1
|
Tatari CR, Andersen B, Kirkegaard P. "We're the very bottom, so it's going to be hard for you to 'catch any fish' around here…" understanding vulnerable Greenlanders' perspectives on cancer and barriers to screening in Denmark- A qualitative study. Int J Equity Health 2024; 23:11. [PMID: 38254148 PMCID: PMC10802048 DOI: 10.1186/s12939-024-02094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cancer is a major global health concern. Unfortunately, Indigenous populations such as Greenlanders living in Denmark, face significant disparities in cancer risk, incidence, diagnosis, care quality, and outcomes. In Denmark, vulnerable Greenlanders face challenges accessing cancer screening. The aim of this study was to explore their perceptions of cancer, barriers to participation in cancer screening, and potential for developing a tailored intervention. METHODS This qualitative study was based on participant observations and qualitative interviews. The sample comprised 46 participants from four distinct drop-in centres. Of these, 28 were vulnerable Greenlanders (19 women and 9 men), 9 were staff members (6 women and 3 men), and 6 were relatives (4 women and 2 men). The data were analysed through inductive content analysis. RESULTS Vulnerable Greenlanders in Denmark believed they were responsible for their own health and were generally satisfied with the healthcare system. However, they found it challenging to manage their own health and many depended on support from others. Fear of cancer and death shaped their attitudes towards screening. CONCLUSION For vulnerable Greenlanders in Denmark participation in cancer screening programmes was positively viewed for most but could be challenging. Different intervention ideas raised by the vulnerable Greenlanders, relatives and staff members could guide the development of strategies to increase participation rates.
Collapse
Affiliation(s)
- Camilla Rahr Tatari
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Berit Andersen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Verma A, Priyank H, P R, Kumari M, Sayed Abdul N, Shivakumar S. A Systematic Review and Meta-Analysis on Oral Health Disparities Among the Indigenous Paediatric Population. Cureus 2023; 15:e41673. [PMID: 37575701 PMCID: PMC10412898 DOI: 10.7759/cureus.41673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
There is a knowledge gap in the literature regarding oral health disparities (OHD) in minority and indigenous (IG) paediatric cohorts that needs to be addressed. Disparities in oral health among children are a pressing concern, highlighting inequities in access to dental care and meeting needs. The current systematic review aims to provide a comprehensive synthesis of the prevailing understanding of OHD in the minority and IG strata. A meticulous search strategy was formulated by a team of reviewers to identify pertinent studies from databases of PubMed, MEDLINE, Scopus, Google Scholar and EMBASE. Data extraction and article selection strictly adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the methodological quality of the studies included. Review Manager version 5.4 was used to synthesise quantitative data. A total of five cross-sectional studies were included in the final analysis. The findings consistently demonstrated the existence of racial and socioeconomic disparities in oral health across varying age groups and geographical locations in the defined population. Significant disparities in oral health outcomes were observed between IG and non-IG populations, with IG and minority groups exhibiting a heightened vulnerability to oral health challenges. Through a meta-analysis of the compiled data, a statistically significant association was established between children (being a member of a minority group) and unmet oral health needs. Socioeconomic status (SES) and maternal education were factors that showed a significant impact on oral health disparity. All studies were graded to be of the low-risk category based on the NOS risk of bias tool. This review successfully identified several influential factors contributing to oral health disparities, such as cultural practices, dietary patterns and access to oral healthcare services. Additionally, discernible differences in oral health status were evident between IG and non-IG children, with IG children enduring a greater burden of oral health difficulties. These findings underscore the imperative for targeted interventions and policy measures aimed at addressing the specific oral health needs of minority and IG paediatric populations, with the overarching goal of mitigating the existing disparities.
Collapse
Affiliation(s)
- Ankita Verma
- Department of Pedodontics and Preventive Dentistry, Hazaribag College of Dental Sciences and Hospital, Ranchi, IND
| | - Harsh Priyank
- Department of Conservative, Endodontics and Aesthetic Dentistry, Dental Institute Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Renuka P
- Department of Pedodontics and Preventive Dentistry, Government Dental College, Dibrugarh, IND
| | - Minti Kumari
- Department of Public Health Dentistry, Patna Dental College and Hospital, Patna, IND
| | - Nishath Sayed Abdul
- Department of Oral Pathology, College of Dentistry, Oral Diagnostic Sciences, Riyadh Elm University, Riyadh, SAU
| | - Sahana Shivakumar
- Department of Public Health Dentistry, People's College of Dental Science and Research Center, Bhopal, IND
| |
Collapse
|
3
|
Liblik K, Desai V, Yin G, Ng R, Maho S, Cohen N, Soleas EK. Professional Development in Health Sciences: Scoping Review on Equity, Diversity, Inclusion, Indigeneity, and Accessibility Interventions. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:120-125. [PMID: 37389481 DOI: 10.1097/ceh.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Equity, diversity, inclusion, indigeneity, and accessibility (EDIIA) are critical considerations in the formation of professional development (PD) programs for health care workers. Improving EDIIA competency in health care serves to enhance patient health, staff confidence and well-being, delivery of care, and the broader health care system. There is a gap in the literature as to the efficacy of EDIIA-based PD programs and their individual components. The present article will review available quantitative data pertaining to EDIIA-based PD programs for health care workers as well as their effectiveness. METHODS A scoping review of articles published in the EBSCOhost, MEDLINE, PubMed, EMBASE, and CINAHL databases was performed. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS A total of 14,316 references were identified with 361 reaching full-text review. A final 36 articles were included in the scoping review with 6552 total participants (72.9% women; 26.9% men; 0.2% nonbinary). EDIIA-based PD interventions were developed around the topics of culture ( n = 22), gender ( n = 11), sexual orientation ( n = 9), indigeneity ( n = 6), race ( n = 6), ableism ( n = 1), and ageism ( n = 1). DISCUSSION Despite an increased interest in developing EDIIA-based PD curricula for health care workers, there are glaring disparities in the quality of care received by marginalized and equity-seeking populations. The present scoping review delineated key features which were associated with increased quantitative efficacy of EDIIA-based PD training programs. Future work should focus on large-scale implementation and evaluation of these interventions across health care sectors and levels of training.
Collapse
Affiliation(s)
- Kiera Liblik
- Ms. Liblik: Medical Student, School of Medicine, Queen's University, Kingston, Ontario, Canada. Mr. Desai: Medical Student, School of Medicine, Queen's University, Kingston, Ontario, Canada. Ms. Yin: Medical Student, School of Medicine, Queen's University, Kingston, Ontario, Canada. Ms. Ng: Medical Student, School of Medicine, Queen's University, Kingston, Ontario, Canada. Ms. Maho: Medical Student, School of Medicine, Queen's University, Kingston, Ontario, Canada. Dr. Cohen: Assistant Professor of Surgery, Department of Otolaryngology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada. Dr. Soleas: Director of Continuing Professional Development, Faculty of Health Sciences, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
4
|
Zambrano Harvey A, Bonilla-Escobar FJ, Hidalgo A, Parra-Lara LG, Mendoza-Urbano DM, Zapata Izquierdo Z, Pacichana Quinayáz SG. Indigenous communities in Colombia: A cultural and holistic view of cancer management. Int J Cancer 2023; 152:1314-1319. [PMID: 36541784 DOI: 10.1002/ijc.34410] [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: 08/25/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Cancer is one of the most burdening global health challenges. Indigenous communities are at high risk for worse healthcare outcomes because of inequalities in the incidence, prevalence, and mortality of oncological diseases, that arise from socioeconomic, racial, cultural, religious beliefs, and ethnic factors. Their perception about themselves is closely related to what affects their territory, making them possess a profound rooted feeling with their surroundings, and intense spiritual believes. Consequently, the disease process is linked to physical and emotional imbalances and alterations in their territory. Researchers from the United States, Canada, New Zealand, and Australia have worked diligently to learn about barriers to cancer management among these populations. Unfortunately, robust cancer data is lacking for most of the world's Indigenous, leading to obstacles in information systems and consequently, inequities in healthcare with the perpetuation of the problem. Therefore, a better understanding of cancer as a global health problem is required. Our study aims to propose a holistic and culturally adapted framework to improve cancer health services and outcomes among Indigenous peoples in Colombia.
