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Bourke L, Merchant N, Matthews S, Fitts M, Liddle Z, Russell D, Murakami-Gold L, Campbell N, Rossingh B, Wakerman J. Who is suited to work in remote First Nations health? Perspectives of staff in remote Aboriginal Community-Controlled Health Services in northern Australia. Aust J Rural Health 2024. [PMID: 39133546 DOI: 10.1111/ajr.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/11/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE There is a shortage of nurses, Aboriginal Health Practitioners, GPs and other staff in remote Australian health clinics. There is also high turnover of staff, leading to questions of 'who' is appropriate for remote First Nations practice? The aim of this paper was to identify the characteristics of staff who are likely to work well in remote First Nations settings, from the perspectives of remote health practitioners. DESIGN This is a qualitative study involving content analysis of interviews. SETTING The study is conducted in and with 11 Aboriginal Community Controlled Health Services across northern and central Australia. PARTICIPANTS Eighty-four staff working in these clinics who spoke about staff qualities suited to remote practice. RESULTS Participants identified a range of qualities desirable in remote practitioners, which were grouped into three topics: (1) professional qualifications and experience, including cultural skills; (2) ways of working, including holisitic approach, resilience, competence, and being a team player, approachable, flexible and hard-working; and (3) specific community needs, namely the need for local First Nations staff, male practitioners and returning short-term staff. The combination of experiences, ways of working, and fit to both the team and community were emphasised. CONCLUSION Identifying the characteristics of staff who are likely to work well in these settings can inform recruitment strategies. This study found that a combination of professional qualifications, skills and experience as well as ways of working, individual characteristics and needs of communities are desirable for working in remote, First Nations settings.
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Affiliation(s)
- Lisa Bourke
- Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Noha Merchant
- Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Supriya Matthews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Michelle Fitts
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Deb Russell
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lorna Murakami-Gold
- Poche Centre, Flinders University, Alice Springs, Northern Territory, Australia
| | - Narelle Campbell
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Bronwyn Rossingh
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Meharg DP, Dennis SM, McNab J, Gwynne KG, Jenkins CR, Maguire GP, Jan S, Shaw T, McKeough Z, Rambaldini B, Lee V, McCowen D, Newman J, Longbottom H, Eades S, Alison JA. A Qualitative Study of Aboriginal Peoples' Health Care Experiences With Chronic Obstructive Pulmonary Disease. QUALITATIVE HEALTH RESEARCH 2024:10497323241259891. [PMID: 39117016 DOI: 10.1177/10497323241259891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Aboriginal Australians experience a high prevalence of chronic obstructive pulmonary disease (COPD), with high rates of potentially preventable hospitalisations. However, little is known about Aboriginal peoples' experiences of living with COPD and how they navigate health care systems. This study used thematic analysis and Aboriginal methodology to explore Aboriginal peoples' lived experiences of COPD, their health care journey from receiving a diagnosis of COPD to the clinical management, and the impact of COPD on their daily lives. We conducted in-depth semi-structured interviews over a 6-month period with 18 Aboriginal adults diagnosed with COPD from four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. Reflexive thematic analysis was employed to ensure rigour. The findings revealed deeply personal and reflective stories shaped by historical, social, and cultural realities of Aboriginal peoples living with COPD. Four themes were identified characterising their experiences. Based on the findings, the following guidance is provided on future COPD care for Aboriginal peoples: Better alignment of existing COPD management with Aboriginal peoples' cultural contexts and perspectives to improve access to culturally safe care; Increased funding for ACCHS to enhance COPD management, such as early detection through case finding and access to ACCHS-led pulmonary rehabilitation; Engaging family members in COPD management and providing culturally centred COPD education that facilitates discussions and builds health literacy and self-management skills; Implementing health promotion initiatives to increase awareness and counteract fear and shame to improve early COPD detection.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Justin McNab
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- University of New South Wales, Sydney, Kensington, NSW, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, Australia
| | - Hayley Longbottom
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, NSW, Australia
| | - Sandra Eades
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Centre for Epidemiology and Biostatistics, The School of Population and Global Health, The University of Melbourne, Carlton South, VIC, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
- Sydney Local Health District, Camperdown, NSW, Australia
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3
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Aryal S, Bennett PN, Bloomer MJ. Culturally responsive care in haemodialysis: A scoping review. J Clin Nurs 2024. [PMID: 39007168 DOI: 10.1111/jocn.17373] [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: 04/02/2024] [Revised: 05/30/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
AIM To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres. BACKGROUND Culturally diverse individuals receiving in-centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care. METHOD A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data. RESULTS From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training. CONCLUSION While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person-centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative. RELEVANCE TO CLINICAL PRACTICE Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3.
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Affiliation(s)
- Sara Aryal
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Paul N Bennett
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia
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Arnold-Ujvari M, Rix E, Kelly J. The emergence of cultural safety within kidney care for Indigenous Peoples in Australia. Nurs Inq 2024; 31:e12626. [PMID: 38476033 DOI: 10.1111/nin.12626] [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: 07/31/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
Cultural safety is increasingly recognised as imperative to delivering accessible and acceptable healthcare for First Nations Peoples within Australia and in similar colonised countries. A literature review undertaken to inform the inaugural Caring for Australians with Renal Insufficiency (CARI) guidelines for clinically and culturally safe kidney care for Aboriginal and Torres Strait Islander peoples revealed a timeline of the emergence of culturally safe kidney care in Australia. Thirty years ago, kidney care literature was purely biomedically focused, with culture, family and community viewed as potential barriers to patient 'compliance' with treatment. The importance of culturally informed care was increasingly recognised in the mid-1990s, with cultural safety within kidney care specifically cited from 2014 onwards. The emergence timeline is discussed in this paper in relation to the five principles of cultural safety developed by Māori nurse Irihapeti Ramsden in Aotearoa/New Zealand. These principles are critical reflection, communication, minimising power differences, decolonisation and ensuring one does not demean or disempower. For the kidney care workforce, culturally safe care requires ongoing critical reflection, deep active listening skills, decolonising approaches and the eradication of institutional racism. Cultural safety is the key to truly working in partnership, increasing Indigenous Governance, respectful collaboration and redesigning kidney care.
