Putting Policy into Practice: How Three Cancer Services Perform against Indigenous Health and Cancer Frameworks

Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.

Equity-Oriented Healthcare: What It Is and Why We Need It in Oncology

Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services.

P-OGC83 The Impact of Covid-19 on Malignant Upper GI Operations in England During 2020

Background Due to the Covid-19 pandemic and the overwhelming number of patients requiring ITU due to serious Covid-19 infections, trusts throughout England reduced their operation numbers to reduce the burden on secondary care services. Whilst efforts were made to preserve cancer services in England, the Covid-19 burden still significantly impacted the provision of oesophagectomies and gastrectomies. The following research aims to look at the true impact of Covid-19 on operation numbers in England and compare these to the Covid-19 burden. Methods Data relating to operation numbers was taken from The Surgical Workload Outcomes Audit (SWORD) database. The SWORD database was interrogated for the years 2017 – 2020. A mean number of operations was calculated using the 2017-2019 data and compared to data from 2020. Operations performed and other demographic data was analysed regionally and compared to Covid-19 deaths throughout England. Covid-19 data was obtained from the national government dashboards. Results Results showed that there was a significant reduction in the number of operations performed in 2020 due to the Covid-19 pandemic. This was closely correlated with Covid deaths throughout England. Variations between centres were present throughout the UK, however the overall trend reflected more than a 40% reduction in gastrectomies and more than a 30% reduction in oesophagectomies, which equated to 1018 less gastrectomies and 490 less oesophagectomies performed in 2020. There was significant variation between centres, the impact on individual centres and oesophagectomy rates ranged from -0.8% reduction to a 100% reduction in operations carried out in 2020. Gastrectomies was similarly affected, varying between a 2.7% and 89.5% reduction in operations carried out in 2020. Conclusions Overall, despite efforts to preserve procedures, particularly for malignant disease, there was significant fall in operations performed throughout 2020. As a consequence of this, it is likely that patients requiring life saving or life extending operations did not receive their treatment. The data suggests that overall gastrectomies were worse hit than oesophagectomies across England. Variances in performance across the UK should be further analysed to allow better planning and resource allocation for future waves or future pandemics.

Perspectives of Muslim husbands' roles in women's health and cancer in Indonesia

<p>In developing countries such as Indonesia, women face many health issues, including cancer. Social, cultural and economic factors are known barriers to women accessing health services and achieving a good health. Studies in Indonesia suggest that husbands’ support may influence women’s health behaviour, including women in breast and cervical screening and treatments. However, little is known in Indonesia about husbands’ roles in women’s health, including illness prevention, early detection, and treatment of women’s cancer. The main objectives of this study were to uncover Muslim husbands’ roles and perspectives regarding women’s health and women’s cancer, and to establish whether there were different perspectives of husbands’ roles related to geographical location, age or other social, health or cultural characteristics. This study used an Islamic ontological approach. The Basic Model of Religiosity and Health, the Health Belief Model, and the Help-Seeking Behaviour and Influencing Factors Framework theories informed data collection. A descriptive exploratory methodology was used. Methods included focus groups with 11 groups (n=73) of married Muslim men, and interviews with married Muslim women (n=20) and health professionals (n=10) from rural and urban areas of West Java province, Indonesia. Data were analysed using two techniques: the Comparative Analysis for Focus Group and the Comparative Analysis for Interviews. The findings revealed that Islamic teaching has an extremely significant position for Muslims husbands in guiding them in their family’s roles. Muslim husbands were very involved in women’s health and cancer. These roles were influenced by internal and external factors. Husbands’ significant roles in women’s health include maintaining women’s health and facilitating health treatments. However, they have a limited role in disease prevention, and early detection of women’s cancer. Muslim husbands’ limited health literacy of women’s cancer was a significant barrier in rural and downtown areas. This study’s findings contribute to a new perspective on religion as a vital influence and driver of health and health behaviour in nursing theory. There is a need for Indonesian nursing practice to incorporate a cultural safety approach to caring for Muslim husbands and wives, and for nurses to ensure men are more fully informed about women’s health. This study identified the need for improvements in health services and a reform of the health system especially in improving husbands’ knowledge and awareness of women’s cancer, and the dissemination of information about women’s cancer services, especially in rural and downtown areas. Additional health education programmes including some that target men’s health literacy are required alongside improvements in health services, especially women’s cancer services.</p>

