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Clark Adnyamathanha JR, Buck Kamilaroi J, Richards-Satour Adnyamathanha And Barngarla A, Lyons Jaadwa L, Brown Yuin A. Towards precision cancer medicine for Aboriginal and Torres Strait Islander cancer health equity. Med J Aust 2024; 221:68-73. [PMID: 38946636 DOI: 10.5694/mja2.52346] [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: 01/15/2024] [Accepted: 05/09/2024] [Indexed: 07/02/2024]
Abstract
Delivering cancer control at scale for Aboriginal and Torres Strait Islander communities is a national priority that requires Aboriginal and Torres Strait Islander leadership and codesign, as well as significant involvement of the Aboriginal community-controlled health sector. The unique genomic variation observed among Aboriginal and Torres Strait Islander peoples may have implications for standard and precision medicine. Yet, Aboriginal and Torres Strait Islander peoples are absent from, or under-represented within, human reference genome resources, genomic studies, cancer studies, cancer cell lines, patient-derived xenografts and cancer clinical trials. Genomics-guided precision cancer medicine offers an opportunity to reduce cancer health disparities experienced by Aboriginal and Torres Strait Islander peoples through personalising prevention, diagnosis, treatment and long term management. Here, we describe what is required to ensure that Aboriginal and Torres Strait Islander peoples can receive the benefits of precision cancer medicine. Equity of access to care, an Aboriginal and Torres Strait Islander cancer workforce, and appropriate genome reference resources are important for safe and effective cancer medicine. Building Indigenous data sovereignty principles and Aboriginal and Torres Strait Islander governance into research is required to protect Aboriginal and Torres Strait Islander rights and collective interests. Aboriginal and Torres Strait Islander community engagement should be undertaken to develop an understanding of the unique cultural and ethical considerations for precision cancer research. Local and national genomic health research guidelines are needed to define a consensus best practice in genomics research with Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
| | - Jessica Buck Kamilaroi
- Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA
- Centre for Child Health Research, University of Western Australia, Perth, WA
| | | | | | - Alex Brown Yuin
- Telethon Kids Institute, Adelaide, SA
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT
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Groot G, Marques Santos JD, Witham S, Leeder E, Carr T. "Somebody That can Meet you on Your Level:" Cancer Survivors' Perspectives on the Role of Indigenous Patient Navigators in Cancer Care. Can J Nurs Res 2024; 56:178-188. [PMID: 38373404 PMCID: PMC11032001 DOI: 10.1177/08445621241230099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer incidence has increased for First Nations and Métis Peoples in Canada over recent years. Despite a growing cancer burden, there remain challenges to accessing culturally appropriate and quality care in Saskatchewan. OBJECTIVE The study aimed to explore, from cancer survivors' perspectives, the potential of Indigenous patient navigators to enhance the healthcare experiences of First Nations and Métis cancer survivors in Saskatchewan. METHODS We conducted semi-structured interviews with 19 First Nations and Métis cancer survivors. Participants were interviewed by phone between May 2022 to March 2023. Thematic analysis was conducted to generate themes, categories, and codes reflecting participants' experiences with patient navigators. RESULTS Participants reported several supports to help patients with cancer through their cancer journey, including family, community, traditional ways, and First Nations and Métis health support services. Challenges to accessing care included language and communication barriers, logistical challenges, cultural differences, financial challenges, and gaps in care. Indigenous patient navigators may play a critical role in overcoming barriers by providing communication, translation, coordination, education, advocacy, and guidance to Indigenous cancer survivors. In participants' view, the tasks of Indigenous patient navigators could vary, ranging from helping schedule appointments to advocating for the patient's treatment preferences. In addition, Indigenous patient navigators could be helpful bridging Western medicine with traditional medicine when supporting patients seeking cancer care. CONCLUSION According to study participants, Indigenous patient navigators could be beneficial to Indigenous cancer survivors in Saskatchewan.
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Affiliation(s)
- Gary Groot
- Department of Community Health and Epidemiology and Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | | | - Stephanie Witham
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Erin Leeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Kleszynski K, Jervis L, TallBull G, Porter O, Bair BD, Shore JH, Manson SM, Kaufman CE. Tribal Perspectives on Patient Navigation for Rural Native Veterans Using Veteran Health Administration Services. J Community Health 2024; 49:475-484. [PMID: 38103115 DOI: 10.1007/s10900-023-01305-6] [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] [Accepted: 10/25/2023] [Indexed: 12/17/2023]
Abstract
American Indian and Alaska Native (Native) Veterans enrolled in the U.S. Department of Veterans Affairs (VA) benefits program are far less likely to access health care compared to other racial/ethnic groups, in part driven by challenges posed by often distant, complex, and culturally unresponsive health care that does not easily interface with the Indian Health Service (IHS) and local Tribal Health Care. To address this disparity, in 2020 the Veteran's Health Administration's (VHA) Office of Rural Health (ORH) initiated the development of a patient navigation program designed specifically for rural Native Veterans. There are no navigation programs for rural Native Veterans to guide development of such a program. Hence, the project team sought perspectives from rural Native Veterans, their families, and community advocates, (n = 34), via video and phone interviews about the role and functions of a Veteran patient navigator and personal characteristics best be suited for such a position. Participants believed a navigator program would be useful in assisting rural Native Veterans to access VHA care. They emphasized the importance of empathy, support, knowledge of local culture, and of Veteran experience within tribal communities, adeptness with VHA systems, and personnel consistency. These insights are critical to create a program capable of increasing rural Native Veteran access to VHA services.
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Affiliation(s)
- Keith Kleszynski
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | | | | | | | - Byron D Bair
- Veterans Rural Health Resources Center, Salt Lake City, UT, USA
| | - Jay H Shore
- Veterans Rural Health Resources Center, Salt Lake City, UT and University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Spero M Manson
- University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Carol E Kaufman
- Veterans Rural Health Resources Center, Salt Lake City, UT and University of Colorado Anschutz Medical Center, Denver, CO, USA
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Clifford-Motopi A, Brown Nununccal R, White Palawa Iningai A, Harald Gangulu P, Butler D, Mathew S, Mackenzie J, Eaton M, Mills R. Aboriginal and Torres Strait Islander community members' experiences of care in an urban Aboriginal Community Controlled Health Service transforming to a Patient Centred Medical Home. Aust J Prim Health 2024; 30:PY23163. [PMID: 38739738 DOI: 10.1071/py23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews. Yarns were conducted using a guide containing open-ended questions in the same domains as those used in patient satisfaction surveys at the participating clinic. Data from yarns were analysed by Aboriginal and non-Indigenous researchers using thematic analysis. The interpretations of Aboriginal and Torres Strait Islander researchers were privileged in the analysis. Results Key themes highlighted the importance of relationships, connectedness, and personal growth and empowerment to community members' health and wellbeing, which they described as a journey of healing and recovery. Delays in implementing a process to empanel patients in a care team meant that most community members were unaware a PCMH had been implemented. However, community members commonly reported a more welcoming environment, more contact with the same doctor and more involvement of Aboriginal Health Workers in their care. Conclusions Aboriginal and Torres Strait Islander community members' narratives of their experiences bear evidence of the acceptability of a PCMH model for delivery in Aboriginal Community Controlled Health Services to improve relational care between patients and health staff. A patient-directed empanelment process has been implemented to better connect patients to their care team in the clinic, and the role of the Aboriginal Health Worker reshaped to strengthen connections between patients and their care team in and outside the clinic.