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Affiliation(s)
- Melissa Arnold-Ujvari
- Adelaide Nursing School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth Rix
- Adelaide Nursing School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Kelly
- Adelaide Nursing School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
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5
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Kerr M, Jaure A, Stephens JH, Kim S, Cutler R, Cashmore B, Dickson M, Evangelidis N, Hughes JT, Roberts I, Scholes-Robertson N, Sinka V, Craig JC. Experiences of Indigenous Patients Receiving Dialysis: Systematic Review of Qualitative Studies. Am J Kidney Dis 2024; 83:139-150.e1. [PMID: 37730171 DOI: 10.1053/j.ajkd.2023.07.014] [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: 04/03/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 09/22/2023]
Abstract
RATIONALE & OBJECTIVE Indigenous People suffer a high burden of kidney disease. Those receiving maintenance dialysis have worse outcomes compared with similarly treated non-Indigenous patients. We characterized the experiences of Indigenous patients receiving dialysis in British-colonized countries to gain insights into which aspects of kidney care may benefit from improvement. STUDY DESIGN A systematic review of published qualitative interview studies. SETTING & STUDY POPULATIONS Indigenous Peoples aged 18 years and over, receiving hemodialysis or peritoneal dialysis in British-colonized countries. SELECTION CRITERIA FOR STUDIES Search terms for Indigenous Peoples, dialysis, and qualitative research were entered into Medline, Embase, PsycINFO, and CINAHL and searched from inception to January 5, 2023. DATA EXTRACTION Characteristics of each study were extracted into Microsoft Excel for quality assessment. ANALYTICAL APPROACH Data were analyzed using thematic synthesis. RESULTS The analysis included 28 studies involving 471 participants from Australia, New Zealand, Canada, and the United States. We identified four themes: centrality of family and culture (continuing dialysis for family, gaining autonomy through shared involvement, balancing primary responsibility to care for family); marginalization due to structural and social inequities (falling through gaps in primary care intensifying shock, discriminated against and judged by specialists, alienated and fearful of hospitals, overwhelmed by travel, financial and regimental burdens); vulnerability in accessing health care (need for culturally responsive care, lack of language interpreters, without agency in decision-making, comorbidities compounding complexity of self-management); and distress from separation from community (disenfranchisement and sorrow when away for dialysis, inability to perpetuate cultural continuity, seeking a kidney transplant). LIMITATIONS We only included articles published in English. CONCLUSIONS Indigenous patients receiving dialysis experience inequities in health care that compound existing accessibility issues caused by colonization. Improving the accessibility and cultural responsiveness of dialysis and kidney transplant services in collaboration with Indigenous stakeholders holds promise to enhance the experience of Indigenous patients receiving dialysis. PLAIN-LANGUAGE SUMMARY Worldwide Indigenous populations suffer a high incidence of chronic disease leading to lower life expectancy, particularly for kidney disease, an insidious condition requiring long-term dialysis treatment. By listening to Indigenous dialysis patients' stories, we hoped to understand how to improve their experience. We gathered 28 qualitative research studies from four countries reporting Indigenous adults' experiences of dialysis. They described lacking awareness of kidney disease, poor access to health services, systemic racism, inadequate cultural safety, and being dislocated from family, community, and culture. These findings indicate that respectful collaboration with Indigenous Peoples to craft and implement policy changes holds promise to improve prevention, integrate culturally responsive health care practices, and provide better access to local dialysis services and opportunities for kidney transplants.
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Affiliation(s)
- Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Jaure
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jacqueline H Stephens
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Richard Cutler
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Brydee Cashmore
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Michelle Dickson
- Poche Centre for Indigenous Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jaquelyne T Hughes
- College of Medicine and Public Health, Rural and Remote Health, Flinders University, Adelaide, Australia
| | - Ieyesha Roberts
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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6
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Tunnicliffe DJ, Bateman S, Arnold‐Chamney M, Dwyer KM, Howell M, Gebadi A, Jesudason S, Kelly J, Lambert K, Majoni SW, Oliva D, Owen KJ, Pearson O, Rix E, Roberts I, Stirling‐Kelly R, Taylor K, Wittert GA, Widders K, Yip A, Craig J, Phoon RK. Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary. Med J Aust 2023; 219:374-385. [PMID: 37838977 PMCID: PMC10952490 DOI: 10.5694/mja2.52114] [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: 12/05/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. MAIN RECOMMENDATIONS These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. CHANGES IN MANAGEMENT AS RESULT OF THE GUIDELINES Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
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Affiliation(s)
- David J Tunnicliffe
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Samantha Bateman
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and Transplantation Services, Central Adelaide Local Health NetworkAdelaideSA
| | | | | | - Martin Howell
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Azaria Gebadi
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | | | | | - Kelly Lambert
- University of WollongongWollongongNSW
- Illawarra Health and Medical Research InstituteUniversity of WollongongWollongongNSW
| | | | - Dora Oliva
- Drug and Alcohol Services, South Australia HealthAdelaideSA
| | - Kelli J Owen
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and TransplantationRoyal Adelaide HospitalAdelaideSA
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research InstituteAdelaideSA
- Cancer Research InstituteUniversity of South AustraliaAdelaideSA
| | - Elizabeth Rix
- University of AdelaideAdelaideSA
- Southern Cross UniversityLismoreNSW
| | - Ieyesha Roberts
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Ro‐Anne Stirling‐Kelly
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
- NSW Health Mid‐North Coast Local Health DistrictSydneyNSW
| | - Kimberly Taylor
- Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research InstituteAdelaideSA
| | - Gary A Wittert
- University of AdelaideAdelaideSA
- Royal Adelaide HospitalAdelaideSA
| | - Katherine Widders
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Adela Yip
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
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7
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Wray J, Kim JS, Marks SD. Cultural and other beliefs as barriers to pediatric solid organ transplantation. Pediatr Transplant 2023; 27 Suppl 1:e14337. [PMID: 36468332 DOI: 10.1111/petr.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
Abstract
Organ shortage for transplantation is a global problem for both adult and pediatric recipients and this is particularly apparent in certain areas of the world and within specific communities. Cultural and religious beliefs can influence both a decision by a potential donor and/or their family to donate as well as a potential recipient's or their family's decision to accept the need for transplantation, agree to be listed and accept an organ. Globally, there are cultural and religious diversities that can present significant challenges for the transplant professional, particularly those whose practice is based in multicultural communities. In the pediatric population, in particular, barriers to organ transplantation related to culture and religion have not been well-described, with resulting implications for how they should or could be effectively addressed. Therefore, this review was undertaken to elucidate cultural and religious barriers to pediatric organ transplantation and, where feasible, to identify facilitators and strategies for overcoming these barriers.
