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Henningham M, Gilroy J, McGlone J, Meehan D, Nila F, McAtamney A, Buchanan T. Utilising the CREATE quality appraisal tool to analyse Aboriginal and Torres Strait Islander peoples' involvement and reporting of cancer research in Australia. Aust N Z J Public Health 2024; 48:100142. [PMID: 38574430 DOI: 10.1016/j.anzjph.2024.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE We aimed to evaluate Aboriginal and Torres Strait Islander involvement in research focusing on cancer experiences using an Aboriginal and Torres Strait Islander quality appraisal tool (the QAT). METHODS We conducted a systematic review of the peer-reviewed literature on Aboriginal and Torres Strait Islander peoples' experiences associated with cancer, recently published elsewhere. We then appraised articles for the inclusion of Aboriginal and Torres Strait Islander-led research, community consultation, and involvement. RESULTS 91 articles were appraised. A lack of Aboriginal and Torres Strait Islander-led research and consultation was reported in the majority of articles, only 10 (11%) demonstrated success across seven (50%) or more questions of the QAT. CONCLUSIONS This review underscores the need for anti-racist research and publication practices that actively engage Aboriginal and Torres Strait Islander peoples and researchers. This approach is vital to enhance cancer outcomes within these communities. IMPLICATIONS FOR PUBLIC HEALTH To advance and prioritise appropriate involvement of Aboriginal and Torres Strait Islander peoples in cancer research, the onus must be on 'systems owners,' including academic journals and institutions, to require and report genuine engagement as standard practice. Researchers will produce higher-calibre research with a strengths-based focus, advancing the cause of equitable research.
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Affiliation(s)
- Mandy Henningham
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - John Gilroy
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | - Drew Meehan
- Cancer Council Australia, Sydney, NSW, 2000, Australia
| | - Farhana Nila
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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Gilroy J, Henningham M, Meehan D, Nila F, McGlone J, McAtamney A, Whittaker K, Brown B, Varlow M, Buchanan T. Systematic review of Aboriginal and Torres Strait Islander peoples' experiences and supportive care needs associated with cancer. BMC Public Health 2024; 24:523. [PMID: 38378574 PMCID: PMC10877816 DOI: 10.1186/s12889-024-18070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Persistent disparities exist between Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) and non-Indigenous Australians associated with cancer, with Aboriginal and Torres Strait Islander peoples experiencing a longer time to treatment, higher morbidity rates, and higher mortality rates. This systematic review aimed to investigate findings and recommendations in the literature about the experiences and supportive care needs of Aboriginal and Torres Strait Islander peoples with cancer in Australia. METHODS A qualitative systematic review was conducted using thematic analysis. Database searches were conducted in CINAHL, Informit, MEDLINE, ProQuest, Scopus, and Web of Science for articles published between January 2000 and December 2021. There were 91 included studies which were appraised using the Mixed Methods Appraisal Tool. The included studies reported on the experiences of cancer and supportive care needs in Aboriginal and Torres Strait Islander populations. RESULTS Six key themes were determined: Culture, family, and community; cancer outcomes; psychological distress; access to health care; cancer education and awareness; and lack of appropriate data. Culture was seen as a potential facilitator to achieving optimal cancer care, with included studies highlighting the need for culturally safe cancer services and the routine collection of Aboriginal and Torres Strait Islander status in healthcare settings. CONCLUSION Future work should capitalize on these findings by encouraging the integration of culture in healthcare settings to increase treatment completion and provide a positive experience for Aboriginal and Torres Strait Islander peoples with cancer.