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Affiliation(s)
- Anton Clifford-Motopi
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld 4066, Australia
| | - Renee Brown Nununccal
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | | | - Patrice Harald Gangulu
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Danielle Butler
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Saira Mathew
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld 4066, Australia
| | - Julie Mackenzie
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Martie Eaton
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Richard Mills
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
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Cummins R, Preston R, Topp SM, Taylor J, Larkins S, Callander E, Bell L, Arley B, Garvey G. A qualitative exploration of the non-financial costs of cancer care for Aboriginal and Torres Strait Islander Australians. Aust N Z J Public Health 2023; 47:100085. [PMID: 37688836 DOI: 10.1016/j.anzjph.2023.100085] [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: 12/29/2022] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVE Knowledge is growing about cancer care and financial costs for Aboriginal and Torres Strait Islander people. However, much remains unknown about the true costs of cancer care, encompassing financial, emotional, and spiritual aspects. We aimed to explore and explain how non-financial costs affect the health-seeking behaviours of these clients. METHODS Following Indigenous research protocols, this research was led by Aboriginal and Torres Strait Islander researchers and guided by Indigenous Hospital Liaison Officers. In-depth interviews and focus groups were conducted with 29 participants (Aboriginal and Torres Strait Islander cancer clients, their carers, and cancer-care professionals) at two Queensland public hospitals. RESULTS Four interwoven themes encompass non-financial costs of healthcare: leaving home and family; loss of control during cancer treatment; health of the spirit; social costs. The Aboriginal relational concept of 'being held' is useful in considering client, family, and carer as central to care with the Indigenous Hospital Liaison Officer two-way interpreting between the care and client team. IMPLICATIONS FOR PUBLIC HEALTH Framing the reasons that clients and carers have difficulty in engaging in treatment as 'costs' enables a focus on how the health system itself is implicated in the disengagement of Aboriginal and Torres Strait Islander clients from treatment.
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Affiliation(s)
- Rachel Cummins
- Djiru/Jirrabal/Bwgcolman, College of Medicine and Dentistry, Bebegu Yumba, James Cook University, Townsville, Australia
| | - Robyn Preston
- Public Health, College of Science and Sustainability, School of Health, Medical and Applied Sciences, CQUniversity, Townsville, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Australia.
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Emily Callander
- Monash University, School of Public Health and Preventive Medicine, Melbourne, VIC 3004, Australia; Health Services Management, University of Technology Sydney, School of Public Health, Sydney, Australia
| | - Lorraine Bell
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Australian e-Health Research Centre CSIRO, Brisbane, Queensland, Australia
| | - Brian Arley
- Daru, Tudugal, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Gail Garvey
- Menzies School of Health Research, Darwin, Northern Territory, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Darwin, Australia
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Perspectives of Aboriginal People Affected by Cancer on the Need for an Aboriginal Navigator in Cancer Treatment and Support: A Qualitative Study. Healthcare (Basel) 2022; 11:healthcare11010114. [PMID: 36611574 PMCID: PMC9819407 DOI: 10.3390/healthcare11010114] [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: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Aboriginal and Torres Strait Islander Australians suffer higher rates of cancer and poorer outcomes than the wider population. These disparities are exacerbated by rurality and remoteness due to reduced access and limited engagement with health services. This study explored the cancer journeys of Aboriginal patients and carers, and their views on the establishment of an Aboriginal Patient Navigator role within the Western Australian healthcare system to support cancer patients and their families. Sixteen Aboriginal participants were interviewed either face to face, by telephone, or via video conferencing platforms. The interviews were then recorded, transcribed, and thematically analyzed using standard qualitative techniques. Close consultation within the research team enhanced the rigour and robustness of the study findings. Patients and carers identified many gaps in cancer service delivery that made their experiences stressful and unnecessarily complex. Challenges included a lack of stable accommodation, financial burdens, constant travel, being "off-Country", and miscommunication with health professionals. Key sources of support and strength were the centrality of family and ongoing cultural connectedness. All participants were supportive of an Aboriginal Patient Navigator role that could address shortfalls in cancer service delivery, especially for patients from rural and remote communities. A culturally safe model of support has the potential to increase access, reduce anxiety and improve health outcomes.
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Rankin A, Baumann A, Downey B, Valaitis R, Montour A, Mandy P. The Role of the Indigenous Patient Navigator: A Scoping Review. Can J Nurs Res 2022; 54:199-210. [PMID: 35014886 PMCID: PMC9109580 DOI: 10.1177/08445621211066765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare systems are complex and as a result patients may experience
fragmentation of services. Indigenous populations experience increasingly
disproportionate health disparities compared to non-Indigenous populations.
Patient navigation is known as a patient-centered approach to empower
individuals to connect with appropriate services. Literature surrounding the
Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping
review. Purpose: To map the current state of the role of the IPN
internationally within Canada, United States, Australia and New Zealand. Methods Estalished methodological framework by Arksey and O’Malley and the PRISMA
extension for scoping reviews was used. Results A total of 820 articles were reviewed from four databases, yielding sixteen
articles. Conclusions The absence of published literature surrounding the IPN role in Australia and
New Zealand was surprising considering similar histories of colonization.
The term navigator was used most often and was typically used when
describing lay/peer roles. Professional roles were described using specific
role descriptions. Six IPN roles were identified including: (1) social
service navigation, (2) wholistic support of Indigenous people, (3)
advocacy/building capacity, (4) health assessment, (5) administrative
navigation, and (6) outreach. Additionally, barriers and enablers IPNs
address are identified. This scoping review will assist to promote and
reinforce the IPN role.