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Affiliation(s)
- Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ji Soo Kim
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephen D Marks
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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8
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Caruana L, Nichols L, Lambert K. Malnutrition, symptom burden and predictive validity of the Patient-Generated Subjective Global Assessment in Central Australian haemodialysis patients: A cross sectional study. Nutr Diet 2022; 79:555-562. [PMID: 35903960 PMCID: PMC9796483 DOI: 10.1111/1747-0080.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 01/01/2023]
Abstract
AIM To (i) describe the prevalence of malnutrition among a cohort of central Australian, predominantly Indigenous, haemodialysis patients and (ii) determine the sensitivity and specificity of the Patient Generated Subjective Global Assessment total score for identification of malnutrition in these patients. METHODS Cross-sectional observational study of all patients attending haemodialysis units within the Central Australia Health Service. Patients were assessed using the Patient-Generated Subjective Global Assessment. Chi-Square tests were used to determine the association between nutritional status and location, age and gender. Receiver Operator Characteristic curves were used to ascertain the predictive validity for malnutrition of the total score. RESULTS Indigenous patients comprised 98% of study haemodialysis patients (n = 249/253). One third were male, and 72% were aged between 30 and 59 years. Approximately 29% (74/253) were malnourished, and 93% (69/74) had a total score ≥ 4. The most frequently reported problems that kept malnourished patients from eating were early satiety (32%), no appetite (31%), diarrhoea (26%) and dental problems (24%). Money problems were reported by 32%, as were transport (20%) and depression (19%). The traditional tool cut off score of ≥9 had low sensitivity (50%) for detecting malnutrition. Instead, a score ≥ 3 is suggested due to a higher sensitivity (96%) and specificity (45%). CONCLUSION Malnutrition was found to be common, and we suggest using a Patient-Generated Subjective Global Assessment total score of ≥3 to improve the identification of malnourished individuals in this cohort of predominantly Indigenous haemodialysis patients. This will significantly increase referrals for dietetic intervention.
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Affiliation(s)
| | - Liz Nichols
- Department of Nutrition & DieteticsAlice Springs HospitalThe GapNorthern TerritoryAustralia
| | - Kelly Lambert
- University of WollongongWollongongNew South WalesAustralia
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9
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Kelly J, Stevenson T, Arnold-Chamney M, Bateman S, Jesudason S, McDonald S, O'Donnell K, Pearson O, Sinclair N, Williamson I. Aboriginal patients driving kidney and healthcare improvements: recommendations from South Australian community consultations. Aust N Z J Public Health 2022; 46:622-629. [PMID: 35797067 DOI: 10.1111/1753-6405.13279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/01/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the experiences, perceptions and suggested improvements in healthcare identified by Aboriginal patients, families and community members living with kidney disease in South Australia. METHODS Community consultations were held in an urban, rural and remote location in 2019 by the Aboriginal Kidney Care Together - Improving Outcomes Now (AKction) project and Kidney Health Australia. Consultations were co-designed with community members, using participatory action research, Yarning, Dadirri and Ganma Indigenous Methodologies. Key themes were synthesised, verified by community members and shared through formal and community reports and media. RESULTS Aboriginal participants identified the importance of: family and community and maintaining their wellbeing, strength and resilience; the need for prevention and early detection that is localised, engages whole families and prevents diagnosis shock; better access to quality care that ensures Aboriginal people can make informed choices and decisions about their options for dialysis and transplantation, and; more Aboriginal health professionals and peer navigators, and increased responsiveness and provision of cultural safety care by all kidney health professionals. CONCLUSION Aboriginal community members have strong and clear recommendations for improving the quality and responsiveness of health care generally, and kidney care specifically. IMPLICATIONS FOR PUBLIC HEALTH Aboriginal people with lived experience of chronic conditions wish to significantly inform the way care is organised and delivered.
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Affiliation(s)
- Janet Kelly
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Tahlee Stevenson
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | | | - Samantha Bateman
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital
| | - Stephen McDonald
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital
| | - Kim O'Donnell
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Odette Pearson
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
- South Australian Health and Medical Research Institute, Adelaide
| | - Nari Sinclair
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
- AKction Community Reference Group, University of Adelaide, South Australia
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10
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Kennedy M, Maddox R, Booth K, Maidment S, Chamberlain C, Bessarab D. Decolonising qualitative research with respectful, reciprocal, and responsible research practice: a narrative review of the application of Yarning method in qualitative Aboriginal and Torres Strait Islander health research. Int J Equity Health 2022; 21:134. [PMID: 36100899 PMCID: PMC9472448 DOI: 10.1186/s12939-022-01738-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Indigenous academics have advocated for the use and validity of Indigenous methodologies and methods to centre Indigenous ways of knowing, being and doing in research. Yarning is the most reported Indigenous method used in Aboriginal and Torres Strait Islander qualitative health research. Despite this, there has been no critical analysis of how Yarning methods are applied to research conduct and particularly how they privilege Indigenous peoples. OBJECTIVE To investigate how researchers are applying Yarning method to health research and examine the role of Aboriginal and Torres Strait Islander researchers in the Yarning process as reported in health publications. DESIGN Narrative review of qualitative studies. DATA SOURCES Lowitja Institute LitSearch January 2008 to December 2021 to access all literature reporting on Aboriginal and Torres Strait Islander health research in the PubMed database. A subset of extracted data was used for this review to focus on qualitative publications that reported using Yarning methods. METHODS Thematic analysis was conducted using hybrid of inductive and deductive coding. Initial analysis involved independent coding by two authors, with checking by a third member. Once codes were developed and agreed, the remaining publications were coded and checked by a third team member. RESULTS Forty-six publications were included for review. Yarning was considered a culturally safe data collection process that privileges Indigenous knowledge systems. Details of the Yarning processes and team positioning were vague. Some publications offered a more comprehensive description of the research team, positioning and demonstrated reflexive practice. Training and experience in both qualitative and Indigenous methods were often not reported. Only 11 publications reported being Aboriginal and/or Torres Strait Islander led. Half the publications reported Aboriginal and Torres Strait Islander involvement in data collection, and 24 reported involvement in analysis. Details regarding the role and involvement of study reference or advisory groups were limited. CONCLUSION Aboriginal and Torres Strait Islander people should be at the forefront of Indigenous research. While Yarning method has been identified as a legitimate research method to decolonising research practice, it must be followed and reported accurately. Researcher reflexivity and positioning, and Aboriginal and Torres Strait Islander ownership, stewardship and custodianship of data collected were significantly under detailed in the publications included in our review. Journals and other establishments should review their processes to ensure necessary details are reported in publications and engage Indigenous Editors and peer reviewers to uphold respectful, reciprocal, responsible and ethical research practice.
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Affiliation(s)
- Michelle Kennedy
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Raglan Maddox
- National Centre for Epidemiology and Public Health, The Australian National University, Canberra ACT, Australia
| | - Kade Booth
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sian Maidment
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Catherine Chamberlain
- School of Population and Global Health, Centre for Health Equity, University of Melbourne, Melbourne, VIC, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, WA, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, UWA Medical School, Crawley, WA, Australia
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Kerr M, Evangelidis N, Abbott P, Craig JC, Dickson M, Scholes-Robertson N, Sinka V, Vastani RT, Widders K, Stephens J, Tong A. Indigenous peoples' perspectives of living with chronic kidney disease: systematic review of qualitative studies. Kidney Int 2022; 102:720-727. [PMID: 35788358 DOI: 10.1016/j.kint.2022.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Nicole Evangelidis
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Penrith, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Rahim T Vastani
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katherine Widders
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jacqueline Stephens
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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12
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Sobels E, Best M, Chadban S, Pais R. End Stage Kidney Disease Patient Experiences of Renal Supportive Care in an Australian Teaching Hospital - A Qualitative Study. J Pain Symptom Manage 2022; 63:737-746. [PMID: 34954064 DOI: 10.1016/j.jpainsymman.2021.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Renal Supportive Care Services (RSCS) were introduced in Australia to provide patient-centred care with a focus on better symptom management and improved quality of life in end stage kidney disease (ESKD) patients managed with or without dialysis. While RSCS have demonstrated clinical benefits with reduced length of hospital stay and symptom burden, there is a gap in understanding the experience of patients referred to RSCS. OBJECTIVES To identify patient attitudes, beliefs, and perspectives on the RSCS. METHODS Qualitative interviews were conducted with 20 participants from both dialysis and conservative treatment pathways. Transcripts were then thematically analysed and primary themes identified, which were reviewed with a stakeholder group that included doctors, nurses and allied health staff to provide triangulation. RESULTS Patients perceived the RSCS as a provider of multidisciplinary, holistic and patient-centred care that, in addition, helped to ensure prognostic awareness and timely end-of-life care planning. This contributed to an overall sense of patient empowerment with healthcare decisions. This study identified three major themes: (1) Expectations of care; (2) Experience of care; and (3) Understanding patient needs. CONCLUSION The study found that RSCS support patient-centred and family-orientated initiatives in decision making and control over healthcare management. This is empowering for patients. Additional patient values, needs and wants from the RSCS were also identified and these could be addressed to improve the patient experience. Our findings support the ongoing use of RSCS to improve the experience of ESKD patients.
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Affiliation(s)
- Eloise Sobels
- Central Clinical School (E.S.), University of Sydney, Sydney, Australia.
