient outcomes, a reduced quality of life, and at a higher cost to the healthcare system. Those who face significant barriers to access are under-represented in cancer control services Consequently, these inequities result in people dying from cancers that are highly treatable and preventable, however; little is known about their treatment and care course. The aim of this study was to explore barriers to accessing cancer treatment among people experiencing structural vulnerability within a Canadian context. METHODS We conducted a secondary analysis of ethnographic data informed by critical theoretical perspectives of equity and social justice. The original research draws from 30 months of repeated interviews (n = 147) and 300 h of observational fieldwork with people experiencing health and social inequities at the end-of-life, their support persons, and service providers. RESULTS Our analysis identified four themes presenting as 'modifiable' barriers to inequitable access to cancer treatment: (1) housing as a key determinant for cancer treatment (2) impact of lower health literacy (3) addressing social care needs is a pre-requisite for treatment (4) intersecting and compounding barriers reinforce exclusion from cancer care. These inter-related themes point to how people impacted by health and social inequities are at times 'dropped' out of the cancer system and therefore unable to access cancer treatment. CONCLUSION Findings make visible the contextual and structural factors contributing to inequitable access to cancer treatment within a publically funded healthcare system. Identifying people who experience structural vulnerability, and approaches to delivering cancer services that are explicitly equity-oriented are urgently needed.
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Affiliation(s)
- Amber Bourgeois
- School of Nursing, University of Victoria, Institute on Aging & Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada.
| | - Tara C Horrill
- College of Nursing, University of Manitoba, 89 Curry Place Winnipeg, R3T 2N2, Victoria, MB, Canada
| | - Ashley Mollison
- Social Dimensions of Health, University of Victoria Institute on Aging and Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada
| | - Leah K Lambert
- School of Nursing, University of British Columbia, BC Cancer Suite 500, 686 West Broadway, V5Z 1G1, Vancouver, BC, Canada
| | - Kelli I Stajduhar
- School of Nursing, University of Victoria, Institute on Aging & Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada
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Chan J, Griffiths K, Turner A, Tobias J, Clarmont W, Delaney G, Hutton J, Olson R, Penniment M, Bourque JM, Brundage M, Rodin D, Slotman B, Yap ML. Radiation Therapy and Indigenous Peoples in Canada and Australia: Building Paths Toward Reconciliation in Cancer Care Delivery. Int J Radiat Oncol Biol Phys 2023; 116:421-429. [PMID: 36990919 DOI: 10.1016/j.ijrobp.2022.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/17/2022] [Accepted: 09/28/2022] [Indexed: 03/29/2023]
Abstract
Indigenous peoples represent approximately 5% of the world's population and reside in over 90 countries worldwide. They embody a rich diversity of cultures, traditions, languages and relationships with the land that are shared through many generations and that are distinct from those of the settler societies within which they now live. Many Indigenous peoples have a shared experience of discrimination, trauma, and violation of rights, rooted in complex sociopolitical relationships with settler societies that are still ongoing. This results in continuing social injustices and pronounced disparities in health for many Indigenous peoples around the globe. Indigenous peoples exhibit a significantly higher cancer incidence, mortality, and poorer survival compared to non-Indigenous peoples. Cancer services, including radiotherapy, have not been designed to support the specific values and needs of Indigenous populations, resulting in poorer access to cancer services for Indigenous peoples globally across the entire cancer care spectrum. Specific to radiotherapy, available evidence demonstrates disparities in radiotherapy uptake between Indigenous and non-Indigenous patients. Radiotherapy centres are also located disparately further away from Indigenous communities. Studies are limited by a lack of Indigenous-specific data to help inform effective radiotherapy delivery. Recent Indigenous-led partnerships and initiatives have helped to address existing gaps in cancer care, and radiation oncologists play an important role in supporting such efforts. In this article, we present an overview of access to radiotherapy for Indigenous peoples in Canada and Australia, with a focus on strengthening cancer care delivery through education, partnerships, and research.
