scholarly journals 'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment

2011 ◽  
Vol 35 (2) ◽  
pp. 235 ◽  
Author(s):  
Shaouli Shahid ◽  
Lizzie Finn ◽  
Dawn Bessarab ◽  
Sandra C. Thompson
Keyword(s):  
Decision Making ◽  
Cancer Treatment ◽  
Primary Healthcare ◽  
Support Services ◽  
Aboriginal People ◽  
Cultural Safety ◽  
System Level ◽  
Indigenous Australians ◽  
Cancer Outcomes ◽  
Treatment Services

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. What is known about the topic? Cancer is a major cause of death among Indigenous Australians who are generally diagnosed later with their disease, have poorer continuity of care and lower uptake and completion of cancer treatment. For cancer diagnosis at an equivalent stage of cancer, Aboriginal people have poorer outcomes. What does this paper add? This study documents Aboriginal perspectives on basic infrastructure and logistical problems which impede their accessing hospital-based cancer treatments: transport, accommodation, preparation for the experience of hospital and cancer treatment, service affordability and the certainty of support services. What are the implications for practitioners? There are difficulties for practitioners in addressing the geographic, socioeconomic and cultural differences that Aboriginal people face in accessing cancer treatment. System level changes to ensure cultural safety, social support and better coordination with primary healthcare are essential to improve outcomes of Aboriginal people with cancer.

scholarly journals Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?

2013 ◽  
Vol 37 (2) ◽  
pp. 232 ◽  
Author(s):  
Ronald Donato ◽  
Leonie Segal
Keyword(s):  
Healthcare System ◽  
Primary Healthcare ◽  
System Performance ◽  
Health Reform ◽  
Aboriginal People ◽  
Indigenous Health ◽  
Indigenous Australians ◽  
Reform Agenda ◽  
Reform Strategy ◽  
Performance Gains

This paper provides an analysis of the national Indigenous reform strategy – known as Closing the Gap – in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance. The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare. What is known about the topic? Notwithstanding the intention of previous policies, considerable health disparity exists between Indigenous and non-Indigenous Australians. Australia has now embarked on its most ambitious national Indigenous health reform strategy, but there has been little academic analysis of whether such reforms are capable of eliminating health disadvantage for Aboriginal people. What does the paper add? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians. What are the implications for practitioners? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia’s First Peoples provides the opportunity for policymakers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.

scholarly journals Accessibility of Cancer Treatment Services for Indigenous Australians in the Northern Territory: Perspectives of Patients and Care Providers

2020 ◽  
Author(s):  
Kate M Anderson ◽  
Abbey Diaz ◽  
Darshit Rajeshkumar Parikh ◽  
Gail Garvey
Keyword(s):  
Health Care ◽  
Cancer Treatment ◽  
Care Provider ◽  
Northern Territory ◽  
Indigenous Australians ◽  
Access Barriers ◽  
Care Providers ◽  
Five Dimensions ◽  
Face To Face ◽  
Treatment Services

Abstract Background: The poorer cancer outcomes of Indigenous Australians in Australia’s Northern Territory (NT) compared with their non-Indigenous counterparts is partially due to diminished access to cancer treatment services (CTS). The 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.Aim: 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 study employed a mixed-methods convergent design to explore and map the accessibility of one CTS (CTS-NT) that services a large number of Indigenous Australians in the NT. Patient and care provider views were included. Patient perspectives were obtained via secondary analysis of data from open- and closed-questions 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 semi-structured 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 five dimensions including: inadequate preparation of Indigenous cancer patients for treatment; delayed and complicated commencement of treatment; dislocation from home; competing priorities; a scarcity of Indigenous care providers and staff; a 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 five dimensions of health care access. Urgent action in addressing these issues is required at individual, service and state levels.

scholarly journals Accessibility of cancer treatment services for Indigenous Australians in the Northern Territory: perspectives of patients and care providers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate Anderson ◽  
Abbey Diaz ◽  
Darshit Rajeshkumar Parikh ◽  
Gail Garvey
Keyword(s):  
Health Care ◽  
Cancer Treatment ◽  
Care Provider ◽  
Northern Territory ◽  
Cultural Dimensions ◽  
Indigenous Australians ◽  
Access Barriers ◽  
Care Providers ◽  
Face To Face ◽  
Treatment Services

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.

scholarly journals P9 A study to investigate the impact of the COVID-19 pandemic on paediatric cancer patients: an international, multicentre, observational cohort study (COVIDPaedsCancer)

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Soham Bandyopadhyay
Keyword(s):  
Cohort Study ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Global Health Research ◽  
Cancer Outcomes ◽  
Paediatric Cancer ◽  
Cancer Management ◽  
Anti Cancer ◽  
The Impact

Abstract Introduction Childhood cancers are a leading cause of non-communicable disease deaths for paediatric patients around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children’s Non-Communicable Diseases (Global Children’s NCDs) is currently undertaking the first international study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short to medium term impacts on childhood cancer outcomes. Methods and analysis This is a multicentre, international, cohort study that will use routinely collected hospital data in a de-identified and anonymised form. Patients will be recruited consecutively into the study, with a 12 -month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anti-cancer treatment for the following cancers: Acute lymphoblastic leukaemia, Burkitt’s Lymphoma, Hodgkin's lymphoma, Wilms Tumour, Sarcoma, Retinoblastoma, Gliomas, Medulloblastomas and Neuroblastomas. Patients must be newly presented or be undergoing active anti-cancer treatment from the 12th March 2020 to the 12th December 2020. The primary objective of the study is to determine 30- and 90-day all-cause mortality rates. This study will examine the factors that influenced these outcomes. Chi-squared analysis will be used to compare mortality between low and middle-income countries and high-income countries. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors. Ethics and dissemination At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally, and internationally. The results will be submitted for publication in a peer reviewed journal.