| | - Megan Best
- Department of Palliative Medicine (M.B., R.P.), Royal Prince Alfred Hospital, Sydney, Australia; Institute for Ethics and Society (M.B.), University of Notre Dame Australia, Sydney, Australia
| | - Steve Chadban
- Department of Renal Medicine (S.C., R.P.), Royal Prince Alfred Hospital, Sydney, Australia; Kidney Node, Charles Perkins Centre (S.C.), University of Sydney, Sydney, Australia
| | - Riona Pais
- Department of Palliative Medicine (M.B., R.P.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Renal Medicine (S.C., R.P.), Royal Prince Alfred Hospital, Sydney, Australia
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13
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De Zilva S, Walker T, Palermo C, Brimblecombe J. Culturally safe health care practice for Indigenous Peoples in Australia: A systematic meta-ethnographic review. J Health Serv Res Policy 2021; 27:74-84. [PMID: 34875923 DOI: 10.1177/13558196211041835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Culturally safe health care services contribute to improved health outcomes for Aboriginal and Torres Strait Islander Peoples in Australia. Yet there has been no comprehensive systematic review of the literature on what constitutes culturally safe health care practice. This gap in knowledge contributes to ongoing challenges providing culturally safe health services and policy. This review explores culturally safe health care practice from the perspective of Indigenous Peoples as recipients of health care in Western high-income countries, with a specific focus on Australian Aboriginal and Torres Strait Islander Peoples. METHODS A systematic meta-ethnographic review of peer-reviewed literature was undertaken across five databases: Ovid MEDLINE, Scopus, PsychINFO, CINAHL Plus and Informit. Eligible studies included Aboriginal and Torres Strait Islander Peoples receiving health care in Australia, had a focus on exploring health care experiences, and a qualitative component to study design. Two authors independently determined study eligibility (5554 articles screened). Study characteristics and results were extracted and quality appraisal was conducted. Data synthesis was conducted using meta-ethnography methodology, contextualised by health care setting. RESULTS Thirty-four eligible studies were identified. Elements of culturally safe health care identified were inter-related and included personable two-way communication, a well-resourced Indigenous health workforce, trusting relationships and supportive health care systems that are responsive to Indigenous Peoples' cultural knowledge, beliefs and values. CONCLUSIONS These elements can form the basis of interventions and strategies to promote culturally safe health care practice and systems in Australia. Future cultural safety interventions need to be rigorously evaluated to explore their impact on Indigenous Peoples' satisfaction with health care and improvements in health care outcomes.
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Affiliation(s)
- Stephanie De Zilva
- Department of Nutrition Dietetics and Food, 22457Monash University, Victoria, VIC, Australia
| | - Troy Walker
- Department of Nutrition Dietetics and Food, 22457Monash University, Victoria, VIC, Australia.,Deakin University, 22457Geelong, Australia
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, 22457Monash University, Victoria, Australia
| | - Julie Brimblecombe
- Department of Nutrition Dietetics and Food, 22457Monash University, Victoria, VIC, Australia.,22457Menzies School of Health Research, Australia
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14
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Huria T, Pitama SG, Beckert L, Hughes J, Monk N, Lacey C, Palmer SC. Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies. BMC Public Health 2021; 21:1447. [PMID: 34301234 PMCID: PMC8299576 DOI: 10.1186/s12889-021-11180-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples. METHODS We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was conducted to 31 December 2019. Eligible studies were quantitative analyses (case series, case-control, cross-sectional or cohort study) including the following Indigenous Peoples: Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan. In the first cycle of coding, a descriptive synthesis of the study research aims, methods and outcomes was used to categorise findings inductively based on similarity in meaning using the David R Williams framework headings and subheadings. In the second cycle of analysis, the numbers of studies contributing to each category were summarised by frequency analysis. Completeness of reporting related to health research involving Indigenous Peoples was evaluated using the CONSIDER checklist. RESULTS Four thousand three hundred seventy-two unique study reports were screened and 180 studies proved eligible. The key finding was that epidemiological investigators most frequently reported biological processes of chronic kidney disease, particularly type 2 diabetes and cardiovascular disease as the principal causes of inequities in the burden of chronic kidney disease for colonised Indigenous Peoples. Social and basic causes of unequal health including the influences of economic, political and legal structures on chronic kidney disease burden were infrequently reported or absent in existing literature. CONCLUSIONS In this systematic review with meta-synthesis, a Kaupapa Māori methodology and the David R Williams framework was used to evaluate reported causes of health differences in chronic kidney disease in Indigenous Peoples. Current epidemiological practice is focussed on biological processes and surface causes of inequity, with limited reporting of the basic and social causes of disparities such as racism, economic and political/legal structures and socioeconomic status as sources of inequities.
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Affiliation(s)
- Tania Huria
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand.
| | - Suzanne G Pitama
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Nathan Monk
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Cameron Lacey
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Gatwiri K, Rotumah D, Rix E. BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094399. [PMID: 33919080 PMCID: PMC8122304 DOI: 10.3390/ijerph18094399] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
Despite decades of evidence showing that institutional and interpersonal racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience 'epidemic' levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of 'doing' healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.
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Affiliation(s)
- Kathomi Gatwiri
- Center for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia
- Correspondence:
| | - Darlene Rotumah
- Gnibi College, Southern Cross University, Gold Coast, QLD 4225, Australia;
| | - Elizabeth Rix
- Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia;
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Sinka V, Lopez-Vargas P, Tong A, Dickson M, Kerr M, Sheerin N, Blazek K, Teixeira-Pinto A, Stephens JH, Craig JC. Chronic disease prevention programs offered by Aboriginal Community Controlled Health Services in New South Wales, Australia. Aust N Z J Public Health 2021; 45:59-64. [PMID: 33559961 DOI: 10.1111/1753-6405.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify and describe chronic disease prevention programs offered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia. METHODS ACCHSs were identified through the Aboriginal Health and Medical Research Council of NSW website. Chronic disease programs were identified from the Facebook page and website of each ACCHS. Characteristics, including regions, target population, condition, health behaviour, modality and program frequency were extracted and summarised. RESULTS We identified 128 chronic disease programs across 32 ACCHSs. Of these, 87 (68%) programs were broad in their scope, 20 (16%) targeted youth, three (2%) targeted Elders, 16 (12%) were for females only and five (4%) were for males only. Interventions included physical activity (77, 60%), diet and nutrition (74, 58%), smoking (70, 55%), and the Aboriginal and Torres Strait Islander Health Check (44, 34%), with 93 programs (73%) of ongoing duration. CONCLUSIONS Chronic disease prevention programs address chronic conditions by promoting physical activity, diet and nutrition, smoking cessation and health screening. Most target the general Aboriginal community, a few target specific groups based on gender and age, and more than one-quarter are time-limited. Implications for public health: Chronic disease programs that are co-produced with specific groups, based on age and gender, may be needed.