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Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, Howard AF, Kaur J, McKenzie M, Stajduhar KI, Thorne S. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Health 2023; 22:20. [PMID: 36709295 PMCID: PMC9883825 DOI: 10.1186/s12939-023-01829-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. METHODS A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. RESULTS Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. CONCLUSION Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
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Affiliation(s)
- Leah K. Lambert
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Tara C. Horrill
- grid.21613.370000 0004 1936 9609College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Scott M. Beck
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada
| | - Amber Bourgeois
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Annette J. Browne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - A. Fuchsia Howard
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jagbir Kaur
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Michael McKenzie
- Radiation Therapy Program, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Kelli I. Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Sally Thorne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
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Horrill TC, Martin DE, Lavoie JG, Schultz ASH. Access Denied: Nurses' Perspectives of Access to Oncology Care Among Indigenous Peoples in Canada. ANS Adv Nurs Sci 2022; 45:292-308. [PMID: 35696372 DOI: 10.1097/ans.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inequitable access to oncology care is a significant issue among Indigenous Peoples in Canada; however, the perspectives of oncology nurses have not been explored. Guided by an interpretive descriptive methodology, we explored nurses' perspectives on access to oncology care among Indigenous Peoples in Canada. Nurses described the health care system as "broken" and barriers to accessing oncology care as layered and compounding. Lack of culturally safe care was articulated as a significant issue impacting equitable access, while biomedical discourses were pervasive and competed with nurses' attempts at providing culturally safe and trauma- and violence-informed care by discounting the relational work of nurses.
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Affiliation(s)
- Tara C Horrill
- School of Nursing, University of British Columbia (Dr Horrill), and Nursing and Allied Health Research and Knowledge Translation, BC Cancer (Dr Horrill), Vancouver, British Columbia, Canada; College of Nursing (Drs Martin and Schultz) and Department of Community Health Sciences (Dr Lavoie), University of Manitoba, Winnipeg, Manitoba, Canada
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Access to Hematopoietic Stem Cell Transplant in Canada for Patients with Acute Myeloid Leukemia. Curr Oncol 2022; 29:5198-5208. [PMID: 35892981 PMCID: PMC9332420 DOI: 10.3390/curroncol29080412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Hematopoietic stem cell transplant is a complicated intervention only offered in specialized centers. Access to transplants may vary based on the location of primary residence, income levels, age, and reported race or ethnicity. Using data from the Canadian Institute of Health (CIH) Discharge abstract database (DAD), all non-Quebec Canadians under the age of 65 with a diagnosis of AML between 2004 and 2015 were included in this study. Descriptive statistics were produced for the variables of interest: time period, age, sex, rurality, transplant status, proportion of visible minorities, proportion identifying as indigenous, and proportion of low-income families. Transplant rates were compared and reported using univariable and multivariable analysis. In multivariable analysis, time period, province of residence, gender, and age were significantly associated with the receipt of an allogeneic hematopoietic stem cell transplant. However, differences in transplant rates observed in indigenous patients, low-income families, and visible minorities were not found to be statistically significant. In non-Quebec Canada, transplant rates vary significantly with province of residence, with the highest rates recorded in Alberta. Contrary to findings previously reported in studies exploring access to transplant in the United States, a low-income level was not associated with lower rates of transplants. This might suggest that Canada’s universal health care insurance program is protective against socioeconomic barriers that impact access to health care services.
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McVicar JA, Hoang-Nguyen J, O'Shea J, Champion C, Sheffield C, Allen J, Kimmaliardjuk DM, Poon A, Bould MD, Nickerson JW, Caron NR, McIsaac DI. Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study. CMAJ Open 2022; 10:E304-E312. [PMID: 35504694 PMCID: PMC9259461 DOI: 10.9778/cmajo.20210108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Structural aspects of health care systems, such as limited access to specialized surgical and perioperative care, can negatively affect the outcomes and resource use of patients undergoing elective and emergency surgical procedures. The aim of this study was to compare postoperative outcomes of Nunavut Inuit and non-Inuit patients at a Canadian quaternary care centre. METHODS We conducted a retrospective cohort study involving adult (age ≥ 18 yr) patients undergoing inpatient surgery from 2011 to 2018 at The Ottawa Hospital, the quaternary referral hospital for the Qikiqtaaluk Region of Nunavut. The study was designed and conducted in collaboration with Nunavut Tunngavik Incorporated. The primary outcome was a composite of in-hospital death or complications.Secondary outcomes included postoperative length of stay in hospital, adverse discharge disposition, readmissions within 30 days and total hospitalization costs. RESULTS A total of 98 701 episodes of inpatient surgical care occurred among patients aged 18 to 104 years; 928 (0.9%) of these involved Nunavut Inuit, and 97 773 involved non-Inuit patients. Death or postoperative complication occurred more often among Nunavut Inuit than non-Inuit patients (159 [17.2%] v. 15 691 [16.1%]), which was significantly different after adjustment for age, sex, surgical specialty, risk and urgency (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03-1.51). This association was most pronounced in cases of cancer (OR 1.63, 95% CI 1.03-2.58) and elective surgery (OR 1.58, 95% CI 1.20-2.10). Adjusted rates of readmission, adverse discharge disposition, length of stay and total costs were significantly higher for Nunavut Inuit. INTERPRETATION Nunavut Inuit had a 25% relative increase in their odds of morbidity and death after surgery at a major quaternary care hospital in Canada compared with non-Inuit patients, while also having higher rates of other adverse outcomes and resource use. An examination of perioperative systems involving patients, Inuit leadership, health care providers and governments is required to address these differences in health outcomes.