Collapse
Affiliation(s)
| | - Francisco Javier Bonilla-Escobar
- Science to Serve the Community, SCISCO Foundation/Fundación SCISCO, Cali, Colombia.,School of Medicine, Institute for Clinical Research Education (ICRE), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Alejandra Hidalgo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Zeynara Zapata Izquierdo
- Departamento de Medicina, Universidad del Magdalena, Etnia indígena Arhuaca, comunidad de Jewrwa, Santa Marta, Colombia
| | - Sara Gabriela Pacichana Quinayáz
- Science to Serve the Community, SCISCO Foundation/Fundación SCISCO, Cali, Colombia.,Facultad de Salud, Universidad del Valle, Cali, Colombia
| |
Collapse
|
5
|
Waanders A, Brown A, Caron NR, Plisiewicz A, McHugh ST, Nguyen TQ, Lehmann K, Stevens J, Storm PJ, Resnick A, Davidson TB, Mueller S, Kline C. Indigenous peoples and inclusion in clinical and genomic research: Understanding the history and navigating contemporary engagement. Neoplasia 2023; 37:100879. [PMID: 36738585 PMCID: PMC9918407 DOI: 10.1016/j.neo.2023.100879] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
Despite significant improvements in pediatric cancer survival outcomes, there remain glaring disparities in under-represented racial and ethnic groups that warrant mitigation by the scientific and clinical community. To address and work towards eliminating such disparities, the Pacific Pediatric Neuro-Oncology Consortium (PNOC) and Children's Brain Tumor Network (CBTN) established a Diversity, Equity, and Inclusion (DEI) working group in 2020. The DEI working group is dedicated to improving access to care for all pediatric patients with central nervous system (CNS) tumors, broadening diversity within the research community, and providing sustainable data-driven solutions. To this end, the DEI working group aims to coordinate regular educational sessions centered on critical DEI topics in pediatric research and clinical care of pediatric patients, with a focus on pediatric neuro-oncology. In April 2022, the group led a moderated panel of experts on Indigenous Peoples' rights and participation in clinical research activities. The following paper serves to provide the scientific community a perspective on how to prioritize the inclusion of Indigenous Peoples in research with cultural sensitivity and with the intent of improving not only representation, but patient outcomes regardless of patient race, ethnicity, or socioeconomic background.
Collapse
Affiliation(s)
- Angela Waanders
- Department of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA,Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alex Brown
- Australian National University and Telethon Kids Institute, Adelaide, SA, Australia
| | - Nadine R. Caron
- University of Northern British Columbia, Prince George, BC, Canada
| | - Alexa Plisiewicz
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sean T. McHugh
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Thinh Q. Nguyen
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kaitlin Lehmann
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jeffrey Stevens
- Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle Children's Research Institute, Seattle, WA, USA
| | - Phillip J. Storm
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Adam Resnick
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Tom Belle Davidson
- Division of Hematology-Oncology, Cancer and Blood Disease Institute and Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sabine Mueller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA,Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA,University Children's Hospital Zurich, Zurich, Switzerland
| | - Cassie Kline
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
6
|
Basile VA, Dhillon HM, Spoelma MJ, Butow PN, May J, Depczynski J, Pendlebury S. Medical treatment decision-making in rural cancer patients: A qualitative systematic review and meta-synthesis. PATIENT EDUCATION AND COUNSELING 2022; 105:2693-2701. [PMID: 35430096 DOI: 10.1016/j.pec.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Rural cancer patients have unique care needs which may impact upon treatment decision-making. Our aim was to conduct a qualitative systematic review and meta-synthesis to understand their perspectives and experiences of making treatment decisions. METHODS A systematic search of MEDLINE, PsycINFO, CINAHL and RURAL was conducted for qualitative studies in rural cancer patients regarding treatment decision-making. Articles were screened for relevance, and data from the included articles were extracted and analysed using meta-thematic synthesis. RESULTS Twelve studies were included, with 4 themes and 9 subthemes identified. Many studies reported patients were not given a choice regarding their treatment. Choice, if given, was influenced by personal factors such as finances, proximity to social supports, convenience, and their personal values. Patients were also influenced by the opinions of others and cultural norms. Finally, it was reported that patients made choices in the context of seeking the best possible medical care and the patient-clinician relationship. CONCLUSIONS In the rural context, there are universal and unique factors that influence the treatment decisions of cancer patients. PRACTICAL IMPLICATIONS Our findings are an important consideration for clinicians when engaging in shared decision-making, as well as for policymakers, to understand and accommodate the unique rural perspective.
Collapse
Affiliation(s)
- Victoria A Basile
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Haryana M Dhillon
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-Making, School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia.
| | - Michael J Spoelma
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia; School of Psychiatry, University of New South Wales, Level 1, AGSM Building, Botany Street, Sydney, NSW 2052, Australia.
| | - Phyllis N Butow
- School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-Making, School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia.
| | - Jennifer May
- University of Newcastle Department of Rural Health, Faculty of Health and Medicine, 114-148 Johnston St, Tamworth, NSW 2340, Australia.
| | - Julie Depczynski
- University of Newcastle Department of Rural Health, Faculty of Health and Medicine, 114-148 Johnston St, Tamworth, NSW 2340, Australia.
| | - Susan Pendlebury
- Department of Radiation Oncology, North West Cancer Centre, Dean St, North Tamworth, NSW 2340, Australia.
| |
Collapse
|
7
|
Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
Collapse
|
8
|
McInerney-Leo AM, West J, Meiser B, West M, Toombs MR, Brown MA, Duncan EL. The impact of Marfan syndrome on an Aboriginal Australian family: 'I don't like it as much as I don't like cancer'. J Genet Couns 2021; 31:620-630. [PMID: 34713948 DOI: 10.1002/jgc4.1529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/09/2021] [Accepted: 10/17/2021] [Indexed: 01/01/2023]
Abstract
Marfan syndrome (MFS) is an autosomal dominantly inherited connective tissue disorder. Aortic dilatation/dissection and ectopia lentis are the most severe features, which affect physical functioning and psychological well-being. In Aboriginal Australians, there is little psychosocial research on genetic conditions. This study explored the physical, psychological, and practical impacts of MFS on Aboriginal Australians. Eighteen (8 affected and 10 unaffected) members of a large Aboriginal Australian family with MFS participated in an ethically approved study. Semi-structured qualitative interviews were conducted, transcribed verbatim, and analyzed thematically. All individuals reported challenges from MFS, negatively affecting day-to-day living. Severe vision impairment was perceived as the greatest challenge, contributing to feelings of stigma and exclusion. With aging, concerns shifted toward cardiac complications. The unpredictability of lens dislocation and aortic dissection was reported to be psychologically challenging. Participants described MFS-related barriers to obtaining and retaining employment, especially following cardiac surgery; with consequential psychological and financial hardships. Participants articulated that their cultural drive to support the ill and respectfully mourn the deceased, regardless of distance, resulted in a significant financial burden. Additionally, when hospitalization and/or funerals occurred, financially solvent individuals were expected to share resources, without any expectation of repayment or reciprocity (i.e., 'demand sharing', common in Aboriginal Australian culture). This study documents the nature and pervasiveness of uncertainty for both affected and unaffected members of an MFS family. Many reported challenges are consistent with other MFS cohorts (including stigma, social exclusion, and unemployment). However, our findings suggest that cultural values may exacerbate the financial costs of MFS for Aboriginal Australians.
