Table 1
Targeted recruitment numbers by hospital.
| SITE (HOSPITAL PEER GROUP CLASSIFICATION) | REMOTENESS AREA | MEDICINE | NURSING | ALLIED HEALTH | TOTAL (n) |
|---|---|---|---|---|---|
| Hospital 1 Public acute Group A | Inner regional | 8 | 12 | 12 | 32 |
| Hospital 2 Public acute Group A | Inner regional | 8 | 12 | 12 | 32 |
| Hospital 3 Public Acute Group A | Inner regional | 0 | 10 | 8 | 20 |
| Hospital 4 Public acute Group B | Inner regional | 0 | 10 | 8 | 20 |
| Hospital 5 Public Acute Group C | Inner regional | 0 | 5 | 5 | 10 |
| Hospital 6 Public Acute Group C | Outer regional | 0 | 5 | 5 | 10 |
Table 2
Optimal Care Pathway questions by category and sub-category.
| CATEGORY 1: ABORIGINAL AND/OR TORRES STRAIT ISLANDER PERSPECTIVES ON | |
|---|---|
| Sub-categories | Health, illness, well-being. |
| Cancer perspectives (meaning, fears, concerns, and taboos). | |
| Gender-specific matters (‘Men’s Business’ and ‘Women’s Business’). | |
| The connection between country, spirituality, family, community and health. | |
| Spiritual practices, traditional healers, and traditional, complementary or alternative medicine therapies. | |
| Knowing when to use traditional terminology (e.g. when to use ‘Aunty’ or ‘Uncle’). | |
| CATEGORY 2: PREVENTION AND EARLY DETECTION: USING CULTURALLY APPROPRIATE INFORMATION TO DISCUSS | |
| Sub-categories | Risk reduction (e.g. quit smoking and healthy eating). |
| Screening and immunisation (e.g. mammograms and HPV vaccination). | |
| Early detection (cancer signs and symptoms, and co-morbidities). | |
| CATEGORY 3: PRESENTATION, INITIAL INVESTIGATIONS AND REFERRAL) | |
| Sub-categories | Using culturally relevant information to explain the reasons for diagnostic/referral investigations to the patient and their family/carer. |
| Addressing patient and family concerns about cancer and cancer treatment. | |
| CATEGORY 4: DIAGNOSIS, STAGING & TREATMENT PLANNING | |
| Sub-categories | Understanding factors which influence Aboriginal and/or Torres Strait Islander patients’ decisions about treatment and ongoing care. |
| Speaking in a culturally appropriate way about treatment options and the expected outcomes of these treatments. | |
| Checking/knowing if the person has understood the information I have provided about the treatment plan. | |
| Access to an expert with culturally appropriate knowledge in the multidisciplinary meetings (MDM). | |
| Culturally appropriate resources to discuss and seek informed consent to participate in clinical trials (if clinically appropriate). | |
| CATEGORY 5: TREATMENT | |
| Sub-categories | Practising trauma-informed care using culturally informed approaches. |
| Understanding cultural practices in the clinical setting (e.g. touching patients and who to discuss diagnosis/prognosis with). | |
| Working with families during cancer treatment and follow-up care. | |
| Understanding cultural perceptions about pain experiences, relief and management. | |
| Pathways/processes to work with the Aboriginal Hospital Liaison Officer/Aboriginal Health Worker during treatment and follow-up care. | |
| Knowing about Indigenous-specific patient assistance programs/schemes (e.g. Close the Gap prescriptions). | |
| Understanding the potential barriers to Aboriginal and/or Torres Strait Islander people accessing treatment, health services, and/or follow-up care. | |
| CATEGORY 6: CARE AFTER INITIAL TREATMENT AND RECOVERY | |
| Sub-categories | Developing culturally appropriate treatment summaries and/or follow-up care plans. |
| Strategies to provide culturally appropriate information about the signs and symptoms of recurrent and secondary prevention of disease. | |
| Strategies to provide culturally appropriate information about healthy living after cancer treatment. | |
| Information about referral options/pathways for social and emotional well-being and mental health services. | |
| Processes to keep a patient’s General Practitioner updated (e.g. prognosis and a follow-up care plan). | |
| CATEGORY 7: SUPPORTIVE CARE | |
| Sub-categories | Using the Supportive Care Need Assessment Tool - Indigenous Patients (SCNAT-IP) to identify supportive care needs. |
| Using a culturally appropriate pain tool to better identify and manage pain. | |
| Culturally appropriate supportive care services (internal and external to service). | |
| Category 8: RECURRENT, RESIDUAL AND METASTATIC DISEASE | |
| Sub-categories | Using culturally appropriate language to explain treatment intent, outcomes or adverse events for recurrent, residual or metastatic disease. |
| Discussing advance care planning in a culturally relevant manner with patients and their families/carers. | |
| Discussing referral to palliative care with patients and their families/carers. | |
| CATEGORY 9: END OF LIFE CARE | |
| Sub-categories | Using culturally appropriate language when discussing death or dying. |
| Discussing cultural preferences related to practices around death and dying. | |
Table 3
Demographic and practice variables for health professionals who responded to the questionnaire.