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Affiliation(s)
- Jason A McVicar
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jenny Hoang-Nguyen
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Justine O'Shea
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Caitlin Champion
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Chelsey Sheffield
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jean Allen
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Donna May Kimmaliardjuk
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Alana Poon
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jason W Nickerson
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Nadine R Caron
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
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Rankin A, Baumann A, Downey B, Valaitis R, Montour A, Mandy P. The Role of the Indigenous Patient Navigator: A Scoping Review. Can J Nurs Res 2022; 54:199-210. [PMID: 35014886 PMCID: PMC9109580 DOI: 10.1177/08445621211066765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare systems are complex and as a result patients may experience
fragmentation of services. Indigenous populations experience increasingly
disproportionate health disparities compared to non-Indigenous populations.
Patient navigation is known as a patient-centered approach to empower
individuals to connect with appropriate services. Literature surrounding the
Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping
review. Purpose: To map the current state of the role of the IPN
internationally within Canada, United States, Australia and New Zealand. Methods Estalished methodological framework by Arksey and O’Malley and the PRISMA
extension for scoping reviews was used. Results A total of 820 articles were reviewed from four databases, yielding sixteen
articles. Conclusions The absence of published literature surrounding the IPN role in Australia and
New Zealand was surprising considering similar histories of colonization.
The term navigator was used most often and was typically used when
describing lay/peer roles. Professional roles were described using specific
role descriptions. Six IPN roles were identified including: (1) social
service navigation, (2) wholistic support of Indigenous people, (3)
advocacy/building capacity, (4) health assessment, (5) administrative
navigation, and (6) outreach. Additionally, barriers and enablers IPNs
address are identified. This scoping review will assist to promote and
reinforce the IPN role.
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Affiliation(s)
| | | | | | | | | | - Pat Mandy
- 3710McMaster University, Hamilton, Canada
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Horrill TC, Browne AJ, Stajduhar KI. Equity-Oriented Healthcare: What It Is and Why We Need It in Oncology. Curr Oncol 2022; 29:186-192. [PMID: 35049692 PMCID: PMC8774995 DOI: 10.3390/curroncol29010018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services.
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Affiliation(s)
- Tara C. Horrill
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Correspondence:
| | - Annette J. Browne
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kelli I. Stajduhar
- School of Nursing, University of Victoria, Victoria, BC V8P 5C2, Canada;
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Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach. Curr Oncol 2021; 29:132-143. [PMID: 35049686 PMCID: PMC8775083 DOI: 10.3390/curroncol29010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.
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Brock T, Chowdhury MA, Carr T, Panahi A, Friesen M, Groot G. Métis Peoples and Cancer: A Scoping Review of Literature, Programs, Policies and Educational Material in Canada. Curr Oncol 2021; 28:5101-5123. [PMID: 34940068 PMCID: PMC8700482 DOI: 10.3390/curroncol28060429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Much of the existing Indigenous cancer research focuses on First Nation populations or reports on pan-Indigenous data that include First Nations, Métis, and Inuit metrics together, which fails to capture the distinct lived realities, experiences of colonialism, and culture of each Indigenous group. The purpose of this scoping review was to summarize existing knowledge on cancer among Métis peoples in Canada, offering direction to researchers, institutions, and policymakers for future actions that enhance Métis-specific cancer surveillance and cancer care. We searched Embase, Medline, iPortal, and Proquest Theses and Dissertations databases, Google Scholar and Google, alongside ten websites relevant to cancer and Métis peoples. Two reviewers gathered 571 records. After screening, 77 records were included. Data show that Métis peoples experience higher behavioral risk factors, lower screening participation, higher cancer incidence for some cancers, and higher mortality rates compared to the non-Indigenous population. Existing research is piece-meal and researchers emphasize that there is inadequate Métis-specific cancer data. There is a need for targeted, Peoples-specific cancer control interventions to reduce these health inequities and a coordinated, Peoples-specific approach to cancer research. These efforts must involve collaboration among Métis Nations and organizations, provincial governments and agencies, researchers, and policymakers.