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Affiliation(s)
| | | | | | | | | | - Pat Mandy
- 3710McMaster University, Hamilton, Canada
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Tan CE, Lau SCD, Latiff ZA, Lee CC, Teh KH, Sidik SM. Information needs of Malaysian parents of children with cancer: a qualitative study. Asia Pac J Oncol Nurs 2021; 9:143-152. [PMID: 35494095 PMCID: PMC9052854 DOI: 10.1016/j.apjon.2021.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Informational support is an important pillar of psychosocial care for parents of children with cancer. Understanding the information needs of these parents may improve the provision of family-centered informational support. This paper aims to explore the information needs of Malaysian parents whose children have cancer. Methods This qualitative study was conducted among 14 parents of children with cancer and 8 healthcare providers. The parents were recruited from two urban pediatric oncology centers in Malaysia. Healthcare providers were recruited from these centers, as well as from community-based palliative care providers. In-depth interviews were conducted based on semi-structured topic guides, audio-recorded, and transcribed for thematic analysis using elements of the grounded theory approach. Results Analysis revealed three themes of information needs, which were: “interaction with the healthcare system,” “care for the child at home” and “psychosocial support for parents”. Information needs on parents’ interaction with the healthcare system consisted of disease and treatment-related information, as well as health system navigation. Information needs on care for the child at home were represented by their caregiving for basic activities of daily living, medical caregiving, and psychosocial caregiving. Psychosocial support for parents included information on practical support and self-care. There were differences in priorities for information needs between parents and healthcare providers. Conclusions Meeting the information needs of parents is an important part of psychosocial care in pediatric cancer care. Informational support may empower parents in caregiving for their child. The development of suitable information resources will be invaluable for healthcare providers in supporting parents’ needs.
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Brodie T, Pearson O, Cantley L, Cooper P, Westhead S, Brown A, Howard NJ. Strengthening approaches to respond to the social and emotional well-being needs of Aboriginal and Torres Strait Islander people: the Cultural Pathways Program. Prim Health Care Res Dev 2021; 22:e35. [PMID: 34184630 PMCID: PMC8278791 DOI: 10.1017/s1463423621000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022] Open
Abstract
Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently 'do what it takes' to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being.The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.
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Affiliation(s)
- Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Luke Cantley
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Social Work Innovation Research Living Space, College of Education, Psychology & Social Work, Flinders University, South Australia
| | - Peita Cooper
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Seth Westhead
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. "The support has been brilliant": experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC Health Serv Res 2021; 21:493. [PMID: 34030670 PMCID: PMC8142293 DOI: 10.1186/s12913-021-06535-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Improving health outcomes for Indigenous people by providing person-centred, culturally safe care is a crucial challenge for the health sector, both in Australia and internationally. Many cancer providers and support services are committed to providing high quality care, yet struggle with providing accessible, culturally safe cancer care to Indigenous Australians. Two Australian cancer services, one urban and one regional, were identified as particularly focused on providing culturally safe cancer care for Indigenous cancer patients and their families. The article explores the experiences of Indigenous cancer patients and their families within the cancer services and ascertains how their experiences of care matches with the cancer services’ strategies to improve care. Methods Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience. Results Eight Indigenous people affected by cancer and 23 hospital staff (Indigenous and non-Indigenous) were interviewed. Three experiences were shared by the majority of Indigenous cancer patients and family members interviewed in this study: a positive experience while receiving treatment at the cancer service; a challenging time between receiving diagnosis and reaching the cancer centre; and the importance of family support, while acknowledging the burden on family and carers. Conclusions This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06535-9.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia.
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Lorraine Parsons
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Toni Mason
- Aboriginal Health Unit, Mission, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
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11
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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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"We're very much part of the team here": A culture of respect for Indigenous health workforce transforms Indigenous health care. PLoS One 2020; 15:e0239207. [PMID: 32960933 PMCID: PMC7508383 DOI: 10.1371/journal.pone.0239207] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector, both in Australia and internationally. Although Indigenous people have long requested to have Indigenous practitioners involved in their health care, many health services report difficulties with recruiting and retaining Indigenous staff. This article describes Indigenous workforce policies and strategies from two Australian health services, as well as cancer-service specific strategies. METHODS Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. In-depth interviews were conducted in a small number of identified services. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of Indigenous health workforce. RESULTS Twenty-four hospital staff (Indigenous and non-Indigenous), five Indigenous people with cancer and three family members shared their views and experiences. Eight themes were identified from the way that the two services supported their Indigenous workforce: strong executive leadership, a proactive employment strategy, the Indigenous Health Unit, the Indigenous Liaison Officer, multidisciplinary team inclusion, professional development, work environment and a culture of respect. Participants reported two positive outcomes resulting from the active implementation of the eight workforce themes: 'Improved Indigenous patient outcomes' and 'Improved staff outcomes'. CONCLUSIONS These two cancer services and their affiliated hospitals show how positive patient outcomes and a strong Indigenous health workforce can be achieved when a health service has strong leadership, commits to an inclusive and enabling culture, facilitates two-way learning and develops specific support structures appropriate for Indigenous staff. It is hoped that the strategies captured in this study will be used by health services and cancer services to inform their own policies and programs to support building their Indigenous workforce.
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Ristevski E, Thompson S, Kingaby S, Nightingale C, Iddawela M. Understanding Aboriginal Peoples' Cultural and Family Connections Can Help Inform the Development of Culturally Appropriate Cancer Survivorship Models of Care. JCO Glob Oncol 2020; 6:124-132. [PMID: 32031446 PMCID: PMC6998014 DOI: 10.1200/jgo.19.00109] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To explore the cancer diagnosis, treatment, and survivorship experiences of Aboriginal people in the Gippsland region, Victoria, Australia, and identify factors critical to the development of a culturally appropriate cancer survivorship model of care. PATIENTS AND METHODS Yarning circles were used to capture the stories of 15 people diagnosed with cancer and/or those of family members. Yarning circles were conducted in two locations in the Gippsland region. Sessions were facilitated by an Aboriginal Elder, audio recorded, and transcribed verbatim. Thematic analysis of the data were triangulated among three researchers and incorporated researcher reflexivity. RESULTS Cultural connections and family were critical supports on the cancer journey. Putting the needs of the family first and caring for sick family members were more important than an individual's own health. There was "no time to grieve" for one's own cancer diagnosis and look after oneself. Cancer was a private experience; however, the constancy of deaths highlighted the importance of raising family awareness. Health professionals did not always understand the importance of people's cultural and family supports in their treatment and recovery. There were negatives attitudes in hospitals when family come to visit, seeing family as too large and overstaying visiting times. Health professionals did not seek family assistance with communication of information to family members whose literacy level was low, nor did they include family in treatment decision-making. Access to services depended on family support with transport, finances, and family responsibilities, often resulting in lapses in treatment and follow-up services. CONCLUSION Understanding the importance of Aboriginal peoples' cultural and family connections can help to inform the development of culturally safe cancer survivorship models of care.
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Affiliation(s)
| | | | - Sharon Kingaby
- Latrobe Community Health Service, Traralgon, Victoria, Australia
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Allemang B, Allan K, Johnson C, Cheong M, Cheung P, Odame I, Ward R, Williams S, Mukerji G, Kuo KHM. Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies. Pediatr Blood Cancer 2019; 66:e27781. [PMID: 31045326 DOI: 10.1002/pbc.27781] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. PROCEDURE A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. RESULTS The transition program with TN reduced loss to follow-up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). CONCLUSIONS A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.