Collapse
Affiliation(s)
- Aideen M McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Jennifer West
- Prince Charles Hospital Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Malcolm West
- Prince Charles Hospital Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maree R Toombs
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Matthew A Brown
- NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, UK
| | - Emma L Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Endocrinology, NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Gall A, Butler TL, Lawler S, Garvey G. Traditional, complementary and integrative medicine use among Indigenous peoples with diabetes in Australia, Canada, New Zealand and the United States. Aust N Z J Public Health 2021; 45:664-671. [PMID: 34028943 DOI: 10.1111/1753-6405.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This systematic review aimed to describe traditional, complementary and integrative medicine (TCIM) use among Indigenous peoples with diabetes from Australia, Canada, New Zealand and the United States (US). METHODS A systematic search following the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) statement guidelines was conducted. Data were analysed using meta-aggregation. RESULTS Thirteen journal articles from 12 studies across Australia, Canada and the US were included in the review (no articles from New Zealand were identified). Indigenous peoples used various types of TCIM alongside conventional treatment for diabetes, particularly when conventional treatment did not meet Indigenous peoples' holistic understandings of wellness. TCIM provided opportunities to practice important cultural and spiritual activities. While TCIM was often viewed as an effective treatment through bringing balance to the body, definitions of treatments that comprise safe and effective TCIM use were lacking in the articles. CONCLUSIONS The concurrent use of TCIM and conventional treatments is common among Indigenous peoples with diabetes, but clear definitions of safe and effective TCIM use are lacking. Implications for public health: Healthcare providers should support Indigenous peoples to safely and effectively treat diabetes with TCIM alongside conventional treatment.
Collapse
Affiliation(s)
- Alana Gall
- Menzies School of Health Research, Charles Darwin University, Queensland
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Queensland
| | - Sheleigh Lawler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Queensland
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Ju X, Canfell K, Smith M, Sethi S, Garvey G, Hedges J, Logan RM, Antonsson A, Jamieson LM. High-Risk Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma Among Non-Indigenous and Indigenous Populations: A Systematic Review. Otolaryngol Head Neck Surg 2020; 165:23-32. [PMID: 33228443 DOI: 10.1177/0194599820975042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the prevalence of oral high-risk human papillomavirus (hr-HPV) infection and the proportion of hr-HPV-related oropharyngeal squamous cell carcinoma (OPSCC) among Indigenous and non-Indigenous populations. DATA SOURCE Electronic database searches of PubMed, PubMed Central, Embase, MEDLINE, Scope, and Google Scholar were conducted for articles published from January 2000 until November 2019. REVIEW METHODS Studies were included with a minimum of 100 cases assessing hr-HPV infection in either population samples or oropharyngeal cancer tumor series. The objective was to conduct meta-analyses to calculate the pooled prevalence of oral hr-HPV infection by adjusting for age group or sex in primary studies, the incidence of OPSCC, and the proportion of hr-HPV-related OPSCC in Indigenous people and non-Indigenous/general populations. RESULTS We identified 47 eligible studies from 157 articles for meta-analyses. The pooled prevalence of oral hr-HPV infection was 7.494% (95% CI, 5.699%-9.289%) in a general population, with a higher prevalence among men (10.651%) than women (5.176%). The pooled incidence rate was 13.395 (95% CI, 9.315-17.475) and 7.206 (95% CI, 4.961-9.450) per 100,000 person-years in Indigenous and non-Indigenous populations, respectively. The overall pooled proportion of hr-HPV-related OPSCC was 50.812% (95 CI, 41.656%-59.969%). The highest proportion was in North America (60.221%), while the lowest proportion was in the Asia-Pacific (34.246%). CONCLUSION Our findings suggest that in the general population, the prevalence of oral hr-HPV infection is lower among females and those in younger age groups. The incidence of OPSCC was higher among Indigenous than non-Indigenous populations, with the proportion being highest in North America.
Collapse
Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Karen Canfell
- Cancer Council NSW, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Megan Smith
- Cancer Council NSW, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Gail Garvey
- Menzies School of Health Research, Spring Hill, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Richard M Logan
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
12
|
Older Aboriginal Australians' Health Concerns and Preferences for Healthy Ageing Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207390. [PMID: 33050541 PMCID: PMC7600369 DOI: 10.3390/ijerph17207390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians’ perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants’ health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.
Collapse
|
13
|
Aljassim N, Ostini R. Health literacy in rural and urban populations: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2142-2154. [PMID: 32601042 DOI: 10.1016/j.pec.2020.06.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/09/2020] [Accepted: 06/05/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This review assessed whether health literacy differences exist between rural and urban populations and whether rurality is a determinant. METHODS Eight online databases were searched using the keywords "health literacy", "rural" and "urban", and related terms. Peer-reviewed original research comparing health literacy levels between rural and urban populations were evaluated for strength of evidence. A narrative synthesis summarised the results of included studies. RESULTS Nineteen articles met inclusion criteria and were of sufficient methodological quality for data extraction. The majority of studies found that urban populations had higher health literacy than rural populations. Differences were more likely to be found in developing than developed countries. Studies that performed covariate analysis indicated that rurality may not be a significant determinant of health literacy. CONCLUSION Evidence suggests that rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles. PRACTICE IMPLICATIONS These findings could be used to help inform the development of evidence-based interventions specifically for rural populations, at both health policy and clinical levels; for example, by tackling healthcare access challenges. The findings also provide a lens through which to consider efforts to reduce rural-urban health outcome disparities.
Collapse
Affiliation(s)
- Noor Aljassim
- Rural Clinical School, University of Queensland, Locked bag 9009, Toowoomba DC., QLD, 4350 Australia.
| | - Remo Ostini
- Rural Clinical School, University of Queensland, Locked bag 9009, Toowoomba DC., QLD, 4350 Australia.
| |
Collapse
|
14
|
Butler TL, Anderson K, Condon JR, Garvey G, Brotherton JML, Cunningham J, Tong A, Moore SP, Maher CM, Mein JK, Warren EF, Whop LJ. Indigenous Australian women's experiences of participation in cervical screening. PLoS One 2020; 15:e0234536. [PMID: 32542004 PMCID: PMC7295213 DOI: 10.1371/journal.pone.0234536] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Aboriginal and Torres Strait Islander (collectively, Indigenous Australian) women experience a higher burden of cervical cancer than other women. The National Cervical Screening Program (NCSP) is failing to meet the needs of Indigenous Australian women, resulting in many women not regularly participating in cervical screening. However, one third of Indigenous Australian women do participate in cervical screening. The reasons that some women in this population commence and continue to screen remain unheard but could provide insights to support women who currently do not participate. We aimed to describe Indigenous Australian women’s experiences and views of participation in cervical screening by yarning (a culturally-appropriate interview technique) with 50 Indigenous Australian women aged 25–70 years who had completed cervical screening in the past five years, recruited via Primary Health Care Centres (PHCCs) from three jurisdictions. Aboriginal or Torres Strait Islander women researchers conducted the interviews. Thematic analysis identified six themes: screening as a means of staying strong and in control; overcoming fears, shame, and negative experiences of screening; needing to talk openly about screening; the value of trusting relationships with screening providers; logistical barriers; and overcoming privacy concerns for women employed at PHCCs. Despite describing screening as shameful, invasive, and uncomfortable, women perceived it as a way of staying healthy and exerting control over their health. This ultimately supported their participation and a sense of empowerment. Women valued open discussion about screening and strong relationships with health providers. We identified logistical barriers and specific barriers faced by women employed at PHCCs. This study is strengthened by a research approach that centred Indigenous Australian women’s voices. Understanding the experiences of Indigenous Australian women who participate in screening will help screening providers support women to start and continue to screen regularly. Recommendations for practice are provided.
Collapse
Affiliation(s)
- Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - John R Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne P Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Clare M Maher
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Queensland, Australia
| | | | - Eloise F Warren
- Yerin Eleanor Duncan Aboriginal Health Centre, Wyong, New South Wales, Australia
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| |
Collapse
|
15
|
Gall A, Anderson K, Adams J, Matthews V, Garvey G. An exploration of healthcare providers' experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients. Altern Ther Health Med 2019; 19:259. [PMID: 31533782 PMCID: PMC6751784 DOI: 10.1186/s12906-019-2665-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 08/30/2019] [Indexed: 11/10/2022]
Abstract
Background Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers’ views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients. Methods Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers’ experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data. Results Analysis revealed six themes: concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM. Conclusions Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services.