| VARIABLE (N = 52)† | n | % |
|---|---|---|
| Clinical experience (years) | ||
| Mean (Minimum-Maximum) | 16 (1–41) | |
| Profession: | ||
| Nursing | 19 | 36.5% |
| Allied Health | 19 | 36.5% |
| Medical | 11 | 21.2% |
| Missing | 3 | 5.8% |
| Identify as Aboriginal and/or Torres Strait Islander | ||
| Yes, Aboriginal | 2 | 3.8% |
| Neither Aboriginal nor Torres Strait Islander | 50 | 96.2% |
| Provide services/care in#: | ||
| Treatment | 41 | 78.8% |
| Supportive care | 29 | 55.8% |
| Care after initial treatment and recovery | 24 | 46.2% |
| Managing recurrent, residual and metastatic disease | 23 | 44.2% |
| Palliative care | 22 | 42.3% |
| End-of-life care | 16 | 30.8% |
| Diagnosis, staging and treatment planning | 13 | 25.0% |
| Presentation, initial investigations and referral | 9 | 17.3% |
| Prevention and early detection | 5 | 9.6% |
| Provide care to Aboriginal and Torres Strait Islander people: | ||
| Yes | 41 | 78.8% |
| No | 8 | 15.4% |
| Not sure | 3 | 5.8% |
| Attended cultural awareness/competency/safety training in the last 5 years: | ||
| Yes | 24 | 46.2% |
| No | 25 | 48.1% |
| Cannot remember | 3 | 5.8% |
| Confident in asking patients if they identify as Aboriginal and/or Torres Strait Islander: | ||
| Yes, always | 26 | 50.0% |
| Sometimes | 18 | 34.6% |
| No | 5 | 9.6% |
| Not sure | 3 | 5.8% |
| Aware of cancer Optimal Care Pathway for Aboriginal and Torres Strait Islander people: | ||
| Yes | 12 | 23.1% |
| No | 34 | 65.4% |
| Not sure | 6 | 11.5% |
[i] † Unless otherwise specified.
# More than one choice selected.
Figure 1
OCP sub-categories by high versus low interest (N = 52).
GP = general practitioner; SCNAT-IP = Supportive Care Need Assessment Tool – Indigenous Patients.
Table 4
An integrative approach to implementing Optimal Care Pathways for Aboriginal and Torres Strait Islander people with cancer.
| ISSUES | PATIENT | HEALTH PROFESSIONAL | HEALTH SYSTEM |
|---|---|---|---|
| CULTURAL SAFETY | Use culturally appropriate methods to evaluate patient experiences of care. | Undertake and maintain cultural safety training. Use principles of cultural safety in clinical practice. | Implement regular and refresher cultural safety training. Partner with Elders and Aboriginal Community to ensure training is culturally safe. Evaluate organisational processes and practices in cultural safety. |
| OPTIMAL CARE PATHWAYS | Respect for Aboriginal and Torres Strait Islander culture, family, Community, Country | Use person-centred practice. Take a wholistic approach. Use culturally appropriate assessment tools. Connect with Aboriginal hospital, health & liaison workers. Include cultural supports in Multidisciplinary Meetings. | Create welcoming environments. Find out the needs of local Community. Use self-determination to respond to needs. |
| CONNECTIONS AND PARTNERSHIPS | Create supports for patients outside of hospital system. | Establish links with primary care (e.g. General Practitioners). | Connect with Elders and Community. Establish links with Aboriginal Community Controlled Health Organisations |