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Lambeth C, Burgess P, Curtis J, Currow D, Sara G. Breast cancer screening participation in women using mental health services in NSW, Australia: a population study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:839-846. [PMID: 37306787 PMCID: PMC11087311 DOI: 10.1007/s00127-023-02509-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Population screening programs have contributed to reduced breast cancer mortality, but disadvantaged or vulnerable groups may not have shared these improvements. In North American and European studies, women living with mental health conditions have reduced breast screening rates. There are no current Australasian data to support health system planning and improvement strategies. METHODS The New South Wales (NSW) BreastScreen program offers free screening to NSW women aged 50-74. We compared 2-year breast screening rates for mental health service users (n = 33,951) and other NSW women (n = 1,051,495) in this target age range, after standardisation for age, socioeconomic status and region of residence. Mental health service contacts were identified through linkage to hospital and community mental health data. RESULTS Only 30.3% of mental health service users participated in breast screening, compared with 52.7% of other NSW women (crude incidence rate ratio 0.57, 95% CI 0.56-0.59). Standardisation for age, socioeconomic disadvantage or rural residence did not alter this screening gap. Around 7000 fewer women received screening than would be expected from comparable population rates. Screening gaps were largest in women over 60 and in socioeconomically advantaged areas. Women with severe or persistent mental illness had slightly higher screening rates than other mental health service users. CONCLUSIONS Low breast cancer screening participation rates for NSW mental health service users suggest significant risk of later detection, possibly leading to more extensive treatment and premature mortality. Focussed strategies are needed to support greater breast screening participation for NSW women who use mental health services.
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Affiliation(s)
- Chris Lambeth
- System Information and Analytics Branch, NSW Ministry of Health, St Leonards, Australia
- Biostatistics Training Program, NSW Ministry of Health, St Leonards, Australia
| | - Philip Burgess
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Jackie Curtis
- Faculty of Medicine and Health, University of NSW, Kensington, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, St Leonards, Australia.
- Faculty of Medicine and Health, University of NSW, Kensington, Australia.
- Faculty of Medicine and Health, University of Sydney, St Leonards, Australia.
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Sarmiento I, Rojas-Cárdenas A, Zuluaga G, Belaid L, Cockcroft A, Andersson N. Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review. BMJ Open 2024; 14:e077227. [PMID: 38171628 PMCID: PMC10773383 DOI: 10.1136/bmjopen-2023-077227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Cultural safety, interculturality and antiracism are crucial concepts in addressing health disparities of minority and diverse groups. Measuring them is challenging, however, due to overlapping meanings and their highly contextual nature. Community engagement is essential for evaluating these concepts, yet the methods for social inclusion and protocols for participation remain unclear. This review identifies experimental studies that measure changes resulting from culturally safe, intercultural or antiracist healthcare. The review will describe outcomes and additional factors addressed in these studies. METHODS AND ANALYSIS The study focuses on epidemiological experiments with counterfactual comparisons and explicit interventions involving culturally safe, intercultural or antiracist healthcare. The search strategy covers PubMed, CINAHL, Scopus, Web of Science, ProQuest, LILACS and WHO IRIS databases. We will use critical appraisal tools from the Joanna Briggs Institute to assess the quality of randomised and non-randomised experimental studies. Two researchers will screen references, select studies and extract data to summarise the main characteristics of the studies, their approach to the three concepts under study and the reported effect measures. We will use fuzzy cognitive mapping models based on the causal relationships reported in the literature. We will consider the strength of the relationships depicted in the maps as a function of the effect measure reported in the study. Measures of centrality will identify factors with higher contributions to the outcomes of interest. Illustrative intervention modelling will use what-if scenarios based on the maps. ETHICS AND DISSEMINATION This review of published literature does not require ethical approval. We will publish the results in a peer-reviewed journal and present them at conferences. The maps emerging from the process will serve as evidence-based models to facilitate discussions with Indigenous communities to further the dialogue on the contributing factors and assessment of cultural safety, interculturality and antiracism. PROSPERO REGISTRATION NUMBER CRD42023418459.
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Affiliation(s)
- Ivan Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- GESTS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Andrés Rojas-Cárdenas
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Germán Zuluaga
- GESTS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Cundinamarca, Colombia
- Centro de Estudios Médicos Interculturales (CEMI), Cota, Cundinamarca, Colombia
| | - Loubna Belaid
- École nationale d'administration publique (ENAP), Quebec, Quebec, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
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Christie V, Riley L, Green D, Snook K, Henningham M, Rambaldini B, Amin J, Pyke C, Varlow M, Goss S, Skinner J, O'Shea R, McCowen D, Gwynne K. Does breast cancer policy meet the needs of Aboriginal and Torres Strait Islander women in Australia? a review. Int J Equity Health 2023; 22:129. [PMID: 37408069 DOI: 10.1186/s12939-023-01941-3] [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: 05/03/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE To evaluate if existing Australian public policy related to screening, diagnosis, treatment and follow up care for breast cancer addresses the needs of and outcomes for Indigenous1 women? METHODS This review of policy employed a modified Delphi method via an online panel of experts (n = 13), who were purposively recruited according to experience and expertise. A series of online meetings and online surveys were used for data collection. The aims of the study were to: Identify all existing and current breast cancer policy in Australia; Analyse the extent to which consideration of Indigenous peoples is included in the development, design and implementation of the policy; and Identify policy gaps and make recommendations as to how they could be addressed. The policies were evaluated using 'A Guide to Evaluation under the Indigenous Evaluation Strategy, 2020'. RESULTS A list of current breast cancer policies (n = 7) was agreed and analysed. Five draft recommendations to improve breast cancer outcomes for Indigenous women were developed and refined by the panel. CONCLUSIONS Current breast cancer policy in Australia does not address the needs of Indigenous women and requires change to improve outcomes.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia.
| | - Lynette Riley
- Indigenous Studies & Aboriginal Education, The University of Sydney, Education Building (A36), Sydney, NSW, 2006, Australia
| | - Deb Green
- Armajun Aboriginal Health Service, Rusden Street, Armidale, NSW, 2350, Australia
| | - Kylie Snook
- BreastSurgANZ, Black Rock, Melbourne, Victoria, 3193, Australia
| | - Mandy Henningham
- Cancer Council Australia, Level 2, 320 Pitt Street, Sydney, NSW, 2000, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Chris Pyke
- Mater Hospital, Vulture Street, South Brisbane, QLD, 4101, Australia
| | - Megan Varlow
- Cancer Council Australia, Level 2, 320 Pitt Street, Sydney, NSW, 2109, Australia
| | - Sally Goss
- University of Sydney, Sydney, NSW, 2006, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia
| | - Ross O'Shea
- Foundation of Breast Cancer Care and Breast SurgANZ, Black Rock, Melbourne, Victoria, 3193, Australia
| | - Deb McCowen
- Armajun Aboriginal Health Service, Rivers St, Inverell, NSW, 2360, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Macquarie University, 6 First Walk, Sydney, NSW , 2109, Australia
- Indigenous Studies & Aboriginal Education, The University of Sydney, Education Building (A36), Sydney, NSW, 2006, Australia
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Christie V, Green D, Skinner J, Riley L, O'Shea R, Littlejohn K, Pyke C, McCowen D, Rambaldini B, Gwynne K. "Everyone needs a Deb": what Australian indigenous women say about breast cancer screening and treatment services. BMC Health Serv Res 2023; 23:672. [PMID: 37344905 DOI: 10.1186/s12913-023-09633-y] [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: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Breast cancer continues to be the second most diagnosed cancer overall and the most diagnosed cancer for women in Australia. While mortality rates overall have declined in recent years, Indigenous women continue to be diagnosed at more marginal rates (0.9 times) and are more likely to die (1.2 times). The literature provides a myriad of reasons for this; however, the voices of Indigenous women are largely absent. This study sets out to understand what is happening from the perspectives of Australian Indigenous women with a view to charting culturally safer pathways that improve participation in screening and treatment by Indigenous women. METHODS This co-design study was conducted using semi-structured, in-depth interviews and focus group discussions. Recruitment of study participants was via snowball sampling. Participants were subsequently consented into the study through the Aboriginal Health Service and the research team. Interviews were audio recorded and transcribed verbatim, and data coded in NVivo12 using inductive thematic analysis. RESULTS A total of 21 Indigenous women and 14 health service providers were interviewed predominantly from the same regional/rural area in NSW, with a small proportion from other states in Australia. Six major themes were identified: Access, Awareness, Community and Family, Lack of control, Negative feelings and associations and Role of services. CONCLUSION To improve access and participation of Indigenous women and ultimately improve mortality rates, breast cancer services must explicitly address cultural and community needs.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia.