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Affiliation(s)
- Tegan Brock
- Ministry of Health, Métis Nation—Saskatchewan, Saskatoon, SK S7M 5X8, Canada; (A.P.); (M.F.)
- Correspondence:
| | - Maniza Abedin Chowdhury
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.A.C.); (T.C.); (G.G.)
| | - Tracey Carr
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.A.C.); (T.C.); (G.G.)
| | - Adel Panahi
- Ministry of Health, Métis Nation—Saskatchewan, Saskatoon, SK S7M 5X8, Canada; (A.P.); (M.F.)
| | - Marg Friesen
- Ministry of Health, Métis Nation—Saskatchewan, Saskatoon, SK S7M 5X8, Canada; (A.P.); (M.F.)
| | - Gary Groot
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.A.C.); (T.C.); (G.G.)
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Cole KM, Hutton B, Hamel C, Bourque JM, Arnaout A, Clemons M. Breast cancer in Indigenous women living in Canada: a scoping review protocol. JBI Evid Synth 2021; 19:3412-3422. [PMID: 34171894 DOI: 10.11124/jbies-20-00522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to describe and synthesize the current state of knowledge pertaining to breast cancer in Indigenous women living in Canada. We will examine the continuum of breast cancer care in this population, including breast cancer screening, diagnosis, treatment, and surveillance. INTRODUCTION Breast cancer in Indigenous women is an evolving health care concern in Canada, with mounting evidence suggesting that these women present at later stages, and have poorer survival rates compared with the general population. A comprehensive overview of the state of knowledge of breast cancer in this population is required. INCLUSION CRITERIA The population of interest will include Indigenous women living in Canada aged 18 years or older who have been screened or require screening for breast cancer, or who have been diagnosed with breast cancer. "Indigenous" will include women who identify as First Nations, Métis, or Inuit. Eligible sources must report on breast cancer risk factors, tumor characteristics, health systems access, screening, diagnosis, treatment, surveillance, or breast cancer outcomes. We will include analytic studies, surveys, case series, reviews, meta-analyses, and gray literature. METHODS We will conduct a search of five health sciences databases for relevant studies published in English or French from database inception onward. We will utilize dual independent screening for titles, abstracts, and full-text articles, and will utilize a similar method for gray literature sources. Data will be synthesized using a narrative approach, and outcomes of interest will be compared with data from the general breast cancer population. REGISTRATION Open Science Framework https://osf.io/xkde5.
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Affiliation(s)
- Katherine Marie Cole
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Candyce Hamel
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jean-Marc Bourque
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Angel Arnaout
- Department of Surgery, Division of General Survey, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
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21
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DECOLONIZING CANCER CARE IN CANADA. J Cancer Policy 2021; 30:100309. [DOI: 10.1016/j.jcpo.2021.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
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22
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Rieger KL, Bennett M, Martin D, Hack TF, Cook L, Hornan B. Digital Storytelling as a Patient Engagement and Research Approach With First Nations Women: How the Medicine Wheel Guided Our Debwewin Journey. QUALITATIVE HEALTH RESEARCH 2021; 31:2163-2175. [PMID: 34238067 PMCID: PMC8564217 DOI: 10.1177/10497323211027529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
When research is conducted from a Western paradigm alone, the findings and resultant policies often ignore Indigenous peoples' health practices and fail to align with their health care priorities. There is a need for decolonized approaches within qualitative health research to collaboratively identify intersecting reasons behind troubling health inequities and to integrate Indigenous knowledge into current health care services. We engaged with First Nations women to explore to what extent digital storytelling could be a feasible, acceptable, and meaningful research method to inform culturally safe health care services. This novel approach created a culturally safe and ethical space for authentic patient engagement. Our conversations were profound and provided deep insights into First Nations women's experiences with breast cancer and guidance for our future qualitative study. We found that the digital storytelling workshop facilitated a Debwewin journey, which is an ancient Anishinabe way of knowing that connects one's heart knowledge and mind knowledge.