Collapse
|
16
|
Tapia KA, Garvey G, McEntee MF, Rickard M, Lydiard L, Brennan PC. Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia. Aust N Z J Public Health 2019; 43:334-339. [PMID: 31268228 DOI: 10.1111/1753-6405.12917] [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: 12/01/2018] [Revised: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare breast screening attendances of Indigenous and non-Indigenous women. METHODS A total of 4,093 BreastScreen cases were used including 857 self-identified Indigenous women. Chi-squared analysis compared data between Indigenous and non-Indigenous women. Logistic regression was used for groupings based on visits-to-screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. RESULTS Indigenous women were younger and had fewer visits to screening compared with non-Indigenous women. Non-English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3-2.9). Living remotely was associated with fewer visits for non-Indigenous women only (OR 1.3, 95%CI 1.1-1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1-18.8; and OR 11.5, 95%CI 9.6-13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3-3.3; and OR 1.8, 95%CI 1.5-2.1, respectively). CONCLUSIONS Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non-Indigenous women. Implications for public health: Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote-living non-Indigenous women should also be addressed.
Collapse
Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales
| | - Gail Garvey
- Faculty of Health Sciences, The University of Sydney, New South Wales.,Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division Menzies School of Health Research, Northern Territory
| | - Mark F McEntee
- Department of Medicine, University College Cork, Ireland
| | - Mary Rickard
- Faculty of Health Sciences, The University of Sydney, New South Wales.,BreastScreen New South Wales
| | | | - Patrick C Brennan
- Faculty of Health Sciences, The University of Sydney, New South Wales
| |
Collapse
|
17
|
Kidd J, Raphael D, Cassim S, Black S, Blundell R, Egan R. Health service provider responses to indigenous peoples with cancer: An integrative review. Eur J Cancer Care (Engl) 2018; 28:e12975. [PMID: 30537074 DOI: 10.1111/ecc.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/12/2018] [Accepted: 10/27/2018] [Indexed: 11/27/2022]
Abstract
Indigenous populations around the world have a higher burden of cancer incidence, severity and mortality. This integrative review aims to identify and appraise the evidence of health providers' responses to the issue of indigenous peoples with cancer. A surprisingly small number of studies were found (n = 9) that reported on programmes and interventions for indigenous people with cancer, the majority of which were from the USA. Our review shows that a service delivery approach that is focused on the indigenous population and includes culturally appropriate activities, resources and environments resulted in an increase in cancer knowledge, reduction in treatment interruption, improved access to cancer care and enrolment in clinical cancer trials, and increased satisfaction with health care. However, the question of why there are so few published studies needs further consideration.
Collapse
Affiliation(s)
- Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | - Deborah Raphael
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Stella Black
- School of Nursing, University of Auckland, Auckland, New Zealand
| | | | - Richard Egan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
18
|
Gall A, Leske S, Adams J, Matthews V, Anderson K, Lawler S, Garvey G. Traditional and Complementary Medicine Use Among Indigenous Cancer Patients in Australia, Canada, New Zealand, and the United States: A Systematic Review. Integr Cancer Ther 2018; 17:568-581. [PMID: 29779402 PMCID: PMC6142081 DOI: 10.1177/1534735418775821] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer 'patients' are increasingly using traditional indigenous and complementary medicines (T&CM) alongside conventional medical treatments to both cure and cope with their cancer diagnoses. To date T&CM use among Indigenous cancer patients from Australia, Canada, New Zealand, and the United States has not been systematically reviewed. METHODS We systematically searched bibliographic databases to identify original research published between January 2000 and October 2017 regarding T&CM use by Indigenous cancer patients in Australia, Canada, New Zealand, and the United States. Data from records meeting eligibility criteria were extracted and appraised for quality by 2 independent reviewers. RESULTS Twenty-one journal articles from 18 studies across all 4 countries met our inclusion criteria. T&CM use ranged from 19% to 57.7% (differing across countries). T&CM was mostly used concurrently with conventional cancer treatments to meet their spiritual, emotional, social, and cultural needs; however, bush, traditional, and herbal medicines were used in a minority of cases as an alternative. CONCLUSIONS Our findings highlight the importance of T&CM use to Indigenous cancer patients across these 4 countries; we identified multiple perceived spiritual, emotional and cultural benefits to its use. The patient's perception of their health professional's attitudes toward T&CM in some cases hindered or encouraged the patient's disclosure. Additional research is required to further explore the use and disclosure of T&CM among Indigenous cancer patients to help inform and ensure effective, safe, coordinated care for Indigenous cancer patients that relies on shared open decision making and communication across patients, communities, and providers.
Collapse
Affiliation(s)
- Alana Gall
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | - Stuart Leske
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | - Jon Adams
- 2 University of Technology Sydney, Sydney, New South Wales, Australia
| | - Veronica Matthews
- 3 University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Kate Anderson
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | | | - Gail Garvey
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| |
Collapse
|
19
|
Whiting C, Cavers S, Bassendowski S, Petrucka P. Using Two-Eyed Seeing to Explore Interagency Collaboration. Can J Nurs Res 2018; 50:133-144. [PMID: 29648461 DOI: 10.1177/0844562118766176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Health-care environments influence service delivery; approaches need to be more wholistic and culturally competent requiring effective interagency collaboration to bridge traditional Indigenous and mainstream health services. Despite considerable research on collaboration, the concept remains misunderstood, at worst, and formative, at best. Within the nexus of these two diverse health services, there is limited information on how collaborations could be created and sustained effectively. Purpose To explore the perspectives/experiences of collaboration of select Saskatchewan health professionals practicing across these diverse services to understand the concept from their perspectives. Methods This qualitative study explored collaboration through observation and interviews to elicit perspectives (two-eyed seeing) of health professionals working within the context of a traditional-mainstream health services partnership. Results Individual- and system-level factors and accountabilities are needed for successful cross-cultural collaboration and can be enabled by embedding the virtues of Indigenous and values of mainstream health services along with building and maintaining relationships, valuing difference, creating supportive environments and wholistic approaches, having the right people at the table, and making a change for impactful outcomes. Conclusion Findings support the need for implementing contextually relevant collaborative practice models for productive, wholistic health services. Two-eyed seeing provides the ability to capture and catalyze the tremendous value and strengths of both worlds, potentiating complementary aspects to meet the needs of clients and communities.
Collapse
Affiliation(s)
- Cheryl Whiting
- 1 Population Health, Quality and Research Division, Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Stephanie Cavers
- 2 Eagle Moon Health Office, former Regina Qu'Appelle Health Region (now Saskatchewan Health Authority), Regina, Saskatchewan, Canada
| | - Sandra Bassendowski
- 3 College of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Pammla Petrucka
- 3 College of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada
| |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
Durey A, Halkett G, Berg M, Lester L, Kickett M. Does one workshop on respecting cultural differences increase health professionals' confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation. BMC Health Serv Res 2017; 17:660. [PMID: 28915810 PMCID: PMC5603013 DOI: 10.1186/s12913-017-2599-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Aboriginal Australians have worse cancer survival rates than other Australians. Reasons include fear of a cancer diagnosis, reluctance to attend mainstream health services and discrimination from health professionals. Offering health professionals education in care focusing on Aboriginal patients' needs is important. The aim of this paper was to evaluate whether participating in a workshop improved the confidence of radiation oncology health professionals in their knowledge, communication and ability to offer culturally safe healthcare to Aboriginal Australians with cancer. METHODS Mixed methods using pre and post workshop online surveys, and one delivered 2 months later, were evaluated. Statistical analysis determined the relative proportion of participants who changed from not at all/a little confident at baseline to fairly/extremely confident immediately and 2 months after the workshop. Factor analysis identified underlying dimensions in the items and nonparametric tests recorded changes in mean dimension scores over and between times. Qualitative data was analysed for emerging themes. RESULTS Fifty-nine participants attended the workshops, 39 (66% response rate) completed pre-workshop surveys, 32 (82% of study participants) completed post-workshop surveys and 25 (64% of study participants) completed surveys 2 months later. A significant increase in the proportion of attendees who reported fair/extreme confidence within 2 days of the workshop was found in nine of 14 items, which was sustained for all but one item 2 months later. Two additional items had a significant increase in the proportion of fair/extremely confident attendees 2 months post workshop compared to baseline. An exploratory factor analysis identified three dimensions: communication; relationships; and awareness. All dimensions' mean scores significantly improved within 2 days (p < 0.005) and persisted to 2 months. The workshop raised awareness about barriers and enablers to delivering services respectful of cultural differences, led to a willingness to reflect on pre-existing beliefs and assumptions about Aboriginal Australians that in some cases resulted in improved care. CONCLUSION Single workshops co-delivered by an Aboriginal and non-Aboriginal presenter can be effective in building health professionals' confidence and translating into practice knowledge of respectful care of Aboriginal patients with cancer. Sustaining improvements may require integrating this approach into ongoing professional development.