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Affiliation(s)
- Brooke Allemang
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kate Allan
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Johnson
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Melina Cheong
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Patrina Cheung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Odame
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Ward
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suzan Williams
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Kevin H M Kuo
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ho-Huynh A, Tran A, Bray G, Abbot S, Elston T, Gunnarsson R, de Costa A. Factors influencing breast cancer outcomes in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13038. [PMID: 30919536 DOI: 10.1111/ecc.13038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates factors influencing breast cancer outcomes for women treated in Australia, facilitating the exploration of disparities in breast cancer outcomes for certain groups of women in Australia. METHOD A systematic literature search was performed using MEDLINE and Scopus focusing on breast cancer in Australia with outcome measures being breast cancer survival and recurrence with no restrictions on date. Risk of bias was assessed using Cairns Assessment Scale for Observational studies of Risk factors (CASOR). RESULTS Fifteen quantitative studies were included: two were high quality, 11 were intermediate quality, and two were low quality. Traditional risk factors such as invasive tumour type, larger size, higher grade and stage, lymph node involvement and absence of hormone receptors were found to be associated with breast cancer mortality. Being younger (<40 years old) and older (>70 years old), having more comorbidities, being of lower socioeconomic status, identifying as Aboriginal or Torres Strait Islander, living in more rural areas or having a mastectomy were factors found to be associated with poorer breast cancer outcomes. CONCLUSION Despite the heterogeneity of the studies, this review identified significant risk factors for breast cancer mortality and recurrence. The use of this data would be most useful in developing evidence-based interventions and in optimising patient care through creation of a prediction model. PROSPERO REGISTRATION CRD42017072857.
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Affiliation(s)
- Albert Ho-Huynh
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alex Tran
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Gerard Bray
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Samuel Abbot
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Timothy Elston
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Ronny Gunnarsson
- Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Alan de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Lakhan P, Askew D, Hayman N, Pokino LA, Sendall C, Clark PJ. Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic. Aust N Z J Public Health 2019; 43:228-235. [PMID: 30908846 DOI: 10.1111/1753-6405.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/01/2018] [Accepted: 02/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,The University of Queensland, Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Queensland
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Cheryl Sendall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Paul J Clark
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,Faculty of Medicine, The University of Queensland.,Department of Gastroenterology, The Princess Alexandra and Mater Hospitals, Queensland
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Hilder J, Gray B, Stubbe M. Health navigation and interpreting services for patients with limited English proficiency: a narrative literature review. J Prim Health Care 2019; 11:217-226. [DOI: 10.1071/hc18067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONCulturally and linguistically diverse populations (CALD) have significant health outcome disparities compared to dominant groups in high-income countries. The use of both navigators and interpreters are strategies used to address these disparities, but the intersections between these two roles can be poorly understood.
AIMTo gain an overview of the literature on health navigation and similar roles, with particular reference to the New Zealand context, and to explore the interface between these roles and that of interpreters for CALD populations with limited English proficiency.
METHODSA narrative review of the literature was conducted using a range of search strategies and a thematic analysis was conducted.
RESULTSThere are several barriers to health-care access relating to health systems and CALD populations. For over 50 years, health workers who are members of these communities have been used to address these barriers, but there are many terms describing workers with wide-ranging roles. There is some evidence of efficacy in economic, psychosocial and functional terms. For health navigation services to work, they need to have staff who are well selected, trained and supported; are integrated into health-care teams; and have clearly defined roles. There may be a place for integrating interpreting more formally into the navigator role for members of communities who have limited English proficiency.
CONCLUSIONTo achieve better access to health care for CALD populations, there is an argument for adding another member to the health team who combines clearly defined aspects of the roles of interpreter, community health worker and navigator. Organisations considering setting up such a position should have a clear target population, carefully consider the barriers they are trying to address and define a role, scope of practice and training requirements best suited to addressing those barriers.
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Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature. Support Care Cancer 2018; 27:97-108. [PMID: 30293093 DOI: 10.1007/s00520-018-4479-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/18/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Evidence suggests peer support (PS) is as an effective strategy for enhancing prevention and control of chronic and infectious diseases, including cancer. This systematic scoping review examines the range and variety of interventions on the use of PS across the cancer care continuum. METHOD We used a broad definition of PS to capture a wide-range of interventions and characterize the current status of the field. Literature searches were conducted using PubMed, SCOPUS, and CINAHL to identify relevant articles published from January 2011 to June 2016. We screened the title and abstracts of 2087 articles, followed by full-text screening of 420 articles, resulting in a final sample of 242 articles of which the most recent 100 articles were reviewed (published June 2014 to May 2016). RESULTS A number of the recent intervention studies focused on breast cancer (32%, breast cancer only) or multiple cancer sites (23%). Although the interventions spanned all phases of the cancer care continuum, only 2% targeted end-of-life care. Seventy-six percent focused on clinical outcomes (e.g., screening, treatment adherence) and 72% on reducing health disparities. Interventions were primarily phone-based (44%) or delivered in a clinic setting (44%). Only a few studies (22%) described the impact of providing PS on peer supporters. CONCLUSION PS appears to be a widely used approach to address needs across the cancer care continuum, with many opportunities to expand its reach.
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Phillips S, Villalobos AVK, Crawbuck GSN, Pratt-Chapman ML. In their own words: patient navigator roles in culturally sensitive cancer care. Support Care Cancer 2018; 27:1655-1662. [PMID: 30109486 PMCID: PMC6449285 DOI: 10.1007/s00520-018-4407-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
Purpose Patient navigation has emerged as a promising strategy in reducing disparities among diverse cancer patients. However, little is known about navigators’ own perspectives on their roles in providing culturally competent care. The purpose of the present study is to describe these self-identified roles. Methods Data were collected from an online survey with a convenience sample of cancer patient navigators. Using NVivo 10, qualitative content analysis was conducted on free text responses to the question: “In your opinion, what is the role of a patient navigator or nurse navigator in the provision of culturally sensitive care to patients?” Frequencies of each navigator-identified role mentioned were tabulated. Results Of 294 respondents, 50.7% (n = 149) provided a response to the question of interest. Respondents described the following 11 interrelated navigator roles in the provision of culturally competent care: (1) assess and understand patient needs, (2) tailor care to patient, (3) build rapport/open communication, (4) facilitate communication between patient and health care team, (5) educate/provide resources to the patient, (6) advocate, (7) self-motivated learning, (8) address barriers to care, (9) involve/meet the needs of family or support people, (10) educate/support health care team, and (11) support patient empowerment in care. Conclusions Patient navigators are uniquely well-positioned to improve cultural competence of cancer care given their role as liaison to patients and providers. Cancer care settings should use navigators with direct knowledge of patient culture whenever possible; however, communication and cultural competence training is highly recommended for all navigators given the diversity of patient needs.