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Affiliation(s)
- John Gilroy
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mandy Henningham
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Drew Meehan
- Cancer Council Australia, Sydney, NSW, 2000, Australia.
| | - Farhana Nila
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | | | | | - Bena Brown
- Inala Indigenous Health Service, Metro South Health, Inala, QLD, 4077, Australia
| | - Megan Varlow
- Cancer Council Australia, Sydney, NSW, 2000, Australia
| | - Tanya Buchanan
- Cancer Council Australia, Sydney, NSW, 2000, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia
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Huang J, Faisal W, Brand M, Smith S, Alexander M, Briggs L, Conron M, Duffy M, John T, Langton D, Lesage J, MacManus M, Mitchell P, Olesen I, Parente P, Philip J, Samuel E, Torres J, Underhill CR, Zalcberg JR, Harden S, Stirling R. Patterns of care for people with small cell lung cancer in Victoria, 2011-19: a retrospective, population-based registry data study. Med J Aust 2023; 219:120-126. [PMID: 37365486 DOI: 10.5694/mja2.52017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To report stage-specific patterns of treatment and the influence of management and treatment type on survival rates for people newly diagnosed with small cell lung cancer (SCLC). DESIGN Cross-sectional patterns of care study; analysis of data prospectively collected for the Victorian Lung Cancer Registry (VLCR). SETTING, PARTICIPANTS All people diagnosed with SCLC in Victoria during 1 April 2011 - 18 December 2019. MAIN OUTCOME MEASURES Stage-specific management and treatment of people with SCLC; median survival time. RESULTS During 2011-19, 1006 people were diagnosed with SCLC (10.5% of all lung cancer diagnoses in Victoria); their median age was 69 years (interquartile range [IQR], 62-77 years), 429 were women (43%), and 921 were current or former smokers (92%). Clinical stage was defined for 896 people (89%; TNM stages I-III, 268 [30%]; TNM stage IV, 628 [70%]) and ECOG performance status at diagnosis for 663 (66%; 0 or 1, 489 [49%]; 2-4, 174 [17%]). The cases of 552 patients had been discussed at multidisciplinary meetings (55%), 377 people had received supportive care screening (37%), and 388 had been referred for palliative care (39%). Active treatment was received by 891 people (89%): chemotherapy, 843 (84%); radiotherapy, 460 (46%); chemotherapy and radiotherapy, 419 (42%); surgery, 23 (2%). Treatment had commenced within fourteen days of diagnosis for 632 of 875 patients (72%). Overall median survival time from diagnosis was 8.9 months (IQR, 4.2-16 months; stage I-III: 16.3 [IQR, 9.3-30] months; stage IV: 7.2 [IQR, 3.3-12] months). Multidisciplinary meeting presentation (hazard ratio [HR], 0.66; 95% CI, 0.58-0.77), multimodality treatment (HR, 0.42; 95% CI, 0.36-0.49), and chemotherapy within fourteen days of diagnosis (HR, 0.68; 95% CI, 0.48-0.94) were each associated with lower mortality during follow-up. CONCLUSION Rates of supportive care screening, multidisciplinary meeting evaluation, and palliative care referral for people with SCLC could be improved. A national registry of SCLC-specific management and outcomes data could improve the quality and safety of care.
