'Nowhere to Room . . . Nobody Told Them': Logistical and Cultural Impediments to Aboriginal Peoples' Participation in Cancer Treatment

Article excerpt

Abstract

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.Alarge 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.

Introduction

Death rates for IndigenousA Australians are three times higher than for non-Indigenous Australians,1,2 with markedly higher cancer mortality rates.3-6 Poorer Indigenous cancer outcomes are occurring despite advances in detection and treatment techniques and overall improvements in cancer outcomes in Australia.7 Indigenous Australians are less likely to access cancer screening; are diagnosed at a more advanced stage of cancer; have poorer continuity of care; lower compliance with treatment; and lower five-year survival rates.4,8,9 This situation clearly warrants consideration and appropriate action by both primary healthcare services and cancer treatment services.

Health service access is an important determinant of health outcomes for both preventive care and treatment.10,11 Access to healthcare is particularly difficult in geographically extensive territories like Australia1 where many people need to travel large distances to health centres and services.12,13 Poorer access to cancer detection, screening, treatment and support services for rural and remote people as compared to urban dwellers, is a primary reason for a reduced likelihood of cancer survival.2,14 Thus, poorer cancer outcomes for Indigenous Australians are compounded by the rural and remote residency of over half of Australia's Indigenous people. …