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Affiliation(s)
- Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA
| | - Aubrey V K Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA
| | - Graham S N Crawbuck
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA
| | - Mandi L Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA.
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Improving cancer care for American Indians with cervical cancer in the Indian Health Service (IHS) system - Navigation may not be enough. Gynecol Oncol 2018; 149:89-92. [PMID: 29605056 DOI: 10.1016/j.ygyno.2017.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/10/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patient navigation programs have been shown to positively impact cancer outcomes for minority populations. Little is known regarding the effects of these programs on American Indian (AI) populations. The purpose of this study is to characterize the impact of a patient navigation program on AI cervical cancer patients at a tertiary care center. METHODS A retrospective review of all AI cervical cancer patients receiving navigation services and a cohort of AI patients treated prior to navigation services was performed. Additional comparisons were made between those with and without Indian Health Service (IHS) funding. Summary statistics were used to describe demographic, clinical characteristics, treatment, and survivorship across groups. RESULTS Of 55 patients identified, 34 received navigation and 21 did not. In navigated patients, median age was 46years (27-80years) compared with 42years (17-68years) in pre-navigation patients (p=0.53). There was no difference between stage at diagnosis (p=0.73). No difference was noted in treatment received between groups (p=0.48). Distance traveled for treatment between groups did not differ (p=0.46). Median time to initiation of treatment was not different between groups, 30.5days vs. 27.5days (p=0.18). Among patients with IHS funding, navigation services did not alter time to initiation of treatment (p=0.57), and there was no difference in completion of prescribed therapy between groups (92% navigated vs 100% pre-navigation). CONCLUSIONS Navigation services for AI cervical cancer patients did not alter initiation or completion of treatment. Navigation programs may provide less tangible benefits to AI cervical cancer patients and further study is warranted.
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Taylor EV, Haigh MM, Shahid S, Garvey G, Cunningham J, Thompson SC. Cancer Services and Their Initiatives to Improve the Care of Indigenous Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040717. [PMID: 29641441 PMCID: PMC5923759 DOI: 10.3390/ijerph15040717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 02/02/2023]
Abstract
Indigenous Australians continue to experience significantly poorer outcomes from cancer than non-Indigenous Australians. Despite the importance of culturally appropriate cancer services in improving outcomes, there is a lack of awareness of current programs and initiatives that are aimed at meeting the needs of Indigenous patients. Telephone interviews were used to identify and describe the Indigenous-specific programs and initiatives that are implemented in a subset of the services that participated in a larger national online survey of cancer treatment services. Fourteen services located across Australia participated in the interviews. Participants identified a number of factors that were seen as critical to delivering culturally appropriate treatment and support, including having a trained workforce with effective cross-cultural communication skills, providing best practice care, and improving the knowledge, attitudes, and understanding of cancer by Indigenous people. However, over a third of participants were not sure how their service compared with others, indicating that they were not aware of how other services are doing in this field. There are currently many Indigenous-specific programs and initiatives that are aimed at providing culturally appropriate treatment and supporting Indigenous people affected by cancer across Australia. However, details of these initiatives are not widely known and barriers to information sharing exist. Further research in this area is needed to evaluate programs and initiatives and showcase the effective approaches to Indigenous cancer care.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
| | - Margaret M Haigh
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
- Centre for Aboriginal Studies, Curtin University, Kent Street, Perth, WA 6102, Australia.
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
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Horný M, Glover W, Gupte G, Saraswat A, Vimalananda V, Rosenzweig J. Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study. BMC Health Serv Res 2017; 17:759. [PMID: 29162073 PMCID: PMC5699176 DOI: 10.1186/s12913-017-2700-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 11/07/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Recent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate the effect of a patient navigation program on medical and administrative outcomes among patients with diabetes in an urban, safety-net hospital clinic setting. METHODS A retrospective cohort study with pre- and post-intervention periods was conducted. Eligible patients were those with A1C ≥ 8.5% and at least one appointment no-show in the previous 12 months. The intervention and reference groups were balanced on observed characteristics and baseline outcome levels using propensity score matching. The effect of patient navigation was isolated using the difference-in-differences approach. Primary outcomes were A1C, low-density lipoprotein cholesterol, triglycerides, random urine microalbumin, the number of scheduled appointments, clinic visits, emergency visits, and inpatient stays, and the percentage of arrivals, cancellations, and no-shows to scheduled appointments. RESULTS Of 797 eligible patients, 328 entered the navigation program. Matching reduced the sample size to 392 individuals (196 in each group). Patient navigation resulted in improved A1C (-1.1 percentage points; p < .001), more scheduled appointments (+ 5.3 per year; p < .001), more clinic visits (+6.4 per year; p < .001), more arrivals to scheduled appointments (+7.4 percentage points; p = .009) and fewer no-shows (-9.8 percentage points; p < .001). CONCLUSIONS Navigation was associated with improved glycemic control and better clinic engagement among patients with diabetes. Further research is important to identify what features of navigation in diabetes care are critical to achieving success and to understand navigators' role in other settings.
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Affiliation(s)
- Michal Horný
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1215A, 101 Woodruff Circle, Atlanta, GA 30322 USA
- Department of Health Policy and Management, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322 USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
| | - Wiljeana Glover
- Department of Technology, Operations, and Information Management, Babson College, 231 Forest Street, Babson Park, MA 02457 USA
| | - Gouri Gupte
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
- Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139 USA
| | - Aruna Saraswat
- Tufts Medical Center, 800 Washington Street, Boston, MA 02111 USA
| | - Varsha Vimalananda
- Department of Medicine, Boston University School of Medicine, 715 Albany St, Boston, MA 02118 USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, 200 Springs Road, Bedford, MA 01730 USA
| | - James Rosenzweig
- Department of Medicine, Boston University School of Medicine, 715 Albany St, Boston, MA 02118 USA
- Hebrew Rehabilitation Hospital, 1200 Centre Street, Boston, MA 02131 USA
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Pilkington L, Haigh MM, Durey A, Katzenellenbogen JM, Thompson SC. Perspectives of Aboriginal women on participation in mammographic screening: a step towards improving services. BMC Public Health 2017; 17:697. [PMID: 28893225 PMCID: PMC5594450 DOI: 10.1186/s12889-017-4701-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Early detection of breast cancer using screening mammography provides an opportunity for treatment which can lead to significantly improved outcomes. Despite considerable efforts having been made, the rate at which Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Aboriginal) women in Western Australia participate in BreastScreen WA’s screening mammogram program remains below that for the overall female population of Western Australia. This study aimed to examine perspectives on breast screening amongst Aboriginal women in Western Australia. We explored the factors which impact on participation in breast screening and sought to identify potential initiatives to address lower participation in screening. Methods Semi-structured interviews, focus group discussions and yarning sessions were conducted with a total of 65 research participants. They were all Aboriginal and comprised consumers and health professionals from locations across the state. Results Our findings show that research participants generally were willing to have a mammogram. Key reasons given were having a genetic predisposition to breast cancer and a perception of investing in health for the sake of the next generation, as well as personal well-being. Barriers identified included lack of education about or understanding of screening, inadequacies in cultural appropriateness in the screening program, cultural beliefs around cancer in general and breast cancer in particular, and competing health and life priorities. However, many enablers were identified which can serve as potential strategies to assuage fear and increase screening uptake. These included increased education delivered by respected Aboriginal women, culturally appropriate promotion and the provision of care and support from other women in the community. Conclusion The higher participation rates for Aboriginal women in Western Australia than are found for Aboriginal women nationally demonstrate the success of the strategies put in place by BreastScreen WA. These efforts must be supported and existing policies and practices enhanced to address the limitations in the existing program. Only by implementing and evaluating such initiatives and making breast screening programs more accessible to Aboriginal women can the current disparity between the screening participation rates of Aboriginal and non-Aboriginal women be reduced.
