In Australia it has been recognized that specific measures are needed to improve access to healthcare for Aboriginal and Torres Strait Islander people. Innovative models of primary healthcare in Australia have emerged to ensure appropriate services are available to rural, remote, and the most disadvantaged within the communities.
The Congress of Aboriginal and Torres Strait Nurses (CATSIN) acknowledged the need for the provision of culturally appropriate care and that assistance may be needed from suitable qualified nurses in managing complex clinical issues, including specific cancer care issues.
In 2006 to 2010, cancer was the second most common cause of death for indigenous people. The types of cancer that caused the most deaths among indigenous people were lung cancer, cancer of an unknown primary site, breast cancer (for women), and bowel cancer. The fact that indigenous people are more likely than non-indigenous people to die from cancer may be because:
- The types of cancers they develop (such as cancers of the lung and liver) are more likely to result in death.
- Their cancer may be more advanced by the time it is found (which is partly because indigenous people may visit their doctor later and/or may not participate in screening programs).
- They are less likely to receive adequate treatment.
A working relationship between cancer services and Aboriginal health was established to work on a community development model. This project undertook an extensive period of consultation with Aboriginal communities where the following themes have emerged:
- Aboriginal people perceive cancer as a “death sentence.”
- Cancer services need to be delivered in the heart of the community.
- Cancer services need to be culturally safe and respectful of Aboriginal society.
From consultation flowed the cancer service outreach with the focus on training and community education. The focus was mainly on building relationships between the Aboriginal communities and cancer services.
Central to Aboriginal engagement in cancer services, a culturally accessible information brochure about cancer was written, incorporating Aboriginal artwork. Funding has been made available for Aboriginal healthcare workers to experience a supervised placement in a cancer care facility to increase their awareness about cancer treatments. Reverse supervised placements are also funded, where non-indigenous healthcare workers can experience a supervised placement in an Aboriginal healthcare center.
In working with Aboriginal patients, these patients often have an existing case manager or Aboriginal health worker who provides medical and/or social support within the community. As with any patient receiving cancer treatment, we need to ensure all treatments are explained in full to Aboriginal patients in clear, concise language.
I never presume that if a patient is nodding or agreeing that he or she completely understands the information being discussed. In addition, many Aboriginal people speak a number of languages and may not be fluent in English. Therefore patients may need an interpreter to ensure information is effectively communicated and understood.
It is crucial that we are equally aware of our body language, as discrimination and hostility can occur through non-verbal communication. In addition, it must be recognized that an interpreter may be required to be present in order to ensure appropriate discussion of the patient’s disease. Effective communication, building trust and strong relationships, will help patients feel more comfortable while receiving services, essential for improving Aboriginal cancer outcomes.
I'm wondering if there are similar initiatives towards Native American cancer patients. How does your healthcare system meet the cultural needs of your indigenous population?
- Aboriginal and Torres Strait Islander Cancer Care Resource Guide- Peter Mac
- Australian Institute of Health and Welfare (2010) Cancer in Australia 2010: an overview. Canberra: Australian Institute of Health and Welfare
- Australian Institute of Health and Welfare, Australasian Association of Cancer Registries (2012) Cancer in Australia: an overview 2012. Canberra: Australian Institute of Health and Welfare
- Australian Institute of Health and Welfare, Australasian Association of Cancer Registries (2012) Cancer in Australia: an overview 2012: supplementary tables. Canberra: Australian Institute of Health and Welfare
- Cancer Institute NSW 2012. Working together to improve cancer outcomes for Aboriginal people
- Cunningham J, Rumbold AR, Zhang X, Condon JR (2008) Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncology; 9(6): 585-595