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Affiliation(s)
- Victoria Sinka
- Sydney School of Public Health, The University of Sydney, New South Wales
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Pamela Lopez-Vargas
- Sydney School of Public Health, The University of Sydney, New South Wales
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Noella Sheerin
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Katrina Blazek
- Sydney School of Public Health, The University of Sydney, New South Wales
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, New South Wales
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales
| | - Jacqueline H Stephens
- College of Medicine and Public Health, Flinders University, South Australia
- Flinders Health and Medical Research Institute, Flinders University, South Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, South Australia
- Flinders Health and Medical Research Institute, Flinders University, South Australia
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Jones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. Int J Equity Health 2020; 19:222. [PMID: 33317556 PMCID: PMC7734845 DOI: 10.1186/s12939-020-01334-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/26/2020] [Indexed: 11/11/2022] Open
Abstract
Background It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. Methods A systematic search strategy was developed and applied to six electronic databases between January 2000 and July 2019. Titles and abstracts were screened before applying the inclusion criteria to full text articles. A meta-narrative synthesis was undertaken. Results Fifty-four publications were identified from four research traditions; each with a unique conceptualisation of patient experience. Three themes emerged that demonstrate Aboriginal and Torres Strait Islander patient experiences are informed by 1) beliefs about wellbeing and healthcare provision, 2) their level of trust in the healthcare system, and 3) individual and community health system interactions. The findings highlight a range of aspects of patient experience that were important to participating Aboriginal and Torres Strait Islanders in the included studies but not captured currently in health system surveys. Conclusion This review highlights the influence of beliefs about health and wellbeing on the patient experience amongst Aboriginal and Torres Strait Islander populations in the Australian health system. Patient experiences were informed by past experience and their trust in the health system. The different factors influencing patient experience and the gravity of their influence must be considered in current approaches to capturing patient experience data collection methods. Trial registration PROSPERO (ID: CRD42019134765).
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Affiliation(s)
- Benjamin Jones
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - David Heslop
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia.
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Scholes-Robertson NJ, Howell M, Gutman T, Baumgart A, SInka V, Tunnicliffe DJ, May S, Chalmers R, Craig J, Tong A. Patients' and caregivers' perspectives on access to kidney replacement therapy in rural communities: systematic review of qualitative studies. BMJ Open 2020; 10:e037529. [PMID: 32967878 PMCID: PMC7513603 DOI: 10.1136/bmjopen-2020-037529] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) requiring kidney replacement therapy (KRT) in rural communities encounter many barriers in accessing equitable care and have worse outcomes compared with patients in urban areas. This study aims to describe the perspectives of patients and caregivers on access to KRT in rural communities to inform strategies to maximise access to quality care, and thereby reduce disadvantage, inequity and improve health outcomes. SETTING 18 studies (n=593 participants) conducted across eight countries (Australia, Canada, the UK, New Zealand, Ghana, the USA, Tanzania and India). RESULTS We identified five themes: uncertainty in navigating healthcare services (with subthemes of struggling to absorb information, without familiarity and exposure to options, grieving former roles and yearning for cultural safety); fearing separation from family and home (anguish of homesickness, unable to fulfil family roles and preserving sense of belonging in community); intense burden of travel and cost (poverty of time, exposure to risks and hazards, and taking a financial toll); making life-changing sacrifices; guilt and worry in receiving care (shame in taking resources from others, harbouring concerns for living donor, and coping and managing in isolation). CONCLUSION Patients with CKD in rural areas face profound and inequitable challenges of displacement, financial burden and separation from family in accessing KRT, which can have severe consequences on their well-being and outcomes. Strategies are needed to improve access and reduce the burden of obtaining appropriate KRT in rural communities.
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Affiliation(s)
- Nicole Jane Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria SInka
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen May
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Rachel Chalmers
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Richels L, Sutherland W, Prettyshield K, Kappel J, McCarron M, Richardson B. Community-Based Dialysis in Saskatchewan First Nations: A Grassroots Approach to Gaining Insight and Perspective From First Nations Patients With Chronic Kidney Disease. Can J Kidney Health Dis 2020; 7:2054358120914689. [PMID: 32489670 PMCID: PMC7241204 DOI: 10.1177/2054358120914689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Renal replacement options or dialysis can be delivered in the home setting or hospital setting. Home dialysis offers a number of benefits over hospital-delivered dialysis. These advantages include improved quality of life, less travel, and fewer dietary restrictions. Despite the benefits, home-based dialysis therapies are significantly underutilized by First Nations with only 16.2% uptake versus 25.7% uptake in non-First Nations people in Saskatchewan. It is important to recognize that First Nations have a greater burden of end-stage renal disease including higher prevalence, younger age at diagnosis, increased severity of disease, mortality at an earlier age, and increased travel distance to access kidney services. OBJECTIVE The goal of this study is to identify the existing barriers to home peritoneal dialysis and provide insight for future programs in Saskatchewan First Nations communities in a culturally meaningful framework. DESIGN Through qualitative research utilizing sharing circles and individual interviews, barriers to utilizing home-based dialysis were identified. SETTING Four sharing circles were held and interviews were conducted with four First Nations dialysis patients. PARTICIPANTS Total number of participants in sharing circles were 67. Sharing circles were composed of patients with chronic kidney disease, patients on hospital-based dialysis, patients on home-based peritoneal dialysis, family members, health care providers (nurses, physicians, dietitians, primary care director, and coordinators). Face-to-face interviews were conducted with four First Nations dialysis patients. MEASUREMENTS The data from the sharing circles and interviews were transcribed and analyzed by a PhD researcher using constructivist grounded theory, with elements of narrative inquiry to ascertain participants' experiences of care. Data were coded and then grouped into categories using qualitative research software NVivo. Saturation of data was achieved. METHODS Documenting and recounting patient and community experience with chronic kidney disease through sharing circles involving patients, family members, and health care providers has been the central information base for this project. Qualitative interviews were conducted with patients who currently use home dialysis and those who travel to hospital for dialysis. Written consent was obtained from all participants. Information was gathered via audio recording of all sharing circles and interviews. Transcription of the interviews was completed with confidentiality maintained during transcription. RESULTS The main theme of our results was addressing the underutilization of home-based peritoneal dialysis in First Nations Communities. Five subthemes emerged from the main theme and included logistics, education and information, training and support, community support, and culture and leadership. Through sharing circles, a secondary theme of observations about living with chronic kidney disease and experiences of being on dialysis was explored. LIMITATIONS A small number of First Nations communities were involved in this project, and although the data reached saturation, we cannot presume that the information is representative of all First Nations in Saskatchewan. There were a limited number of patients currently on home-based peritoneal dialysis, and therefore their perceptions may not be adequately captured. Participant characteristics (patient, caregiver, nurse, etc) were not captured when speaking in the sharing circles, and therefore participants are not classified when quoted. CONCLUSIONS Strategies to help improve home-based dialysis included improved education, local support, integrated traditional medicine, cultural sensitivity, and leadership prioritization.