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Affiliation(s)
- Leanne Pilkington
- Aboriginal Health Strategy, WA Country Health Service, Department of Health, Level 7, 2 Mill Street, Perth, WA, 6000, Australia.,BreastScreen WA, , 9th Floor, Eastpoint Plaza, 233 Adelaide Terrace, Perth, WA, 6000, Australia
| | - Margaret M Haigh
- Western Australian Centre for Rural Health, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Angela Durey
- School of Dentistry, The University of Western Australia M512, 35 Stirling Highway, Perth, WA, 6009, Australia.,Centre for Aboriginal Studies, Curtin University, Perth, WA, 6102, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia M512, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, PO Box 109, Geraldton, WA, 6530, Australia.
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Bernardes CM, Martin J, Cole P, Kitchener T, Cowburn G, Garvey G, Walpole E, Valery PC. Lessons learned from a pilot study of an Indigenous patient navigator intervention in Queensland, Australia. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28513056 DOI: 10.1111/ecc.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 01/08/2023]
Abstract
Indigenous patient navigator (IPN) programmes show promise in addressing barriers to cancer care and facilitation of patient self-efficacy. The purpose of this paper is to describe and reflect upon the experience of training an IPN and implementation of the intervention in the Australian context with Indigenous cancer patients. Randomised clinical trial might provide the best available evaluation measure of an intervention but caution should be taken in the implementation process. Socio-cultural aspects and training can affect the conduct of this type of intervention. We report here five issues needing consideration prior to implementing such intervention. Specifically: (1) recognition of the collective bonds within Indigenous community and understanding by IPN of the degree of personal assistance perceived as not intrusive by the patient; (2) conduct ongoing evaluation of the different role of an IPN involved in this intervention care provider vs. researcher. (3) meaningful engagement develops from a trusting/collaborative relationship between research team and study site staff which may not occur in the study time frame; (4) existing skills as well as training provided may not translate in the IPN understanding and aligning with the study objectives/research values; (5) recruitment of participants requires innovative and highly flexible strategies to be successful.
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Affiliation(s)
- C M Bernardes
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Brisbane, QLD, Australia
| | - J Martin
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - P Cole
- Ipswich Hospital, Brisbane, QLD, Australia
| | - T Kitchener
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - G Cowburn
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - G Garvey
- Menzies School of Health Research, Brisbane, QLD, Australia.,Charles Darwin University, Darwin, NT, Australia
| | - E Walpole
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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26
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Ali-Faisal SF, Colella TJF, Medina-Jaudes N, Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2017; 100:436-448. [PMID: 27771161 DOI: 10.1016/j.pec.2016.10.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/09/2016] [Accepted: 10/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the effects of patient navigation (PN) on healthcare utilization outcomes using meta-analysis and the quality of evidence. METHODS Medical and social science databases were searched for randomized controlled trials published in English between 1989 and May 2015. The review process was guided by PRISMA. Included studies were assessed for quality using the Downs and Black tool. Data were extracted to assess the effect of navigation on: health screening rates, diagnostic resolution, cancer care follow-up treatment adherence, and attendance of care events. Random-effects models were used to compute risk ratios and I2 statistics determined the impact of heterogeneity. RESULTS Of 3985 articles screened, 25 articles met inclusion criteria. Compared to usual care, patients who received PN were significantly more likely to access health screening (OR 2.48, 95% CI, 1.93-3.18, P<0.00001) and attend a recommended care event (OR 2.55, 95% CI, 1.27-5.10, P<0.01). PN was favoured to increase adherence to cancer care follow-up treatment and obtain diagnoses. Most studies involved trained lay navigators (n=12) compared to health professionals (n=9). CONCLUSION PN is effective to increase screening rates and complete care events. PRACTICE IMPLICATIONS PN is an effective intervention for use in healthcare.
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Affiliation(s)
- Sobia F Ali-Faisal
- Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, USA.
| | - Tracey J F Colella
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; University Health Network/Toronto Rehabilitation Cardiovascular Prevention & Rehabilitation Program, Toronto, Canada.
| | - Naomi Medina-Jaudes
- Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, USA.
| | - Lisa Benz Scott
- Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, USA; The School of Health Technology & Management, Stony Brook University, Stony Brook, USA.
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27
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Dasgupta P, Baade P, Youlden D, Garvey G, Aitken J, Wallington I, Chynoweth J, Zorbas H, Roder D, Youl P. Variations in outcomes for Indigenous women with breast cancer in Australia: A systematic review. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12662] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 02/06/2023]
Affiliation(s)
- P. Dasgupta
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - P.D. Baade
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Mathematical Sciences; Queensland University of Technology; Brisbane QLD Australia
- Menzies Health Institute Queensland; Griffith University; Southport QLD Australia
| | - D.R. Youlden
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - G. Garvey
- Menzies School of Health Research; Charles Darwin University; Brisbane Queensland Australia
| | - J.F. Aitken
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Queensland Australia
- School of Population Health; University of Queensland; Brisbane Australia
- Institute for Resilient Regions; University of Southern Queensland; Toowoomba Australia
| | | | - J. Chynoweth
- Cancer Australia; Sydney New South Wales Australia
| | - H. Zorbas
- Cancer Australia; Sydney New South Wales Australia
| | - D. Roder
- Centre for Population Health Research; Samson Institute; University of South Australia; Adelaide SA Australia
| | - P.H. Youl
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Southport QLD Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Queensland Australia
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Olaniran A, Smith H, Unkels R, Bar-Zeev S, van den Broek N. Who is a community health worker? - a systematic review of definitions. Glob Health Action 2017; 10:1272223. [PMID: 28222653 PMCID: PMC5328349 DOI: 10.1080/16549716.2017.1272223] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/22/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. OBJECTIVE To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. DESIGN A systematic review of peer-reviewed papers and grey literature. RESULTS We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. CONCLUSIONS This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.