Collapse
Affiliation(s)
- Angela Durey
- UWA Dental School, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009 Australia
- Centre for Aboriginal Studies, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| | - Melissa Berg
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| | - Leanne Lester
- Health Promotion and Evaluation Unit, University of Western Australia, 35 Stirling Highway, Perth, 6009 Western Australia Australia
| | - Marion Kickett
- Centre for Aboriginal Studies, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| |
Collapse
|
22
|
Zubrzycki J, Shipp R, Jones V. Knowing, Being, and Doing: Aboriginal and Non-Aboriginal Collaboration in Cancer Services. QUALITATIVE HEALTH RESEARCH 2017; 27:1316-1329. [PMID: 28682709 PMCID: PMC5502907 DOI: 10.1177/1049732316686750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This qualitative inquiry explored the processes and practices of collaboration as experienced by a group of Australian multidisciplinary Aboriginal and non-Aboriginal health workers. Each worker had participated, for a period of 2 to 5 years, in an Australian Government-funded project in which a range of health initiatives led to improved access to cancer services by Aboriginal communities in a rural region of South Eastern Australia. Initiatives which addressed high rates of mortality from cancer, poor access to cancer screening, and engagement with cancer treatment were developed through the formation of close working relationships between Aboriginal and non-Aboriginal health workers. These relationships were regarded as personally and professionally transformative. Through the sharing of knowledge, skills, and experiences, new ways of knowing, being, and doing emerged. Developing a deeper understanding of cross-cultural collaboration is one way of addressing complex health problems and building the capacity of the health workforce.
Collapse
Affiliation(s)
- Joanna Zubrzycki
- Australian Catholic University, Canberra, Australian Capital Territory, Australia
| | - Rick Shipp
- Southern NSW Local Health District, Queanbeyan, New South Wales, Australia
| | | |
Collapse
|
23
|
Withrow DR, Pole JD, Nishri ED, Tjepkema M, Marrett LD. Cancer Survival Disparities Between First Nation and Non-Aboriginal Adults in Canada: Follow-up of the 1991 Census Mortality Cohort. Cancer Epidemiol Biomarkers Prev 2016; 26:145-151. [DOI: 10.1158/1055-9965.epi-16-0706] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/04/2016] [Indexed: 11/16/2022] Open
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Moore SP, Soerjomataram I, Green AC, Garvey G, Martin J, Valery PC. Breast cancer diagnosis, patterns of care and burden of disease in Queensland, Australia (1998-2004): does being Indigenous make a difference? Int J Public Health 2016; 61:435-42. [PMID: 26427859 DOI: 10.1007/s00038-015-0739-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We compared patterns of care, comorbidity, disability-adjusted life-years (DALYs) and survival in Indigenous and non-Indigenous women with breast cancer in Queensland, Australia (1998-2004). METHODS A cohort study of Indigenous (n = 110) and non-Indigenous women (n = 105), frequency matched on age and remoteness. We used Pearson's Chi-squared analysis to compare proportions, hazard models to assess survival differences and calculated disability-adjusted life years (DALYs). RESULTS Indigenous women were more likely to be socially disadvantaged (43 vs. 20 %, p < 0.01) have comorbidity (42 vs. 18 % p < 0.01), and have regional spread or distant metastasis (metastasis, 51 vs. 36 %, p = 0.02) than non-Indigenous women; there was no difference in treatment patterns. More Indigenous women died in the follow-up period (p = 0.01). DALY's were 469 and 665 per 100,000 for Indigenous and non-Indigenous women, respectively, with a larger proportion of the burden attributed to premature death among the former (63 vs. 59 %). CONCLUSIONS Indigenous women with breast cancer received comparable treatment to their non-Indigenous counterparts. The higher proportion of DALYs related to early death in Indigenous women suggests higher fatality with breast cancer in this group. Later stage at diagnosis and higher comorbidity presence among Indigenous women reinforce the need for early detection and improved management of co-existing disease.
Collapse
Affiliation(s)
- Suzanne P Moore
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia.
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia
- CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gail Garvey
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - Jennifer Martin
- School of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Patricia C Valery
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
- Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia
| |
Collapse
|
26
|
Whop LJ, Bernardes CM, Kondalsamy-Chennakesavan S, Darshan D, Chetty N, Moore SP, Garvey G, Walpole E, Baade P, Valery PC. Indigenous Australians with non-small cell lung cancer or cervical cancer receive suboptimal treatment. Asia Pac J Clin Oncol 2016; 13:e224-e231. [PMID: 26997361 DOI: 10.1111/ajco.12463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/30/2015] [Accepted: 01/12/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung cancer and cervical cancer are higher in incidence for Indigenous Australians and survival is worse compared with non-Indigenous Australians. Here we aim to determine if being Indigenous and/or other factors are associated with patients receiving "suboptimal treatment" compared to "optimal treatment" according to clinical guidelines for two cancer types. METHODS Data were collected from hospital medical records for Indigenous adults diagnosed with cervical cancer and non-small cell lung cancer (NSCLC) and a frequency-matched comparison group of non-Indigenous patients in the Queensland Cancer Registry between January 1998 and December 2004. The two cancer types were analyzed separately. RESULTS A total of 105 women with cervical cancer were included in the study, 56 of whom were Indigenous. Indigenous women had higher odds of not receiving optimal treatment according to clinical guidelines (unadjusted OR 7.1; 95% CI, 1.5-33.3), even after adjusting for stage (OR 5.7; 95% CI, 1.2-27.3). Of 225 patients with NSCLC, 198 patients (56% Indigenous) had sufficient information available to be analyzed. The odds of receiving suboptimal treatment were significantly higher for Indigenous compared to non-Indigenous NSCLC patients (unadjusted OR 1.9; 95% CI, 1.0-3.6) and remained significant after adjusting for stage, comorbidity and age (adjusted OR 2.1; 95% CI, 1.1-4.1). CONCLUSIONS The monitoring of treatment patterns and appraisal against guidelines can provide valuable evidence of inequity in cancer treatment. We found that Indigenous people with lung cancer or cervical cancer received suboptimal treatment, reinforcing the need for urgent action to reduce the impact of these two cancer types on Indigenous people.
Collapse
Affiliation(s)
- Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Christina M Bernardes
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Deepak Darshan
- Toowoomba Hospital and Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.,Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Naven Chetty
- Mater Adult Hospital, Brisbane, Queensland, Australia
| | - Suzanne P Moore
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Euan Walpole
- Princess Alexandra Hospital and Metro South Health and Hospital Service, Brisbane, Queensland, Australia
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Pape R, Spuur KM, Currie G, Greene L. Mammographic parenchymal patterns and breast cancer risk in New South Wales North Coast Aboriginal and Torres Strait Islander women. J Med Radiat Sci 2016; 63:81-8. [PMID: 27350887 PMCID: PMC4914812 DOI: 10.1002/jmrs.160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 11/29/2015] [Accepted: 12/22/2015] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The objective of the study was to document the distribution of mammographic parenchymal patterns (MPP) of Indigenous Australian women attending BreastScreen New South Wales (NSW) North Coast, to profile breast cancer risk as it relates to breast density and to explore the correlation between MPP, breast size as described by the posterior nipple line (PNL) and age. METHODS Ethics was granted from CQUniversity Human Research Ethics Committee, NSW Population Health Services Research Ethics Committee and the Aboriginal Health and Medical Research Council Ethics Committee. A quantitative retrospective analysis reviewed 502 screening mammograms against the Tabár I-V MPP classification system. The PNL was measured in millimetres (mm) and the age of the patient documented. RESULTS A statistically significant variation in the distribution of MPP (P < 0.0001) was demonstrated, with patterns of I (23.9%), II (45.6%), III (10.4%), IV (15.9%) and V (4.2%). Statistically significant differences were noted in the age of subjects between patterns (P = 0.0002). Patterns I and V demonstrated statistically significant lower ages than II, III and IV (all P < 0.05). Pattern V demonstrated a statistically significant lower age than pattern I (P = 0.0393). Pattern V demonstrated a statistically significant lower PNL value than all other patterns (all P < 0.001/P < 0.0002); pattern II was statistically significantly higher in PNL value than all other patterns (P < 0.002/P < 0.001). No significant relationship was noted between PNL and age. CONCLUSION The study demonstrated that no identifiable or unique distribution of MPP was noted in this snapshot of Indigenous women. A larger study of Indigenous Australian women is required for validation.