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Affiliation(s)
| | | | | | | | - Marliese Alexander
- Peter MacCallum Cancer Institute, Melbourne, VIC
- The University of Melbourne, Melbourne, VIC
| | | | - Matthew Conron
- The University of Melbourne, Melbourne, VIC
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Mary Duffy
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - Thomas John
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - David Langton
- Monash University, Melbourne, VIC
- Peninsula Health, Melbourne, VIC
| | | | | | - Paul Mitchell
- Olivia Newton-John Cancer Centre at Austin Health, Melbourne, VIC
| | - Inger Olesen
- Andrew Love Cancer Centre, Barwon Health, Geelong, VIC
| | - Phillip Parente
- Eastern Health Clinical School, Monash University, Melbourne, VIC
- Eastern Health, Melbourne, VIC
| | | | - Evangeline Samuel
- Alfred Health, Melbourne, VIC
- Latrobe Regional Hospital, Traralgon, VIC
| | | | - Craig R Underhill
- Albury Wodonga Health, Wodonga, NSW
- The University of New South Wales, Sydney, NSW
| | - John R Zalcberg
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Susan Harden
- Monash University, Melbourne, VIC
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - Rob Stirling
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Monash University Central Clinical School, Melbourne, VIC
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Chan J, Griffiths K, Turner A, Tobias J, Clarmont W, Delaney G, Hutton J, Olson R, Penniment M, Bourque JM, Brundage M, Rodin D, Slotman B, Yap ML. Radiation Therapy and Indigenous Peoples in Canada and Australia: Building Paths Toward Reconciliation in Cancer Care Delivery. Int J Radiat Oncol Biol Phys 2023; 116:421-429. [PMID: 36990919 DOI: 10.1016/j.ijrobp.2022.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/17/2022] [Accepted: 09/28/2022] [Indexed: 03/29/2023]
Abstract
Indigenous peoples represent approximately 5% of the world's population and reside in over 90 countries worldwide. They embody a rich diversity of cultures, traditions, languages and relationships with the land that are shared through many generations and that are distinct from those of the settler societies within which they now live. Many Indigenous peoples have a shared experience of discrimination, trauma, and violation of rights, rooted in complex sociopolitical relationships with settler societies that are still ongoing. This results in continuing social injustices and pronounced disparities in health for many Indigenous peoples around the globe. Indigenous peoples exhibit a significantly higher cancer incidence, mortality, and poorer survival compared to non-Indigenous peoples. Cancer services, including radiotherapy, have not been designed to support the specific values and needs of Indigenous populations, resulting in poorer access to cancer services for Indigenous peoples globally across the entire cancer care spectrum. Specific to radiotherapy, available evidence demonstrates disparities in radiotherapy uptake between Indigenous and non-Indigenous patients. Radiotherapy centres are also located disparately further away from Indigenous communities. Studies are limited by a lack of Indigenous-specific data to help inform effective radiotherapy delivery. Recent Indigenous-led partnerships and initiatives have helped to address existing gaps in cancer care, and radiation oncologists play an important role in supporting such efforts. In this article, we present an overview of access to radiotherapy for Indigenous peoples in Canada and Australia, with a focus on strengthening cancer care delivery through education, partnerships, and research.
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Sanjida S, Garvey G, Ward J, Bainbridge R, Shakeshaft A, Hadikusumo S, Nelson C, Thilakaratne P, Hou XY. Indigenous Australians' Experiences of Cancer Care: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416947. [PMID: 36554828 PMCID: PMC9779788 DOI: 10.3390/ijerph192416947] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 05/31/2023]
Abstract
To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples' cancer care experiences in the Australian healthcare system from the patient's point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.
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Affiliation(s)
- Saira Sanjida
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Gail Garvey
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Anthony Shakeshaft
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Stephanie Hadikusumo
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
- Royal Brisbane and Women’s Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Carmel Nelson
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
| | - Prabasha Thilakaratne
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