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Affiliation(s)
- Abimbola Olaniran
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Regine Unkels
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Bar-Zeev
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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29
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van Ee I, Hagedoorn M, Slaets J, Smits C. Patient navigation and activation interventions for elderly patients with cancer: A systematic review. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- I.B. van Ee
- Research Group Innovating with Older Adults; Centre of Expertise in Health Care and Social Work; Windesheim University of Applied Sciences; Zwolle The Netherlands
| | - M. Hagedoorn
- Health Sciences/Health Psychology; University Medical Center Groningen; Groningen The Netherlands
| | - J.P.J. Slaets
- Leyden Academy on Vitality and Ageing, Leiden/Department of Geriatrics; University Medical Center Groningen; Groningen The Netherlands
| | - C.H.M. Smits
- Research Group Innovating with Older Adults; Centre of Expertise in Health Care and Social Work; Windesheim University of Applied Sciences; Zwolle The Netherlands
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Cuesta-Briand B, Bessarab D, Shahid S, Thompson SC. 'Connecting tracks': exploring the roles of an Aboriginal women's cancer support network. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:779-788. [PMID: 26099647 DOI: 10.1111/hsc.12261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 06/04/2023]
Abstract
Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer; however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services; (ii) fostering social interaction; (iii) providing a culturally safe space; and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward.
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Affiliation(s)
- Beatriz Cuesta-Briand
- Western Australian Centre for Rural Health, University of Western Australia, Crawley, Western Australia, Australia.
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Crawley, Western Australia, Australia
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Davy C, Harfield S, McArthur A, Munn Z, Brown A. Access to primary health care services for Indigenous peoples: A framework synthesis. Int J Equity Health 2016; 15:163. [PMID: 27716235 PMCID: PMC5045584 DOI: 10.1186/s12939-016-0450-5] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022] Open
Abstract
Background Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. Methods To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague’s accessibility framework. Results Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Conclusions Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague’s accessibility framework should be broadened to include factors related to the health care system such as funding. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0450-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Davy
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia.
| | - Stephen Harfield
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia
| | - Alexa McArthur
- Joanna Briggs Institute, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Zachary Munn
- Joanna Briggs Institute, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia
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Self-reported health-related quality-of-life issues for Aboriginal and Torres Strait Islander patients with experience of cancer in Australia: a review of literature. INT J EVID-BASED HEA 2016; 13:233-53. [PMID: 26126000 DOI: 10.1097/xeb.0000000000000051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aboriginal peoples and Torres Strait Islander peoples (who comprise the indigenous people or the original inhabitants of Australia before colonization) are more likely to experience cancers with poorer prognoses, are more likely to be diagnosed with cancer at a later stage of disease progression, are less likely to receive adequate cancer treatment and are more likely to pass away due to cancer, compared with other Australians. Cancer and biomedical therapies for cancer often have significant, ongoing effects on patient health-related quality of life (HRQL). Therefore, consideration of HRQL for Aboriginal and Torres Strait Islander peoples with experience of cancer in Australia is imperative. This article examines the literature for HRQL issues self-reported by Aboriginal and/or Torres Strait Islander people with experience of cancer in Australia. METHODS A search of peer-reviewed journal articles, government reports, and other literature was undertaken using electronic databases and citation snowballing. Self-reports from Aboriginal and/or Torres Strait Islander people with experience of cancer were examined. HRQL issues were determined utilizing the Australian Psycho-Oncology Co-operative Research Group's definition of HRQL. RESULTS Fifty-two documents were found with original data from Aboriginal and/or Torres Strait Islander people who self-reported their experiences of cancer. No published reports were found that specifically examined self-reports from Aboriginal and/or Torres Strait Islander people on the impact of cancer and biomedical treatment on their HRQL. CONCLUSION Previous literature suggests that there is urgency for improved communication and cultural competency in cancer care for Aboriginal and Torres Strait Islander patients in Australia, with a stronger focus on meeting patient needs and improving HRQL. This review has provided insight into HRQL issues for Aboriginal and Torres Strait Islander patients with cancer in Australia. Further work using patient-reported outcomes measures would provide greater insight into the impact of cancer and biomedical treatments on Aboriginal and Torres Strait Islander patients' HRQL.
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Lavoie JG, Kaufert J, Browne AJ, O’Neil JD. Managing Matajoosh: determinants of first Nations' cancer care decisions. BMC Health Serv Res 2016; 16:402. [PMID: 27538389 PMCID: PMC4991084 DOI: 10.1186/s12913-016-1665-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/12/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. METHODS The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15). RESULTS Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. CONCLUSIONS We argue that a whole system's approach is required in order to address these limitations.
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Affiliation(s)
- Josée G. Lavoie
- MFN – Centre for Aboriginal Health Research, University of Manitoba, #715, 727 McDermot Avenue, Winnipeg, MB R3P 3E4 Canada
| | - Joseph Kaufert
- Department of Community Health Sciences, University of Manitoba, College of Medicine - University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Annette J. Browne
- UBC School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - John D. O’Neil
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, V5A 1S6 BC Canada
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Ali-Faisal SF, Benz Scott L, Johnston L, Grace SL. Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial. BMJ Open 2016; 6:e010214. [PMID: 27000785 PMCID: PMC4809077 DOI: 10.1136/bmjopen-2015-010214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment. SETTING 3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre. PARTICIPANTS CR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants. INTERVENTION The PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers. OUTCOME MEASURES The primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction. RESULTS Those who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24). CONCLUSIONS There is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest to their home. TRIAL REGISTRATION NUMBER NCT02204449; Results.
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Affiliation(s)
- Sobia F Ali-Faisal
- York University, Toronto, Ontario, Canada
- Stony Brook University, Program in Public Health, Stony Brook Medicine, School of Health, Technology and Management, Stony Brook, New York, USA
| | - Lisa Benz Scott
- Stony Brook University, Program in Public Health, Stony Brook Medicine, School of Health, Technology and Management, Stony Brook, New York, USA
| | - Lauren Johnston
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Kolahdooz F, Jang SL, Corriveau A, Gotay C, Johnston N, Sharma S. Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: a systematic review. Lancet Oncol 2015; 15:e504-16. [PMID: 25281469 DOI: 10.1016/s1470-2045(14)70508-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cancer mortality among indigenous peoples is increasing, but these populations commonly under use cancer-screening services. This systematic review explores knowledge, attitudes, and behaviours towards cancer screening among indigenous peoples worldwide. Searches of major bibliographic databases identified primary studies published in English up to March, 2014; of 33 eligible studies, three were cohort studies, 27 cross-sectional, and three case-control. Knowledge of and participation in screening was greater for breast cancer than for other cancers. Indigenous peoples tended to have less knowledge, less favourable attitudes, and a higher propensity to refuse screening than non-indigenous populations. The most common factors affecting knowledge, attitudes, and behaviours towards cancer screening included access to screening, knowledge about cancer and screening, educational attainment, perceived necessity of screening, and age. Greater understanding of knowledge, attitudes, and behaviours towards cancer screening in diverse indigenous cultures is needed so that culturally appropriate cancer prevention programmes can be provided.