Collapse
Affiliation(s)
- Ruth Pape
- School of Medical and Applied Sciences Faculty of Sciences Engineering and Health CQUniversity Mackay Queensland Australia; School of Medicine and Health Sciences Discipline of Medical Imaging UPNG Taurama Campus University of Papua New Guinea Boroko NCD Papua New Guinea
| | - Kelly Maree Spuur
- School of Medical and Applied Sciences Faculty of Sciences Engineering and Health CQUniversity Mackay Queensland Australia; School of Dentistry and Health Sciences Faculty of Science Charles Sturt University Wagga Wagga New South Wales Australia
| | - Geoffrey Currie
- School of Dentistry and Health Sciences Faculty of Science Charles Sturt University Wagga Wagga New South Wales Australia
| | - Lacey Greene
- School of Dentistry and Health Sciences Faculty of Science Charles Sturt University Wagga Wagga New South Wales Australia
| |
Collapse
|
28
|
Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study. Eur J Cancer Prev 2016; 24:253-60. [PMID: 25734238 PMCID: PMC4372163 DOI: 10.1097/cej.0000000000000140] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, age≥50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. ‘Cancer can often be cured’) and three negatively framed (e.g. ‘A cancer diagnosis is a death sentence’). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that ‘treatment is worse than cancer’, 27% that cancer is ‘a death sentence’ and 16% ‘would not want to know if I have cancer’. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.
Collapse
|
29
|
Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.
Collapse
|
30
|
Tranberg R, Alexander S, Hatcher D, Mackey S, Shahid S, Holden L, Kwok C. Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review. Psychooncology 2015; 25:131-41. [PMID: 26152813 DOI: 10.1002/pon.3900] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples. METHODS Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies. RESULTS Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures. CONCLUSION Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples.
Collapse
Affiliation(s)
- Rona Tranberg
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Susan Alexander
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Deborah Hatcher
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Sandra Mackey
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Shaouli Shahid
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, Perth, Australia.,School of Nursing, Midwifery and Para Medicine, Curtin University, Perth, Australia
| | - Lynda Holden
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Cannas Kwok
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
31
|
Garvey G, Thewes B, He VFY, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, Jones V, Yip D. Indigenous cancer patient and staff attitudes towards unmet needs screening using the SCNAT-IP. Support Care Cancer 2015; 24:215-223. [PMID: 26003424 DOI: 10.1007/s00520-015-2770-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Indigenous Australians have a higher cancer incidence, worse mortality and are less likely to receive optimal cancer treatment compared with non-Indigenous Australians. Culturally appropriate supportive care helps ensure that Indigenous patients engage in and receive optimal care. However, many existing supportive care needs tools lack cultural relevance for Indigenous people, and their feasibility with Indigenous people has not been demonstrated. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) assesses the unmet supportive care needs of Indigenous cancer patients. PURPOSE This descriptive study evaluates the clinical implementation of the SCNAT-IP in routine care. METHODS Two large tertiary cancer treatment centres and two regional oncology clinics participated. Participants included 10 clinical staff and 36 adult Indigenous cancer patients (mean age 54 years). Patients and clinicians completed brief, purpose-designed questionnaires and interviews. RESULTS Patients reported high ratings (means >8/10) for acceptability, helpfulness and timing items. The majority (≥80%) of staff agreed that the SCNAT-IP was useful to clinical practice, should be used in routine care and was acceptable to their patients. CONCLUSIONS The study provides empirical support for the feasibility and acceptability of the SCNAT-IP in routine cancer care with Indigenous Australians. Routine screening with the SCNAT-IP has the potential to improve cancer care for Indigenous people with cancer.
Collapse
Affiliation(s)
- G Garvey
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia.
| | - B Thewes
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - V F Y He
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - V Jones
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | | |
Collapse
|
32
|
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.
Collapse
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.
| |
Collapse
|
33
|
Frydrych AM, Slack-Smith LM, Parsons R, Threlfall T. Oral cavity squamous cell carcinoma - characteristics and survival in aboriginal and non-aboriginal Western australians. Open Dent J 2014; 8:168-74. [PMID: 25328552 PMCID: PMC4200744 DOI: 10.2174/1874210601408010168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 08/15/2014] [Accepted: 08/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background: Squamous cell carcinoma (SCC) is the most common type of malignancy affecting the oral cavity. While exposures to main risk factors for oral SCC such as smoking and alcohol use are higher amongst the Aboriginal people, little is known about oral cancer in this population. This study aimed to describe characteristics and survival of oral SCC in Aboriginal and non-Aboriginal Western Australians. Methods: All primary oral SCC cases reported to the Western Australian Cancer Registry (WACR) between 1990 and 1999 were analysed with respect to person characteristics including: date of birth, sex and indigenous status; and disease characteristics including: date of biopsy, disease stage and site as well as date of recurrence and date of death. Exclusion criteria included diagnosis not based on incisional or excisional biopsy, diagnosis other than oral SCC or a history of another malignant neoplasm. Results: Aboriginal individuals were more likely to reside in rural areas. No statistically significant differences in oral SCC characteristics and survival were noted between Aboriginal and non-Aboriginal Western Australians. Conclusion: This study provides new information on person and disease characteristics of Aboriginal Western Australians diagnosed with oral SCC.
Collapse
Affiliation(s)
- A M Frydrych
- School of Dentistry M512, The University of Western Australia, Perth, Western Australia
| | - L M Slack-Smith
- School of Dentistry M512, The University of Western Australia, Perth, Western Australia
| | - R Parsons
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia
| | - T Threlfall
- Western Australian Cancer Registry, Department of Health (WA) Perth, Western Australia
| |
Collapse
|
34
|
Valery PC, Moore SP, Meiklejohn J, Bray F. International variations in childhood cancer in indigenous populations: a systematic review. Lancet Oncol 2014; 15:e90-e103. [PMID: 24480559 DOI: 10.1016/s1470-2045(13)70553-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although the cancer burden in indigenous children has been reported in some countries, up to now, no international comparison has been made. We therefore aimed to assess the available evidence of the burden of childhood cancer in indigenous populations. We did a systematic review of reports on cancer incidence, mortality, and survival in indigenous children worldwide. Our findings highlight the paucity of accessible information and advocate the pressing need for data by indigenous status in countries where population-based cancer registries are established. The true extent of disparities between the burden in the indigenous community needs to be measured so that targeted programmes for cancer control can be planned and implemented.
Collapse
Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
| | - Suzanne P Moore
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
| | - Judith Meiklejohn
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Freddie Bray
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
35
|
Jiwa M, McManus A, Dadich A. The impact of knowledge, attitudes and beliefs on the engagement of primary and community-based healthcare professionals in cancer care: a literature review. Curr Med Res Opin 2013; 29:1475-82. [PMID: 23998506 DOI: 10.1185/03007995.2013.838154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary health services are well placed to reinforce prevention, early intervention, and connected care. Despite this important role, primary care providers (PCPs) have a limited capacity to meet the varied needs of people with cancer and their carers - furthermore, the reasons for this largely remain unexplored. SCOPE To identify: (1) the knowledge, attitudes, and beliefs held by health professionals and patients that can influence the engagement of PCPs with the early detection of cancer and follow-up care; (2) evidence that attitudes and beliefs can be modified with measureable impact on the engagement of PCPs with cancer care; and (3) potential targets for intervention. This was achieved through a review of English publications from 2000 onwards, sourced from six academic databases and complemented with a search for grey literature. FINDINGS A total of 4212 articles were reviewed to identify studies conducted in the UK, Canada, Holland (or The Netherlands), Australia, or New Zealand given the comparable role of PCPs. Several factors hinder PCP participation in cancer care, all of which are related to knowledge, attitudes, and beliefs. Patients and specialists are uncertain about the role that primary care could play and whether their primary care team has the necessary expertise. PCPs have varied opinions about the ideal content of follow-up programs. Study limitations include: the absence of well accepted definitions of key terms; the indexing systems used by databases to code publications, which may have obscured all relevant publications; the paucity of robust research; and possible researcher bias which was minimized through independent review by trained reviewers and the implementation of rigorous inter-rater reliability measures. CONCLUSIONS Knowledge, attitudes, and beliefs influence PCP engagement in cancer care. It is important to develop shared understandings of these terms because the knowledge, attitudes, and beliefs of PCPs, specialists, patients, and their families can influence the effectiveness of treatment plans.