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Affiliation(s)
- Lindsay Richels
- College of Medicine, University of Saskatchewan, Regina, Canada
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Strobel N, Moylan C, Durey A, Edmond K, McAuley K, McAullay D. Understanding an Aboriginal and Torres Strait Islander child’s journey through paediatric care in Western Australia. Aust N Z J Public Health 2020; 44:95-101. [DOI: 10.1111/1753-6405.12974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Carol Moylan
- Medical SchoolUniversity of Western Australia
- Poche Centre for Indigenous HealthUniversity of Western Australia
| | | | - Karen Edmond
- Medical SchoolUniversity of Western Australia
- Kings College London UK
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Yashadhana A, Lee L, Massie J, Burnett A. Non‐clinical eye care support for Aboriginal and Torres Strait Islander Australians: a systematic review. Med J Aust 2020; 212:222-228. [DOI: 10.5694/mja2.50480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Aryati Yashadhana
- University of New South Wales Sydney NSW
- Brien Holden Vision Institute Sydney NSW
| | - Ling Lee
- University of New South Wales Sydney NSW
- Brien Holden Vision Institute Sydney NSW
| | | | - Anthea Burnett
- University of New South Wales Sydney NSW
- Brien Holden Vision Institute Sydney NSW
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Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliat Care 2019; 18:21. [PMID: 30764810 PMCID: PMC6376644 DOI: 10.1186/s12904-019-0404-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. Methods We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts. Results The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. Discussion Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. Conclusions Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.
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Affiliation(s)
- Kaela Schill
- Cumming School of Medicine, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Susana Caxaj
- School of Nursing, Faculty of Health and Social Development, Okanagan Campus, University of British Columbia, Kelowna, British Columbia, Canada
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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Caxaj CS, Schill K, Janke R. Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e329-e336. [PMID: 28703394 DOI: 10.1111/hsc.12469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
We carried out a scoping review to identify key priorities and challenges relevant to rural Indigenous palliative care stated in existing literature. Our scoping review activities followed Arskey and O'Malley's principles for conducting a scoping review. We included peer-reviewed literature from MEDLINE, CINAHL and EMBASE that included a discussion of Indigenous populations, palliative care, and rural settings, and did not use date limits. The literature search was conducted in April 2016, and the retrieved literature was screened for relevance and appropriateness April 2016-March of 2017. In addition to the academic literature, a scan of the grey literature was conducted in March 2017. The retrieved grey literature was screened for relevance and reviewed by a team from a provincial health authority serving Indigenous peoples to ensure relevance in a rural BC setting. Once reviewed for relevance and appropriateness, we added four reports to supplement our analysis. Ultimately, 44 peer-reviewed articles and 4 pieces of grey literature met our inclusion criteria and were included in the review. Our analysis revealed several challenges and priorities relevant to rural Indigenous palliative care. Key challenges included: (i) environmental and contextual issues; (ii) institutional barriers; and (iii) interpersonal dynamics challenging client/clinician interactions. Priorities included: (i) family connections throughout the dying process; (ii) building local capacity for palliative care to provide more relevant and culturally appropriate care; and (iii) flexibility and multi-sectoral partnerships to address the complexity of day-to-day needs for patients/families. These findings point to several areas for change and action that can improve the relevance, access and comprehensiveness of palliative care programming for rural Indigenous communities in Canada and elsewhere. Taking into account of the diversity and unique strengths of each Indigenous community will be vital in developing sustainable and meaningful change.
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Affiliation(s)
- C Susana Caxaj
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Kaela Schill
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Graduate Studies, Community Health Sciences, The University of Calgary, Calgary, Alberta, Canada
| | - Robert Janke
- Library, The University of British Columbia, Kelowna, British Columbia, Canada
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Walker RC, Walker S, Morton RL, Tong A, Howard K, Palmer SC. Māori patients' experiences and perspectives of chronic kidney disease: a New Zealand qualitative interview study. BMJ Open 2017; 7:e013829. [PMID: 28104711 PMCID: PMC5253593 DOI: 10.1136/bmjopen-2016-013829] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore and describe Māori (the indigenous people of New Zealand) patients' experiences and perspectives of chronic kidney disease (CKD), as these are largely unknown for indigenous groups with CKD. DESIGN Face-to-face, semistructured interviews with purposive sampling and thematic analysis. SETTING 3 dialysis centres in New Zealand (NZ), all of which offered all forms of dialysis modalities. PARTICIPANTS 13 Māori patients with CKD and who were either nearing the need for dialysis or had started dialysis within the previous 12 months. RESULTS The Māori concepts of whakamā (disempowerment and embarrassment) and whakamana (sense of self-esteem and self-determination) provided an overarching framework for interpreting the themes identified: disempowered by delayed CKD diagnosis (resentment of late diagnosis; missed opportunities for preventive care; regret and self-blame); confronting the stigma of kidney disease (multigenerational trepidation; shame and embarrassment; fear and denial); developing and sustaining relationships to support treatment decision-making (importance of family/whānau; valuing peer support; building clinician-patient trust); and maintaining cultural identity (spiritual connection to land; and upholding inner strength/mana). CONCLUSIONS Māori patients with CKD experienced marginalisation within the NZ healthcare system due to delayed diagnosis, a focus on individuals rather than family, multigenerational fear of dialysis, and an awareness that clinicians are not aware of cultural considerations and values during decision-making. Prompt diagnosis to facilitate self-management and foster trust between patients and clinicians, involvement of family and peers in dialysis care, and acknowledging patient values could strengthen patient engagement and align decision-making with patient priorities.