Perspectives of Muslim husbands' roles in women's health and cancer in Indonesia

<p>In developing countries such as Indonesia, women face many health issues, including cancer. Social, cultural and economic factors are known barriers to women accessing health services and achieving a good health. Studies in Indonesia suggest that husbands’ support may influence women’s health behaviour, including women in breast and cervical screening and treatments. However, little is known in Indonesia about husbands’ roles in women’s health, including illness prevention, early detection, and treatment of women’s cancer. The main objectives of this study were to uncover Muslim husbands’ roles and perspectives regarding women’s health and women’s cancer, and to establish whether there were different perspectives of husbands’ roles related to geographical location, age or other social, health or cultural characteristics. This study used an Islamic ontological approach. The Basic Model of Religiosity and Health, the Health Belief Model, and the Help-Seeking Behaviour and Influencing Factors Framework theories informed data collection. A descriptive exploratory methodology was used. Methods included focus groups with 11 groups (n=73) of married Muslim men, and interviews with married Muslim women (n=20) and health professionals (n=10) from rural and urban areas of West Java province, Indonesia. Data were analysed using two techniques: the Comparative Analysis for Focus Group and the Comparative Analysis for Interviews. The findings revealed that Islamic teaching has an extremely significant position for Muslims husbands in guiding them in their family’s roles. Muslim husbands were very involved in women’s health and cancer. These roles were influenced by internal and external factors. Husbands’ significant roles in women’s health include maintaining women’s health and facilitating health treatments. However, they have a limited role in disease prevention, and early detection of women’s cancer. Muslim husbands’ limited health literacy of women’s cancer was a significant barrier in rural and downtown areas. This study’s findings contribute to a new perspective on religion as a vital influence and driver of health and health behaviour in nursing theory. There is a need for Indonesian nursing practice to incorporate a cultural safety approach to caring for Muslim husbands and wives, and for nurses to ensure men are more fully informed about women’s health. This study identified the need for improvements in health services and a reform of the health system especially in improving husbands’ knowledge and awareness of women’s cancer, and the dissemination of information about women’s cancer services, especially in rural and downtown areas. Additional health education programmes including some that target men’s health literacy are required alongside improvements in health services, especially women’s cancer services.</p>

Autonomy, Choice and Treatment: Using Bourdieu's Theory of Practice to Explore Breast Cancer Patients' Preconceptions and Experiences of Public and Private Health Systems in New Zealand

<p>This thesis analyses 11 breast cancer patients’ preconceptions and experiences of public and private health sectors in New Zealand. Previous studies exploring breast cancer have analysed a range of issues including race, socio-economic and age inequalities, issues occuring between the public and private sectors, and the communication strategies patients preferred with health providers. In contrast, this thesis uses concepts from Pierre Bourdieu’s theory of practice to explore breast cancer patients’ accounts of the public and private sectors and how these accounts are shaped. For many of the women interviewed, cultural and social capital played an important role in the negotiation of the health system, whether public or private. This is because both sectors, at times, provided little information about the disease, treatment, side effects, and entitlements. In these circumstances, social and cultural capital were valuable resources providing alternative health assistance. Participants’ preconceptions when relating their choice of public or private health systems showed clear positive associations with the private health sector. When discussing their experiences, the women that used the public sector showed a positive turnaround in their opinions related to the public sector. In comparison, the women that used the private sector maintained their views regardless of some negative issues being experienced. Despite their personal experiences, both public and private participants maintained positive associations with the private sector. The reliance many of the participants had on social and cultural capital in both the public and private health sectors raises questions regarding processes related to patient information, access to services, and about whether case management of cancer services might be appropriate. The contrasts between participants’ preconceptions of the public sector in comparison to experiences highlights the need for a public campaign celebrating the successes of public cancer services.</p>

Autonomy, Choice and Treatment: Using Bourdieu's Theory of Practice to Explore Breast Cancer Patients' Preconceptions and Experiences of Public and Private Health Systems in New Zealand

<p>This thesis analyses 11 breast cancer patients’ preconceptions and experiences of public and private health sectors in New Zealand. Previous studies exploring breast cancer have analysed a range of issues including race, socio-economic and age inequalities, issues occuring between the public and private sectors, and the communication strategies patients preferred with health providers. In contrast, this thesis uses concepts from Pierre Bourdieu’s theory of practice to explore breast cancer patients’ accounts of the public and private sectors and how these accounts are shaped. For many of the women interviewed, cultural and social capital played an important role in the negotiation of the health system, whether public or private. This is because both sectors, at times, provided little information about the disease, treatment, side effects, and entitlements. In these circumstances, social and cultural capital were valuable resources providing alternative health assistance. Participants’ preconceptions when relating their choice of public or private health systems showed clear positive associations with the private health sector. When discussing their experiences, the women that used the public sector showed a positive turnaround in their opinions related to the public sector. In comparison, the women that used the private sector maintained their views regardless of some negative issues being experienced. Despite their personal experiences, both public and private participants maintained positive associations with the private sector. The reliance many of the participants had on social and cultural capital in both the public and private health sectors raises questions regarding processes related to patient information, access to services, and about whether case management of cancer services might be appropriate. The contrasts between participants’ preconceptions of the public sector in comparison to experiences highlights the need for a public campaign celebrating the successes of public cancer services.</p>