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Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples. Cancers (Basel) 2022; 14:cancers14122870. [PMID: 35740536 PMCID: PMC9220984 DOI: 10.3390/cancers14122870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background and Aims: A concerning rise in incidence of young-onset cancers globally led to the examination of trends in incidence and survival of gastrointestinal (GI) adenocarcinomas in the Northern Territory (NT), Australia, over a 28-year period, with a special emphasis on Indigenous peoples. Methods: This cross-sectional analysis of a prospective longitudinal database, NT Cancer Registry (1990−2017), includes all reported cases of GI (oesophagus, gastric, small intestinal, pancreas, colon, and rectum) adenocarcinomas. Poisson regression was used to estimate incidence ratio ratios, and survival was modelled using Cox proportional hazard models separately for people aged 18−50 years and >50 years. Results: A total of 1608 cases of GI adenocarcinoma were recorded during the time of the study. While the overall incidence in people 18−50 years remained unchanged over this time (p = 0.51), the rate in individuals aged >50 years decreased (IRR = 0.65 (95% CI 0.56−0.75; p < 0.0001)). Incidence rates were significantly less in females >50 years (IRR = 0.67 95% CI 0.59−0.75; p < 0.0001), and their survival was significantly better (HR = 0.84 (95%CI 0.72−0.98; p < 0.03)) compared to males. Overall survival across all GI subsites improved in both age cohorts, especially between 2010 and 2017 (HR = 0.45 (95%CI 0.29−0.72; p < 0.0007) and HR = 0.64 (95%CI 0.52−0.78; p < 0.0001), respectively) compared to 1990−1999, driven by an improvement in survival in colonic adenocarcinoma alone, as the survival remained unchanged in other GI subsites. The incidence was significantly lower in Indigenous patients compared to non-Indigenous patients, in both age cohorts (18−50 years IRR = 0.68 95% CI 0.51−0.91; p < 0.009 and >50 years IRR = 0.48 95% CI 0.40−0.57; p < 0.0001). However, Indigenous patients had worse survival rates (18−50 years HR = 2.06 95% CI 1.36−3.11; p < 0.0007 and >50 years HR = 1.66 95% CI 1.32−2.08; p < 0.0001). Conclusions: There is a trend towards an increased incidence of young-onset GI adenocarcinomas in the NT. Young Indigenous patients have lower incidence but worse survival across all GI subsites, highlighting significant health inequities in life expectancy. Targeted, culturally safe Indigenous community-focussed programs are needed for early detection and patient-centred management of GI adenocarcinomas.
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Warner ZC, Reid B, Auguste P, Joseph W, Kepka D, Warner EL. Awareness and Knowledge of HPV, HPV Vaccination, and Cervical Cancer among an Indigenous Caribbean Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5694. [PMID: 35565089 PMCID: PMC9105034 DOI: 10.3390/ijerph19095694] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
Abstract
Caribbean women experience a cervical cancer incidence rate that is three times higher than that among their North American counterparts. In this study, we performed a needs assessment of the knowledge and awareness of HPV, HPV vaccination, and cervical cancer and receipt of cervical cancer screening among an indigenous Caribbean community. We purposively recruited individuals aged ≥18 from a community health care clinic (n = 58) to complete a 57-item structured interview including items on demographics, cancer history, knowledge and awareness of HPV, HPV vaccines, cervical cancer, and cervical cancer screening. Participants' mean age was 47.1 years (SD: 14.4). Most were female (74.1%), were married/partnered (51.7%), had primary education (63.8%), and identified as Kalinago (72.4%). Whereas 79.5% had heard of cervical cancer, few had heard of HPV (19.6%) or the HPV vaccine (21.8%). Among those who knew someone with cancer, 90.9% had heard of the HPV vaccine, compared with only 9.1% of those who did not know anyone with cancer (p = 0.02). Access to HPV vaccination is an immediate, cost-effective cancer prevention priority for reducing the disproportionate burden of HPV-related cancers, particularly cervical cancer, in the Caribbean. We recommend culturally targeted education interventions to improve knowledge about HPV vaccination and the link between HPV and cervical cancer.
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Affiliation(s)
- Zachary Claude Warner
- Department of Internal Medicine, University of Arizona, 1501 N Campbell Avenue, Tucson, AZ 85724, USA
| | - Brandon Reid
- Department of Family Medicine, University of Kansas, 138 N Santa Fe Ave, Salina, KS 67401, USA;
| | - Priscilla Auguste
- Department of Family Medicine, University of Arkansas for Health Sciences, Little Rock, AR 72205, USA;
| | - Winnie Joseph
- Salybia Health Clinic, Saint David Parish, Bataka 00109, Dominica;
| | - Deanna Kepka
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA; (D.K.); (E.L.W.)
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Echo Lyn Warner
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA; (D.K.); (E.L.W.)