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Affiliation(s)
- Kendra L. Rieger
- Trinity Western University, Langley, British
Columbia, Canada
- University of Manitoba, Winnipeg, Manitoba,
Canada
| | | | - Donna Martin
- University of Manitoba, Winnipeg, Manitoba,
Canada
| | | | | | - Bobbie Hornan
- Pimicikamāk Nīhithawī First Nation, Manitoba,
Canada
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23
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Knaul FM, Garcia PJ, Gospodarowicz M, Essue BM, Lee N, Horton R. The Lancet Commission on cancer and health systems: harnessing synergies to achieve solutions. Lancet 2021; 398:1114-1116. [PMID: 34419211 DOI: 10.1016/s0140-6736(21)01895-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Felicia Marie Knaul
- Sylvester Comprehensive Cancer Centre, Institute for Advanced Study of the Americas, Miller School of Medicine, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico; Fundación Mexicana para la Salud, Mexico City, Mexico; Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Global Health, University of Washington. Seattle, WA, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; The George Institute for Global Health, Hyderabad, India
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24
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Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers' perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv Res 2021; 21:848. [PMID: 34419035 PMCID: PMC8380380 DOI: 10.1186/s12913-021-06821-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Saskatchewan, Canada, Indigenous cancer care services at the municipal, provincial, and federal levels are intended to improve quality care but can result in a complex, fragmented, and multi-jurisdictional health care system. A multi-phase needs assessment project was initiated to document Indigenous cancer care needs. Guided by Indigenous patient partners, clinicians, academics, and policy makers, the present study reflects a needs assessment of Indigenous cancer supports from the perspectives of cancer care service providers. METHODS Qualitative data were collected through three focus groups with 20 service providers for cancer patients and their families at three Saskatchewan cities. Participants included chemotherapy and radiation nurses, social workers, a patient navigator, dieticians, and practicum students. A semi-structured interview guide was used to conduct the sessions to allow for freedom of responses. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Service providers' perspectives were categorized into five themes: 1) addressing travel-related issues, 2) logistical challenges, 3) improvements to Indigenous-specific health care supports, 4) cultural sensitivity in health care, and 5) consistency in care. Supports provided differed for the two Indigenous groups, First Nations and Métis. Service providers made recommendations regarding how needs could be met. They saw language translation providers and Elder supports as important. Recommendations for improving travel were for medical taxis to include breaks so that passengers may alleviate any uncomfortable side effects of their cancer treatment. Further, Indigenous-specific accommodations were recommended for those requiring medical travel. These recommendations aligned with supports that are available in four other Canadian provinces. CONCLUSIONS These results identified gaps in supports and outlined recommendations to address barriers to cancer care from the perspectives of service providers. These recommendations may inform evidence-based health system interventions for Indigenous cancer patients and ultimately aim to improve cancer care services, quality of life, and health outcomes of Indigenous patients throughout their cancer journey.
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Affiliation(s)
- Jennifer R Sedgewick
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Anum Ali
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Andreea Badea
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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25
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Horrill TC, Martin DE, Lavoie JG, Schultz ASH. A critical exploration of nurses' perceptions of access to oncology care among Indigenous peoples: Results of a national survey. Nurs Inq 2021; 29:e12446. [PMID: 34342080 PMCID: PMC9286560 DOI: 10.1111/nin.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives.