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Affiliation(s)
- Rachael C Walker
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Hawke's Bay District Health Board, Hawke's Bay, Hastings, New Zealand
| | | | - Rachael L Morton
- NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
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McKercher C, Jose MD, Grace B, Clayton PA, Walter M. Gender differences in the dialysis treatment of Indigenous and non-Indigenous Australians. Aust N Z J Public Health 2016; 41:15-20. [PMID: 27960225 DOI: 10.1111/1753-6405.12621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/01/2016] [Accepted: 08/01/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non-Indigenous Australians also differs by gender. METHODS Using registry data we evaluated 21,832 incident patients (aged ≥18 years) commencing dialysis, 2001-2013. Incidence rates were calculated and multivariate regression modelling used to examine differences in dialysis treatment (modality, location and vascular access creation) by race and gender. RESULTS Dialysis incidence was consistently higher in Indigenous women compared to all other groups. Compared to Indigenous women, both non-Indigenous women and men were more likely to receive peritoneal dialysis as their initial treatment (non-Indigenous women RR=1.91, 95%CI 1.55-2.35; non-Indigenous men RR=1.73, 1.40-2.14) and were more likely to commence initial treatment at home (non-Indigenous women RR=2.07, 1.66-2.59; non-Indigenous men RR=1.95, 1.56-2.45). All groups were significantly more likely than Indigenous women to receive their final treatment at home. CONCLUSIONS Contemporary dialysis treatment in Australia continues to benefit the dominant non-Indigenous population over the Indigenous population, with non-Indigenous men being particularly advantaged. Implications for Public Health: Treatment guidelines that incorporate a recognition of gender-based preferences and dialysis treatment options specific to Indigenous Australians may assist in addressing this disparity.
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Affiliation(s)
| | - Matthew D Jose
- Menzies Institute for Medical Research, University of Tasmania.,School of Medicine, University of Tasmania.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia
| | - Blair Grace
- School of Population Health, University of Adelaide, South Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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28
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Tong A, Crowe S, Chando S, Cass A, Chadban SJ, Chapman JR, Gallagher M, Hawley CM, Hill S, Howard K, Johnson DW, Kerr PG, McKenzie A, Parker D, Perkovic V, Polkinghorne KR, Pollock C, Strippoli GFM, Tugwell P, Walker RG, Webster AC, Wong G, Craig JC. Research Priorities in CKD: Report of a National Workshop Conducted in Australia. Am J Kidney Dis 2015; 66:212-22. [PMID: 25943716 DOI: 10.1053/j.ajkd.2015.02.341] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/06/2015] [Indexed: 11/11/2022]
Abstract
Research aims to improve health outcomes for patients. However, the setting of research priorities is usually performed by clinicians, academics, and funders, with little involvement of patients or caregivers and using processes that lack transparency. A national workshop was convened in Australia to generate and prioritize research questions in chronic kidney disease (CKD) among diverse stakeholder groups. Patients with CKD (n=23), nephrologists/surgeons (n=16), nurses (n=8), caregivers (n=7), and allied health professionals and researchers (n=4) generated and voted on intervention questions across 4 treatment categories: CKD stages 1 to 5 (non-dialysis dependent), peritoneal dialysis, hemodialysis, and kidney transplantation. The 5 highest ranking questions (in descending order) were as follows: How effective are lifestyle programs for preventing deteriorating kidney function in early CKD? What strategies will improve family consent for deceased donor kidney donation, taking different cultural groups into account? What interventions can improve long-term post-transplant outcomes? What are effective interventions for post hemodialysis fatigue? How can we improve and individualize drug therapy to control post-transplant side effects? Priority questions were focused on prevention, lifestyle, quality of life, and long-term impact. These prioritized research questions can inform funding agencies, patient/consumer organizations, policy makers, and researchers in developing a CKD research agenda that is relevant to key stakeholders.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | | | - Shingisai Chando
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Steve J Chadban
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Nephrology, Concord Hospital, Sydney, New South Wales, Australia; Renal and Metabolic Division, The George Institute, Sydney, New South Wales, Australia
| | - Carmel M Hawley
- Queensland School of Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Brisbane, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David W Johnson
- Queensland School of Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Brisbane, Australia
| | - Peter G Kerr
- Monash Medical Centre and Monash University, Clayton, Victoria, Australia
| | - Anne McKenzie
- Centre for Health Services Research, The University of Western Australia, Perth, Western Australia, Australia
| | - David Parker
- Monash Medical Centre and Monash University, Clayton, Victoria, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute, Sydney, New South Wales, Australia
| | - Kevan R Polkinghorne
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
| | - Carol Pollock
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Renal Division, Kolling Institute, Sydney, New South Wales, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Diaverum Medical Scientific Office and Diaverum Academy, Lund, Sweden; Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Bari, Italy; Department of Translational Medicine (Italy), University of Bari, Mario Negri Sud Foundation, Bari, Italy
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Rowan G Walker
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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