Collapse
Affiliation(s)
- Moyez Jiwa
- Curtin University, Medical Education , Bentley, Perth , Australia
| | | | | |
Collapse
|
36
|
Davidson PM, Jiwa M, DiGiacomo ML, McGrath SJ, Newton PJ, Durey AJ, Bessarab DC, Thompson SC. The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery. AUST HEALTH REV 2013; 37:70-8. [DOI: 10.1071/ah10955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 05/04/2012] [Indexed: 11/23/2022]
Abstract
Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar. Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples’ engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities. What is known about the topic? Aboriginal Australians suffer a disproportionate burden of ill health including poor outcomes from lung cancer. What does this paper add? This paper reports the outcomes of an integrative literature review. The paper identifies potential barriers to optimal lung cancer care and management for Aboriginal Australians. This paper describes barriers within the context of individual beliefs and behaviours, healthcare systems issues and environmental issues. The authors conclude that acknowledging entrenched inequality and addressing factors at the patient, provider and system level are needed to reduce the lung cancer burden in Aboriginal Australians. What are the implications for practitioners? This paper highlights the need for a greater focus on lung cancer care, awareness and diagnosis within the Aboriginal Australian population. Addressing culturally appropriate smoking-cessation initiatives is of particular importance. Primary care practitioners are key to reducing the burden of lung cancer in Aboriginal Australians.
Collapse
|
37
|
van Schaik KD, Thompson SC. Indigenous beliefs about biomedical and bush medicine treatment efficacy for indigenous cancer patients: a review of the literature. Intern Med J 2012; 42:184-91. [PMID: 21981135 DOI: 10.1111/j.1445-5994.2011.02598.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Australia's indigenous people suffer from higher cancer mortality than non-indigenous Australians, a discrepancy partly caused by differences in beliefs about treatment efficacy between Indigenous patients and their non-indigenous healthcare providers. This paper critically reviews the literature associated with Indigenous beliefs about cancer treatment, both 'bush medicine' and biomedical, in order to provide recommendations to healthcare providers about accommodating indigenous beliefs when treating cancer. METHODS A search was undertaken of peer-reviewed journal papers using electronic databases and citation snowballing. Papers were selected for inclusion based upon relevance to themes that addressed the research questions. RESULTS Literature suggests that indigenous beliefs about treatment efficacy for cancer involve five themes: (i) concerns about the toxicity of treatment; (ii) disconnect with the physician; (iii) fears about absence from home during treatment; (iv) different beliefs about disease aetiology; (v) biomedical cancer treatments failing to address holistic health. CONCLUSIONS Although some information is known about indigenous Australian healing beliefs and practices associated with cancer treatment, few studies have addressed ways in which indigenous and biomedical approaches to cancer treatment might be integrated. Some recent work has examined the role of belief in cancer treatment, specifically bush medicine, but more research is required.
Collapse
Affiliation(s)
- K D van Schaik
- Harvard University Medical School, Boston, Massachusetts, USA.
| | | |
Collapse
|
38
|
American Indian community leader and provider views of needs and barriers to mammography. J Community Health 2012; 37:307-15. [PMID: 21786207 DOI: 10.1007/s10900-011-9446-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Breast cancer incidence is rising and mortality is disproportionately high among American Indians and Alaska Natives, yet screening rates remain low. Using community-based participatory research, we conducted interviews with community leaders (n = 13) and providers from the Indian Health Service, tribal clinics, and urban safety-net clinics (n = 17). Participants in both groups identified similar needs, including culturally-appropriate mammography education, use of Native elders as patient navigators, and an emphasis on preventive care. Pertinent barriers included culturally-specific issues (e.g., historic mistrust and gender roles), cost, transportation, and fear of mammography and potential results. The results reflect the struggles of promoting mammography across diverse populations.
Collapse
|
39
|
Shahid S, Finn L, Bessarab D, Thompson SC. 'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment. AUST HEALTH REV 2011; 35:235-41. [PMID: 21612740 DOI: 10.1071/ah09835] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 07/28/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. DESIGN, SETTING AND PARTICIPANTS Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. RESULTS The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. CONCLUSION To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services.
Collapse
Affiliation(s)
- Shaouli Shahid
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | | | | | | |
Collapse
|
40
|
Nadimi F, Currow DC. As death approaches: a retrospective survey of the care of adults dying in Alice Springs Hospital. Aust J Rural Health 2011; 19:4-8. [PMID: 21265918 DOI: 10.1111/j.1440-1584.2010.01169.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Australians are more likely to die in a hospital than anywhere else, and most of these deaths are 'expected'. The aims of this survey were to identify if specific end-of-life issues were documented in clinical records of a regional hospital serving remote Australia. DESIGN A retrospective consecutive case-note audit covering 18 months from 1 January 2006. SETTING Alice Springs Hospital. PARTICIPANTS Adult deaths in Alice Springs Hospital. During this period there were 128 deaths. OUTCOME MEASURES Demographic, process (diagnosis of dying documented, 'not for resuscitation' documentation, intensive care unit (ICU) admission, social worker referral and specialised palliative care service referral) and outcome data ('comfort at end of life') were surveyed. RESULTS Of the 128 admissions, 55 cases were excluded: 10 were children under 18, 33 died in < 48 hours, nine were coroner's cases and three files could no't be found. Of the 73 deaths surveyed (33 men), 47 (64%) were Aboriginal. A diagnosis of dying was made in 84%, 88% had an 'not for resuscitation' order, 48% were admitted to ICU during their last admission, 66% were referred to social workers, 68% were referred to palliative care and 85% of people were documented to be 'comfortable' during the dying process with no differential outcomes for Aboriginal and non-Aboriginal decedents except age (P < 0.0001). CONCLUSION This survey highlights the continuing need to diagnose dying, understand optimal use of intensive care and improve comfort care at the end of life.
Collapse
Affiliation(s)
- Fariba Nadimi
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia.
| | | |
Collapse
|
41
|
Thompson SC, Shahid S, Bessarab D, Durey A, Davidson PM. Not just bricks and mortar: planning hospital cancer services for Aboriginal people. BMC Res Notes 2011; 4:62. [PMID: 21401923 PMCID: PMC3068108 DOI: 10.1186/1756-0500-4-62] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/14/2011] [Indexed: 11/16/2022] Open
Abstract
Background Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i) being alone and lost in a big, alien and inflexible system; (ii) failure of open communication, delays and inefficiency in the system; (iii) practicalities: costs, transportation, community and family responsibilities; (iv) the need for Aboriginal support persons; and (v) connection to the community. Conclusions Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes.
Collapse
Affiliation(s)
- Sandra C Thompson
- Winthrop Professor, Chair in Rural Health and Director, Combined Universities Centre for Rural Health, University of Western Australia, 167 Fitzgerald St, Geraldton, Western Australia 6530 Australia.
| | | | | | | | | |
Collapse
|
42
|
Turnbull D. On the trails of markers and proxies: the socio-cognitive technologies of human movement, knowledge assemblage, and their relevance to the etiology of nasopharyngeal carcinoma. CHINESE JOURNAL OF CANCER 2011; 30:85-95. [PMID: 21272440 PMCID: PMC4013337 DOI: 10.5732/cjc.010.10597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 01/14/2023]
Abstract
Bacteria, pigs, rats, pots, plants, words, bones, stones, earrings, diseases, and genetic indicators of all varieties are markers and proxies for the complexity of interweaving trails and stories integral to understanding human movement and knowledge assemblage in Southeast Asia and around the world. Understanding human movement and knowledge assemblage is central to comprehending the genetic basis of disease, especially of a cancer like nasopharyngeal carcinoma. The problem is that the markers and trails, taken in isolation, do not all tell the same story. Human movement and knowledge assemblage are in constant interaction in an adaptive process of co-production with genes, terrain, climate, sea level changes, kinship relations, diet, materials, food and transport technologies, social and cognitive technologies, and knowledge strategies and transmission. Nasopharyngeal carcinoma is the outcome of an adaptive process involving physical, social, and genetic components.