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Affiliation(s)
- Tara C Horrill
- Nursing & Allied Health Research and Knowledge Translation, BC Cancer, Vancouver, BC, Canada
| | - Donna E Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josée G Lavoie
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Avery J, Schulte HK, Campbell KL, Bates A, McCune L, Howard AF. "What We Want Is More Access…": Experiences of Supportive Cancer Care and Strategies for Advancement in a Canadian Provincial Cancer Care Organization. ACTA ACUST UNITED AC 2021; 28:2227-2238. [PMID: 34203638 PMCID: PMC8293065 DOI: 10.3390/curroncol28030205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Objectives: Despite calls for better supportive care, patients and families still commonly bear significant responsibility for managing the physical and mental health and social challenges of being diagnosed with and treated for cancer. As such, there is increased advocacy for integrated supportive care to ease the burden of this responsibility. The purpose of this study was to understand patient and caregiver experiences with supportive care to advance its delivery at a large provincial cancer care organization in Canada. Method: We used a qualitative descriptive approach to analyze focus groups with patients and caregivers from seven sites across the large provincial cancer care organization. Results: Focus group participants (n = 69) included cancer patients (n = 57) and caregivers (n = 12). Participants highlighted positive and negative aspects of their experience and strategies for improvement. These are depicted in three themes: (1) improving patient and provider awareness of services; (2) increasing access; (3) enhancing coordination and integration. Participants’ specific suggestions included centralizing relevant information about services, implementing a coach or navigator to help advocate for access, and delivering care virtually. Conclusions: Participants highlighted barriers to access and made suggestions for improving supportive care that they believed would reduce the burden associated with trying to manage their cancer journey.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Hannah K. Schulte
- Rehabilitation Sciences Graduate Program, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Alan Bates
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada;
- BC Cancer, Vancouver, BC V5Z 1G1, Canada;
| | | | - Amanda Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Correspondence:
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Truant TLO, Lambert LK, Thorne S. Barriers to Equity in Cancer Survivorship Care: Perspectives of Cancer Survivors and System Stakeholders. Glob Qual Nurs Res 2021; 8:23333936211006703. [PMID: 33912623 PMCID: PMC8050754 DOI: 10.1177/23333936211006703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
As more cancer patients survive into post-treatment, the challenge of managing their survivorship care is confronting health care systems globally. In striving to deliver high quality survivorship care, equity constitutes a particularly troublesome challenge. We analyzed accounts from both cancer survivors and stakeholders within care system management to uncover insights with respect to barriers to equitable cancer survivorship services. Beyond the social determinants of health that shape inequities across all of our systems, the cancer care system involves a pattern of prioritizing biomedicine, evidence-based options, and care standardization. We learned that these lead to system rigidities that not only compromise the individualization essential to person-centered care but also obscure the attention to group differences that becomes indispensable to responsiveness to inequities. On the basis of these insights, we reflect on what may be required to begin to redress the current and projected inequities with respect to access to appropriate cancer survivorship supports and services.
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Affiliation(s)
| | - Leah K Lambert
- BC Cancer, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Sally Thorne
- University of British Columbia, Vancouver, Canada
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28
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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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Horrill TC, Martin DE, Lavoie JG, Schultz ASH. Nurses as agents of disruption: Operationalizing a framework to redress inequities in healthcare access among Indigenous Peoples. Nurs Inq 2020; 28:e12394. [PMID: 33348454 DOI: 10.1111/nin.12394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma- and violence-informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity-oriented care for primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma- and violence-informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice.
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Affiliation(s)
- Tara C Horrill
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Donna E Martin
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Josée G Lavoie
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Annette S H Schultz
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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30
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Rieger KL, Gazan S, Bennett M, Buss M, Chudyk AM, Cook L, Copenace S, Garson C, Hack TF, Hornan B, Horrill T, Horton M, Howard S, Linton J, Martin D, McPherson K, Rattray JM, Phillips-Beck W, Sinclair R, Schultz ASH. Elevating the uses of storytelling approaches within Indigenous health research: a critical and participatory scoping review protocol involving Indigenous people and settlers. Syst Rev 2020; 9:257. [PMID: 33148328 PMCID: PMC7640994 DOI: 10.1186/s13643-020-01503-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a complicated and exploitative history of research with Indigenous peoples and accompanying calls to meaningfully and respectfully include Indigenous knowledge in healthcare. Storytelling approaches that privilege Indigenous voices can be a useful tool to break the hold that Western worldviews have within the research. Our collaborative team of Indigenous and non-Indigenous researchers, and Indigenous patients, Elders, healthcare providers, and administrators, will conduct a critical participatory, scoping review to identify and examine how storytelling has been used as a method in Indigenous health research. METHODS Guided by two-eyed seeing, we will use Bassett and McGibbon's adaption of Arksey and O'Malley's scoping review methodology. Relevant articles will be identified through a systematic search of the gray literature, core Indigenous health journals, and online databases including Scopus, MEDLINE, Embase, CINAHL, AgeLine, Academic Search Complete, Bibliography of Native North Americans, Canadian Reference Centre, and PsycINFO. Qualitative and mixed-methods research articles will be included if the researchers involved Indigenous participants or their healthcare professionals living in Turtle Island (i.e., Canada and the USA), Australia, or Aotearoa (New Zealand); use storytelling as a research method; focus on healthcare phenomena; and are written in English. Two reviewers will independently screen titles/abstracts and full-text articles. We will extract data, identify the array of storytelling approaches, and critically examine how storytelling was valued and used. An intensive collaboration will be woven throughout all review stages as academic researchers co-create this work with Indigenous patients, Elders, healthcare professionals, and administrators. Participatory strategies will include four relational gatherings throughout the project. Based on our findings, we will co-create a framework to guide the respectful use of storytelling as a method in Indigenous health research involving Indigenous and non-Indigenous peoples. DISCUSSION This work will enable us to elucidate the extent, range, and nature of storytelling within Indigenous health research, to critically reflect on how it has been and could be used, and to develop guidance for the respectful use of this method within research that involves Indigenous peoples and settlers. Our findings will enable the advancement of storytelling methods which meaningfully include Indigenous perspectives, practices, and priorities to benefit the health and wellbeing of Indigenous communities. SYSTEMATIC REVIEW PROTOCOL REGISTRATION Open Science Framework ( https://osf.io/rvf7q ).