scholarly journals Patients’ preferred and perceived level of involvement in decision making for cancer treatment: a systematic review

2021 ◽  
Author(s):  
Eveline A. Noteboom ◽  
Anne M. May ◽  
Elsken Wall ◽  
Niek J. Wit ◽  
Charles W. Helsper
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Cancer Treatment ◽  
Level Of Involvement

scholarly journals A new measure of group decision-making efficiency

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Cheng-Ju Hsieh ◽  
Mario Fifić ◽  
Cheng-Ta Yang
Keyword(s):  
Decision Making ◽  
Information Processing ◽  
Group Decision Making ◽  
Group Decision ◽  
Detection Task ◽  
Detection Sensitivity ◽  
System Level ◽  
Workload Capacity ◽  
Individual Decisions ◽  
Collective Benefit

Abstract It has widely been accepted that aggregating group-level decisions is superior to individual decisions. As compared to individuals, groups tend to show a decision advantage in their response accuracy. However, there has been a lack of research exploring whether group decisions are more efficient than individual decisions with a faster information-processing speed. To investigate the relationship between accuracy and response time (RT) in group decision-making, we applied systems’ factorial technology, developed by Townsend and Nozawa (Journal of Mathematical Psychology 39, 321–359, 1995) and regarded as a theory-driven methodology, to study the information-processing properties. More specifically, we measured the workload capacity CAND(t), which only considers the correct responses, and the assessment function of capacity AAND(t), which considers the speed-accuracy trade-off, to make a strong inference about the system-level processing efficiency. A two-interval, forced-choice oddball detection task, where participants had to detect which interval contains an odd target, was conducted in Experiment 1. Then, in Experiment 2, a yes/no Gabor detection task was adopted, where participants had to detect the presence of a Gabor patch. Our results replicated previous findings using the accuracy-based measure: Group detection sensitivity was better than the detection sensitivity of the best individual, especially when the two individuals had similar detection sensitivities. On the other hand, both workload capacity measures, CAND(t) and AAND(t), showed evidence of supercapacity processing, thus suggesting a collective benefit. The ordered relationship between accuracy-based and RT-based collective benefit was limited to the AAND(t) of the correct and fast responses, which may help uncover the processing mechanism behind collective benefits. Our results suggested that AAND(t), which combines both accuracy and RT into inferences, can be regarded as a novel and diagnostic tool for studying the group decision-making process.

Aboriginal perspectives on kangaroo management in South Australia

2006 ◽  
Vol 28 (2) ◽  
pp. 127 ◽  
Author(s):  
D. A. Thomsen ◽  
K. Muir ◽  
J. Davies
Keyword(s):  
Decision Making ◽  
Research Methods ◽  
Aboriginal People ◽  
South Australia ◽  
Research Participants ◽  
Commercial Harvest ◽  
Decision Making Processes ◽  
Rights And Interests

Kangaroos are culturally significant to Aboriginal people but Aboriginal people are generally not involved in kangaroo management or in the kangaroo industry. Our research has provided the first opportunity for Aboriginal people in South Australia to present their perspectives on the commercial harvest of kangaroos. Research methods were qualitative, involving consultations with authoritative Aboriginal people about their perspectives, aspirations, and how they see their rights and interests in relation to the commercial harvest of kangaroos. We found diverse views on this topic from Aboriginal research participants. For some Aboriginal people, strict cultural protocols preclude any involvement in the commercial harvest, but for people from other regions where the cultural laws concerning kangaroos are quite different, there is interest in developing enterprises based on kangaroo harvest. Despite the diversity of views about commercial kangaroo harvest, Aboriginal people across South Australia highly value kangaroos, and want to be included in decision-making processes for kangaroo management. There is potential for appropriate engagement of Aboriginal people in kangaroo management through improved communication, greater understanding and respect for the diversity of Aboriginal perspectives and protocols regarding native wildlife.

Enabling cultural safety in Indigenous primary healthcare

2018 ◽  
Vol 32 (1) ◽  
pp. 25-31
Author(s):  
Gertie Mai Muise
Keyword(s):  
Indigenous People ◽  
Primary Healthcare ◽  
Service Providers ◽  
Health Centre ◽  
Aboriginal Health ◽  
Cultural Safety ◽  
Safety Education ◽  
Structural Racism ◽  
Health And Wellbeing ◽  
Mainstream Healthcare

The Aboriginal Health Access Centre (AHAC) and Aboriginal Community Health Centre Model of Wholistic Health and Wellbeing is critical to addressing inequities and barriers that limit access to comprehensive primary healthcare for Indigenous people. Even with this model in place, there are multiple points of intersection with mainstream healthcare service providers across health sectors. Further, there is considerable cultural diversity among Indigenous healthcare staff and professional groups. These factors place Indigenous people at risk of culturally unsafe experiences causing harm. Given this, it is essential that leaders focus on cultural safety education to address both intercultural frictions within the Indigenous centres and systemic and structural racism widespread within the broader healthcare system. This article explores how one AHAC has undertaken to examine these complex challenges, while offering some direction on leadership within the sector.

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