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale and Inverell, NSW, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
| | - Lynette Riley
- Indigenous Studies & Aboriginal Education, The University of Sydney, Camperdown, NSW, Australia
| | - Ross O'Shea
- Foundation for Breast Cancer Care, Brisbane, Australia
| | | | | | - Debbie McCowen
- Armajun Aboriginal Health Service, Armidale and Inverell, NSW, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
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Comparison of Study Quality as Determined by Standard Research and Community Engagement Metrics: A Pilot Study on Breast Cancer Research in Urban, Rural, and Remote Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095008. [PMID: 35564401 PMCID: PMC9102080 DOI: 10.3390/ijerph19095008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this review is to compare research evaluation tools to determine whether the tools typically used for assessing the quality of research adequately address issues of Indigenous health and culture, particularly when the studies are intended to benefit Indigenous peoples in urban, regional, rural, and remote settings. Our previously published systematic review evaluated studies about breast cancer using a modified Indigenous community engagement tool (CET). In this study, we evaluated the same studies using two commonly used tools: the Critical Appraisal Skills Programme (CASP) for qualitative research; and the Effective Public Health Practice Project (EPHPP) for quantitative research. The results were then compared to ascertain whether there was alignment between performances in terms of engagement and the CASP/EPHPP metrics. Of the 15 papers, 3 papers scored weakly on both metrics, and are therefore the least likely to offer reliable findings, while 2 papers scored strongly on both metrics, and are therefore the most likely to offer reliable findings. Beyond this summation, it was clear that the results did not align and, therefore, could not be used interchangeably when applied to research findings intended to benefit Indigenous peoples. There does not appear to be a pattern in the relationship between the reliability of the studies and the study settings. In order to address disparities in health outcomes, we must assess research through a typical research quality and cultural engagement and settings lens, ensuring that there is rigour in all aspects of the studies.
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Christie V, Rice M, Dracakis J, Green D, Amin J, Littlejohn K, Pyke C, McCowen D, Gwynne K. Improving breast cancer outcomes for Aboriginal women: a mixed-methods study protocol. BMJ Open 2022; 12:e048003. [PMID: 35074807 PMCID: PMC8788241 DOI: 10.1136/bmjopen-2020-048003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed cancer affecting Australian women, and the second highest cause of cancer death in Australian women. While the incidence of breast cancer is lower in Aboriginal women than non-Aboriginal women, the mortality rate for Aboriginal women is higher, with Aboriginal women 1.2 times more likely to die from the disease. In New South Wales, Aboriginal women are 69% more likely to die from their breast cancer than non-Aboriginal women.Co-design is a research method recognised to enhance collaboration between those doing the research and those impacted by the research; which when used with Aboriginal communities, ensures research and services are relevant, culturally competent and empowers communities as co-researchers. We report the development of a new protocol using co-design methods to improve breast cancer outcomes for Aboriginal women. METHODS AND ANALYSIS Through a Community Mapping Project in 2018, we co-designed an iterative quantitative and qualitative study consisting of five phases. In Phase 1, we will establish a governance framework. In Phase 2, we will provide information to community members regarding the modified parts of the screening, diagnosis, treatment and follow-up processes and invite them to partake. In Phase 3, the research team will collect data on the outcomes of the modified processes and the outcomes for the women who have and have not participated. The data shall be analysed quantitatively and thematically in Phase 4 with Aboriginal community representatives and reported back to community. Lastly, in Phase 5, we evaluate the co-design process and adapt our protocol for use in partnership with other communities. ETHICS AND DISSEMINATION This study has ethics approval of the Aboriginal Health and Medical Research Council ref:1525/19. The findings will be published in the literature, presented at conferences and short summaries will be issued via social media.
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Affiliation(s)
- Vita Christie
- Faculty of Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - MacKenzie Rice
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jocelyn Dracakis
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale, New South Wales, Australia
| | - Janaki Amin
- Faculty of Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Littlejohn
- Foundation for Breast Cancer Care, Sydney, New South Wales, Australia
| | - Christopher Pyke
- Foundation for Breast Cancer Care, Sydney, New South Wales, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Ung OA. Towards Better Breast Cancer Outcomes for Indigenous Populations in High-Income Countries with Highly Developed Health Systems. World J Surg 2022; 46:622-623. [PMID: 34981150 DOI: 10.1007/s00268-021-06380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Owen A Ung
- University of Queensland, Brisbane, Australia.
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Royal Australasian College of Surgeons, Melbourne, Australia.
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