Collapse
Affiliation(s)
- David Turnbull
- Victorian Eco-Innovation Lab (VEIL), Architecture Faculty, University of Melbourne, Melbourne, Victoria 3052, Australia.
| |
Collapse
|
43
|
Christou A, Katzenellenbogen JM, Thompson SC. Australia's national bowel cancer screening program: does it work for indigenous Australians? BMC Public Health 2010; 10:373. [PMID: 20579344 PMCID: PMC2915957 DOI: 10.1186/1471-2458-10-373] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/25/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups. METHODS A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions. RESULTS The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening. CONCLUSIONS Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.
Collapse
Affiliation(s)
- Aliki Christou
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
| | - Judith M Katzenellenbogen
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
| | - Sandra C Thompson
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
- Combined Universities Centre for Rural Health, University of Western Australia PO Box 109 Geraldton WA 6531, Australia
| |
Collapse
|
44
|
Shahid S, Bleam R, Bessarab D, Thompson SC. "If you don't believe it, it won't help you": use of bush medicine in treating cancer among Aboriginal people in Western Australia. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2010; 6:18. [PMID: 20569478 PMCID: PMC2902429 DOI: 10.1186/1746-4269-6-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/23/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Little is known about the use of bush medicine and traditional healing among Aboriginal Australians for their treatment of cancer and the meanings attached to it. A qualitative study that explored Aboriginal Australians' perspectives and experiences of cancer and cancer services in Western Australia provided an opportunity to analyse the contemporary meanings attached and use of bush medicine by Aboriginal people with cancer in Western Australia METHODS Data collection occurred in Perth, both rural and remote areas and included individual in-depth interviews, observations and field notes. Of the thirty-seven interviews with Aboriginal cancer patients, family members of people who died from cancer and some Aboriginal health care providers, 11 participants whose responses included substantial mention on the issue of bush medicine and traditional healing were selected for the analysis for this paper. RESULTS The study findings have shown that as part of their healing some Aboriginal Australians use traditional medicine for treating their cancer. Such healing processes and medicines were preferred by some because it helped reconnect them with their heritage, land, culture and the spirits of their ancestors, bringing peace of mind during their illness. Spiritual beliefs and holistic health approaches and practices play an important role in the treatment choices for some patients. CONCLUSIONS Service providers need to acknowledge and understand the existence of Aboriginal knowledge (epistemology) and accept that traditional healing can be an important addition to an Aboriginal person's healing complementing Western medical treatment regimes. Allowing and supporting traditional approaches to treatment reflects a commitment by modern medical services to adopting an Aboriginal-friendly approach that is not only culturally appropriate but assists with the cultural security of the service.
Collapse
Affiliation(s)
- Shaouli Shahid
- Centre for International Health, Curtin University, Perth, WA, Australia.
| | | | | | | |
Collapse
|
45
|
Shahid S, Bessarab D, Howat P, Thompson SC. Exploration of the beliefs and experiences of Aboriginal people with cancer in Western Australia: a methodology to acknowledge cultural difference and build understanding. BMC Med Res Methodol 2009; 9:60. [PMID: 19674484 PMCID: PMC2743702 DOI: 10.1186/1471-2288-9-60] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/13/2009] [Indexed: 11/10/2022] Open
Abstract
Background Aboriginal Australians experience poorer outcomes, and are 2.5 times more likely to die from cancer than non-Aboriginal people, even after adjustment for stage of diagnosis, cancer treatment and comorbidities. They are also less likely to present early as a result of symptoms and to access treatment. Psycho-social factors affect Aboriginal people's willingness and ability to participate in cancer-related screening and treatment services, but little exploration of this has occurred within Australia to date. The current research adopted a phenomenological qualitative approach to understand and explore the lived experiences of Aboriginal Australians with cancer and their beliefs and understanding around this disease in Western Australia (WA). This paper details considerations in the design and process of conducting the research. Methods/Design The National Health and Medical Research Council (NHMRC) guidelines for ethical conduct of Aboriginal research were followed. Researchers acknowledged the past negative experiences of Aboriginal people with research and were keen to build trust and relationships prior to conducting research with them. Thirty in-depth interviews with Aboriginal people affected by cancer and twenty with health service providers were carried out in urban, rural and remote areas of WA. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Participants' narratives were divided into broad categories to allow identification of key themes and discussed by the research team. Discussion and conclusion Key issues specific to Aboriginal research include the need for the research process to be relationship-based, respectful, culturally appropriate and inclusive of Aboriginal people. Researchers are accountable to both participants and the wider community for reporting their findings and for research translation so that the research outcomes benefit the Aboriginal community. There are a number of factors that influence whether the desired level of engagement can be achieved in practice. These include the level of resourcing for the project and the researchers' efforts to ensure dissemination and research translation; and the capacity of the Aboriginal community to engage with research given other demands upon their time.
Collapse
Affiliation(s)
- Shaouli Shahid
- Centre for International Health, Curtin University of Technology, Perth WA, Australia.
| | | | | | | |
Collapse
|
46
|
Shahid S, Finn L, Bessarab D, Thompson SC. Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services. BMC Health Serv Res 2009; 9:132. [PMID: 19643031 PMCID: PMC2731745 DOI: 10.1186/1472-6963-9-132] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 07/31/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a lower overall incidence, Aboriginal Australians experience poorer outcomes from cancer compared with the non-Aboriginal population as manifested by higher mortality and lower 5-year survival rates. Lower participation in screening, later diagnosis of cancer, poor continuity of care, and poorer compliance with treatment are known factors contributing to this poor outcome. Nevertheless, many deficits remain in understanding the underlying reasons, with the recommendation of further exploration of Aboriginal beliefs and perceptions of cancer to help understand their care-seeking behavior. This could assist with planning and delivery of more effective interventions and better services for the Aboriginal population. This research explored Western Australian (WA) Aboriginal peoples' perceptions, beliefs and understanding of cancer. METHODS A total of 37 Aboriginal people from various geographical areas within WA with a direct or indirect experience of cancer were interviewed between March 2006 and September 2007. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. A social constructionist framework provided a theoretical basis for analysis. Interpretation occurred within the research team with member checking and the involvement of an Aboriginal Reference Group assisting with ensuring validity and reliability. RESULTS Outcomes indicated that misunderstanding, fear of death, fatalism, shame, preference for traditional healing, beliefs such as cancer is contagious and other spiritual issues affected their decisions around accessing services. These findings provide important information for health providers who are involved in cancer-related service delivery. CONCLUSION These underlying beliefs must be specifically addressed to develop appropriate educational, screening and treatment approaches including models of care and support that facilitate better engagement of Indigenous people. Models of care and support that are more culturally-friendly, where health professionals take account of both Indigenous and Western beliefs about health and the relationship between these, and which engage and include Indigenous people need to be developed. Cultural security, removing system barriers and technical/scientific excellence are all important to ensure Indigenous people utilise healthcare to realise the benefits of modern cancer treatments.
Collapse
Affiliation(s)
- Shaouli Shahid
- Centre for International Health, Curtin University of Technology, GPO Box U1987, Perth WA 6845, Australia
| | - Lizzie Finn
- Centre for International Health, Curtin University of Technology, GPO Box U1987, Perth WA 6845, Australia
| | - Dawn Bessarab
- Centre for International Health, Curtin University of Technology, GPO Box U1987, Perth WA 6845, Australia
| | - Sandra C Thompson
- Centre for International Health, Curtin University of Technology, GPO Box U1987, Perth WA 6845, Australia
| |
Collapse
|