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
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Ju X, Canfell K, Howard K, Garvey G, Hedges J, Smith M, Jamieson L. Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians. BMC Public Health 2021; 21:1455. [PMID: 34311730 PMCID: PMC8314643 DOI: 10.1186/s12889-021-11496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals' preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians. METHODS Development and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test. RESULTS Data from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91-0.92 in 'screened, cytology normal, HPV vaccination' and 'screened, HPV positive, endoscopy normal', to less than 0.90 (ranging from 0.87-0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75-0.79) in 'early stage throat cancer'. Higher utility scores were observed for 'screened, cytology normal and HPV vaccination' among younger participants (18-40 years), for 'early stage invasive throat cancer' among females, and for 'oral intraepithelial neoplasia' and 'early stage invasive throat cancer' among metropolitan-dwelling participants. CONCLUSION Among a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia.
| | - Karen Canfell
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Gail Garvey
- Menzies School of Health Research, Darwin, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia
| | - Megan Smith
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia
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Woods JA, Katzenellenbogen JM, Murray K, Johnson CE, Thompson SC. Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study. BMJ Open 2021; 11:e042268. [PMID: 33727263 PMCID: PMC7970279 DOI: 10.1136/bmjopen-2020-042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient's condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of 'unstable' phases (which indicate unanticipated deterioration in a patient's condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups. DESIGN Cohort study. SETTING Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015). PARTICIPANTS 139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients. OUTCOME MEASURES Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models. RESULTS Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398). CONCLUSIONS Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
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Affiliation(s)
- John A Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- The Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Anderson K, Diaz A, Parikh DR, Garvey G. Accessibility of cancer treatment services for Indigenous Australians in the Northern Territory: perspectives of patients and care providers. BMC Health Serv Res 2021; 21:95. [PMID: 33509170 PMCID: PMC7841038 DOI: 10.1186/s12913-021-06066-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Poorer cancer outcomes of Indigenous Australians in Australia's Northern Territory (NT) compared with their non-Indigenous counterparts are partially due to diminished access to cancer treatment services (CTS). Accessibility of health care is a multidimensional construct, including physical, logistical, psychosocial and cultural dimensions. While previous research has identified specific areas of reduced access to CTS for Indigenous Australians, the higher burden of cancer borne by Indigenous Australians warrants a more comprehensive understanding of access to CTS in the NT. The purpose of this study was to explore and map the accessibility of CTS for Indigenous Australians in the NT and to identify key access barriers. METHODS This predominantly qualitative study, complemented by a descriptive quantitative component, explored and mapped the accessibility of one CTS (CTS-NT) that services a large number of Indigenous Australians in the NT. Patient perspectives were obtained via secondary analysis of data from 75 face-to-face interviews with Indigenous Australian adults attending the CTS-NT. Care provider perspectives were obtained via primary analysis of data from 29 face-to-face interviews with care providers and staff working at CTS-NT. Data were analysed to identify issues of accessibility informed by Leveque and colleagues' conceptual framework of access to health care, which comprises five dimensions of accessibility of the health service and the ability of Indigenous patients to interact with these dimensions to generate access. Applied thematic analysis was conducted on the qualitative data and descriptive analysis was conducted on the quantitative data. RESULTS The analysis of the patient and care provider reports identified multiple access barriers across all dimensions including: inadequate preparation of Indigenous patients for treatment; delayed and complicated commencement of treatment; dislocation from home; competing priorities; scarcity of Indigenous care providers and staff; lack of culturally-relevant care; challenges associated with language, accommodation, transport and finance; and disjointed and fraught relationships with care providers. These barriers posed significant challenges to Indigenous patients maintaining their engagement with treatment. CONCLUSIONS This study provides a valuable snapshot of the barriers facing this population across the dimensions of health care access. Urgent action in addressing these issues is required at individual, service and state levels.
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Affiliation(s)
- Kate Anderson
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Abbey Diaz
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Darshit Rajeshkumar Parikh
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, Northern Territory, Australia
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