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Affiliation(s)
- Kendra L Rieger
- School of Nursing, Trinity Western University, Langley, Canada.
| | - Sarah Gazan
- Lakota First Nation; Professional and French Language Services, Manitoba Teachers Society, Winnipeg, Canada
| | - Marlyn Bennett
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | - Mandy Buss
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Northern Connections Medical Center, Winnipeg, Canada
| | - Anna M Chudyk
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Cindy Garson
- Interlake Reserves Tribal Council, Headingley, Canada
| | - Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Tara Horrill
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Janice Linton
- Neil John Maclean Health Sciences Library, Bannatyne Campus, University of Manitoba, Winnipeg, Canada
| | - Donna Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Wanda Phillips-Beck
- First Nation Health and Social Secretariat of Manitoba, Indigenous Research Chair in Nursing, University of Manitoba, Winnipeg, Canada
| | | | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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31
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Horrill TC, Dahl L, Sanderson E, Munro G, Garson C, Fransoo R, Thompson G, Cook C, Linton J, Schultz ASH. Cancer incidence, stage at diagnosis and outcomes among Manitoba First Nations people living on and off reserve: a retrospective population-based analysis. CMAJ Open 2019; 7:E754-E760. [PMID: 31852681 PMCID: PMC6934385 DOI: 10.9778/cmajo.20190176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Substantial cancer-related disparities exist between First Nations and non-Indigenous Canadians. The objectives of this study were to compare cancer incidence, stage at diagnosis and mortality outcomes between Status First Nations people living on reserve and off reserve in Manitoba. METHODS We conducted a retrospective analysis of population-level administrative health databases in Manitoba. Cancers diagnosed between Apr. 1, 2004, and Mar. 31, 2011, were linked with the Indian Registry System and 5 provincial databases. We compared differences in baseline characteristics, cancer incidence, site and stage at diagnosis between Status First Nations patients living on and off reserve. Linear regression models examined trends in annual cancer incidence. Cox proportional hazard regression models examined mortality. RESULTS There were 1524 newly diagnosed cancers among Status First Nations people in Manitoba between Apr. 1, 2004, and Mar. 31, 2011. First Nations people living on reserve were significantly older than those living off reserve (p < 0.001) and had higher Charlson Comorbidity Index scores at diagnosis (p = 0.01). A lower proportion of on-reserve patients than off-reserve patients were diagnosed with stage I cancers (21.7% v. 26.9%, p = 0.02). There were no differences in annual cancer incidence between groups. The adjusted incidence of cancer over the combined study years was higher in the off-reserve group than in the on-reserve group (287.9 v. 247.9 per 100 000, p = 0.02). No significant differences in mortality were found. INTERPRETATION The lower proportion of on-reserve patients diagnosed with cancer at stage I is concerning, as it suggests less access to screening services or delays in diagnosis. Further research is needed to understand patterns in diagnosis and differences in cancer site and overall cancer incidence between First Nations people living on and off reserve.
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Affiliation(s)
- Tara C Horrill
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
| | - Lindsey Dahl
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Esther Sanderson
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Garry Munro
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Cindy Garson
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Randy Fransoo
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Genevieve Thompson
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Catherine Cook
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Janice Linton
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Annette S H Schultz
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
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