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Affiliation(s)
- Fariba Kolahdooz
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Se Lim Jang
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - André Corriveau
- Office of the Chief Public Health Officer, Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, NT, Canada
| | - Carolyn Gotay
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nora Johnston
- Alberta Centre for Active Living, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Sangita Sharma
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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36
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Treloar C, Rance J, Bath N, Everingham H, Micallef M, Day C, Hazelwood S, Grebely J, Dore GJ. Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:992-8. [PMID: 25697089 DOI: 10.1016/j.drugpo.2015.01.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/12/2014] [Accepted: 01/07/2015] [Indexed: 12/30/2022]
Abstract
AIM Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few examples of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS. METHODS Semi-structured interviews were conducted in two clinics with three groups of participants: clients (n=31), staff (n=8) and peer workers (n=3) and examined the operation of the service in relation to process, outputs and impacts. RESULTS There was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing "feel" of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment. CONCLUSIONS The peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Jake Rance
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | - Hope Everingham
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | | | - Carolyn Day
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sue Hazelwood
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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Seneviratne S, Campbell I, Scott N, Kuper-Hommel M, Round G, Lawrenson R. Ethnic differences in timely adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand: a cohort study. BMC Cancer 2014; 14:839. [PMID: 25406582 PMCID: PMC4242494 DOI: 10.1186/1471-2407-14-839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/04/2014] [Indexed: 01/07/2023] Open
Abstract
Background Indigenous and/or minority ethnic women are known to experience longer delays for treatment of breast cancer, which has been shown to contribute to ethnic inequities in breast cancer mortality. We examined factors associated with delay in adjuvant chemotherapy and radiotherapy for breast cancer, and its impact on the mortality inequity between Indigenous Māori and European women in New Zealand. Methods All women with newly diagnosed invasive non-metastatic breast cancer diagnosed during 1999–2012, who underwent adjuvant chemotherapy (n = 922) or radiation therapy (n = 996) as first adjuvant therapy after surgery were identified from the Waikato breast cancer register. Factors associated with delay in adjuvant chemotherapy (60-day threshold) and radiation therapy (90-day threshold) were analysed in univariate and multivariate models. Association between delay in adjuvant therapy and breast cancer mortality were explored in Cox regression models. Results Overall, 32.4% and 32.3% women experienced delays longer than thresholds for chemotherapy and radiotherapy, respectively. Higher proportions of Māori compared with NZ European women experienced delays longer than thresholds for adjuvant radiation therapy (39.8% vs. 30.6%, p = 0.045) and chemotherapy (37.3% vs. 30.5%, p = 0.103). Rural compared with urban residency, requiring a surgical re-excision and treatment in public compared with private hospitals were associated with significantly longer delays (p < 0.05) for adjuvant therapy in the multivariate model. Breast cancer mortality was significantly higher for women with a delay in initiating first adjuvant therapy (hazard ratio [HR] =1.45, 95% confidence interval [CI] 1.05-2.01). Mortality risks were higher for women with delays in chemotherapy (HR = 1.34, 95% CI 0.89-2.01) or radiation therapy (HR = 1.28, 95% CI 0.68-2.40), although these were statistically non-significant. Conclusions Indigenous Māori women appeared to experience longer delays for adjuvant breast cancer treatment, which may be contributing towards higher breast cancer mortality in Māori compared with NZ European women. Measures to reduce delay in adjuvant therapy may reduce ethnic inequities and improve breast cancer outcomes for all women with breast cancer in New Zealand.
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Affiliation(s)
- Sanjeewa Seneviratne
- Waikato Clinical School, University of Auckland, Breast Cancer Research Office, Waikato Hospital, PO Box 934, Hamilton 3240, New Zealand.
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Gribble MO, Around Him DM. Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review. AJOB Empir Bioeth 2014; 5:1-24. [PMID: 25089283 DOI: 10.1080/21507716.2013.848956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. METHODS Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached. RESULTS We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. CONCLUSIONS Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.
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Affiliation(s)
- Matthew O Gribble
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Deana M Around Him
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Treloar C, Gray R, Brener L, Jackson C, Saunders V, Johnson P, Harris M, Butow P, Newman C. "I can't do this, it's too much": building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers. Int J Public Health 2013; 59:373-9. [PMID: 23604078 DOI: 10.1007/s00038-013-0466-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 03/04/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens. METHODS Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers. RESULTS Participants' narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment. CONCLUSIONS These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.
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Affiliation(s)
- Carla Treloar
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, 2052, Australia,
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Warren-Mears V, Dankovchik J, Patil M, Fu R. Impact of patient navigation on cancer diagnostic resolution among Northwest Tribal communities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:109-18. [PMID: 23242563 PMCID: PMC3610770 DOI: 10.1007/s13187-012-0436-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The patient navigator model has not been widely implemented in American Indian/Alaska Native (AI/AN) communities, but may be effective in improving cancer outcomes for this population. Subjects were enrolled from eight clinics at Tribes throughout the Northwest (n = 1,187). Four clinics received navigation. Time between abnormal finding and definitive diagnosis was recorded. We examined whether odds of obtaining definitive diagnosis by 60, 90, and 365 days differed between the two groups. The odds of definitive diagnosis within 365 days for navigated subjects was 3.6 times (95 % CI, 1.47, 8.88; p = 0.01) the odds for control subjects. The outcome at 60 and 90 days did not significantly differ between the two groups. Our findings indicate that patient navigation did not significantly impact chance of diagnosis by 60 or 90 days from abnormal finding. However, it did improve the chance of avoiding extreme delays in obtaining a definitive diagnosis.
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Affiliation(s)
- Victoria Warren-Mears
- Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, Oregon 97201
| | - Jenine Dankovchik
- Northwest Tribal Cancer Navigator Program & NW IDEA Project, Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR 97201, Ph# 503-416-3265, Fax # 503-228-8182,
| | - Meena Patil
- Northwest Tribal Cancer Navigator Program, Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, Oregon 97201, Ph# 503-416-3265, Fax # 503-228-8182,
| | - Rongwei Fu
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, Ph# 503-494-6069,
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