Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia

Background

Pain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication.

Methods

This qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants.

Results

A total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation.

Conclusion

Communication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.

Contemporary Educational Interventions for General Practitioners (GPs) in Primary Care Settings in Australia: A Systematic Literature Review

Background: The primary purpose of educational interventions is to optimize the clinical management of patients. General practitioners (GPs) play a major role in the detection and management of diseases. This systematic literature review will describe the type and outcomes of educational interventions designed for general practitioners (GPs) in the Australian context.

Methods: PubMed, CINHAL, and Scopus databases were systematically searched for studies on educational interventions conducted for GPs in Australia during 1st January 2008 to 11th June 2018. Data collected on the methodology of the interventions, GPs satisfaction regarding the educational intervention, changes in knowledge, confidence, skills and clinical behavior of the GPs. We also assessed whether the acquired clinical competencies had an impact on organizational change and on patient health.

Results: Thirteen publications were included in this review. The methods with which educational interventions were developed and implemented varied substantially and rigorous evaluation was generally lacking particularly in detailing the outcomes. The reported GP response rate varied between 2 and 96% across studies, depending upon the method of recruitment, the type of intervention and the study setting (rural vs. urban). The most effective recruitment strategy was a combination of initial contact coupled with a visit to GP practices. Nine of the studies reviewed reported improvement in at least one outcome measure: gaining knowledge, improving skills or change in clinical behavior which was translated into clinical practice. In the 3 pre- and post-intervention analysis studies, 90–100% of the participating GPs reported improvement in their knowledge and attitudes.

Conclusion: Education interventions for GPs in Australia had low response (recruitment) and retention (GPs that participated in follow-ups) rates, even when financial benefits or CPD points were used as incentives. Higher GP response rates were achieved through multiple recruitment strategies. Multifaceted interventions were more likely to achieve the primary outcome by improving knowledge, skills or changing practice, but the effect was often modest. Inconsistent results were reported in studies involving the use of multiple contact methods within an intervention and conducting online interventions.

Lessons learned from a pilot study of an Indigenous patient navigator intervention in Queensland, Australia

Indigenous patient navigator (IPN) programmes show promise in addressing barriers to cancer care and facilitation of patient self-efficacy. The purpose of this paper is to describe and reflect upon the experience of training an IPN and implementation of the intervention in the Australian context with Indigenous cancer patients. Randomised clinical trial might provide the best available evaluation measure of an intervention but caution should be taken in the implementation process. Socio-cultural aspects and training can affect the conduct of this type of intervention. We report here five issues needing consideration prior to implementing such intervention. Specifically: (1) recognition of the collective bonds within Indigenous community and understanding by IPN of the degree of personal assistance perceived as not intrusive by the patient; (2) conduct ongoing evaluation of the different role of an IPN involved in this intervention care provider vs. researcher. (3) meaningful engagement develops from a trusting/collaborative relationship between research team and study site staff which may not occur in the study time frame; (4) existing skills as well as training provided may not translate in the IPN understanding and aligning with the study objectives/research values; (5) recruitment of participants requires innovative and highly flexible strategies to be successful.

Australian Indigenous cancer patients’ self-report of diagnosis, treatment and comorbidity data: how does it compare to medical chart review

Rationale: The quality of patient-centred care relies upon the reliability of the data used to produce performance measures. The agreement between patient self-report and medical chart review among Aboriginal and Torres Strait Islander cancer patients is unknown.Objective: To examine the concordance between patient self-report and medical chart review in determining cancer type, current and previous cancer treatment, comorbidities and patient characteristics associated with agreement.Method: Aboriginal and Torres Strait Islander cancer patients (≥18 years) who had received cancer treatment in the past 30 days (n=208) were recruited. The prevalence, sensitivity, specificity, total agreement and Kappa coefficients (K) were estimated to determine the agreement (yes + yes; no + no) between self-reported data and medical records.Results: 13.5% of the patients could not accurately identify their cancer type. For treatment variables, raw agreement ranged from 70.5% to 92.4%, although, after correcting for chance, there was a lack of consistency for current radiation and past treatment variables (K= -0.01 to 0.48). Sensitivity and specificity were moderate to high for current surgery and chemotherapy. The greatest crude prevalence difference by data source was observed for comorbidities not specified in the questionnaire. Sensitivity and specificity were high for diabetes. Conclusion: investigators and policy makers may rely upon patient self-report for diabetes, current cancer treatment of surgery and chemotherapy. However, should be cautious when considering patient self-report for past treatment and other comorbid conditions. 

Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need

Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey.