Indigenous Women's Expectations of Clinical Care during Treatment for a Gynaecological Cancer: Rural and Remote Differences in Expectations
Willis, Eileen M., Dwyer, Judith, Owada, Kei, Couzner, Leah, King, Debra, Wainer, Jo, Australian Health Review
Objectives. To report on differences in Indigenous women's expectations of clinical care during treatment for a gynaecological cancer in rural and remote regions.
Design. Qualitative interviews were conducted in New South Wales, Victoria, South Australia and the Northern Territory in 2008 with 37 clinicians working in gynaecological cancer and 24 women with a gynaecological cancer. Three of the participants were Indigenous women living in large rural towns (others were non-Indigenous), whereas six of the 37 clinicians interviewed worked closely with Indigenous women in remote settings. Indigenous women were contacted through an Indigenous researcher. Interviews were analysed for emerging themes, then compared with each other and with the research literature for similarities and differences.
Results. There is considerable variation between clinician observations of the expectations of Indigenous women in remote regions, and the views of Aboriginal women in rural settings.
Conclusion. Indigenous women in rural settings have specific views about quality medical care. These include expectations of timely and culturally appropriate care, and strong ties to family and kin, but do not accord with other research findings that suggest Aboriginal women must receive care from same sex clinicians or that care is often delayed. The paper alerts practitioners to the fact that culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations.
What is known about this topic? Cross-cultural health care research recognises that health professionals need to be attuned to the cultural preferences and needs of Indigenous patients.
What does this paper add? This study warns against assuming all Indigenous people are the same, or have the same expectations about quality health care. It notes that little guidance is offered to clinicians on how Indigenous responses to Western bio-medical care might differ across the country. The paper identifies some differences and proposes strategies for understanding local preferences.
What are the implications for practitioners? This paper alerts practitioners to the fact that although Indigenous patients share many cultural similarities, clinicians should not make assumptions about what is appropriate culturally safe care. Culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations in terms of timely access, culturally appropriate care and educational materials, the role of family and Aboriginal Health Workers, and sex preferences.
The requirement for culturally safe and respectful care to Indigenous clients is extensively documented in Australian medical and health care research literature.1-4 This advice usually warns against assuming all Indigenous people are the same, or have the same expectations and responses to illness and care.5-8 Despite this, little guidance is offered to clinicians on how Indigenous responses to Western bio-medical care might differ across the country. In this study, we compared the expectations of quality care identified by a small number of Indigenous women living in larger regional centres, who had experienced gynaecological cancer, with the literature and with the perceptions of six clinicians who had experience in caring for Indigenous women in remote areas. This study was conducted as part of a larger project commissioned by Cancer Australia.9
According to the research literature two major issues confront Indigenous women with a gynaecological cancer: poor access to health services, including lack of resources, and culturally inappropriate care. The high rate of gynaecological cancers among Indigenous women, particularly those living in remote and rural regions has been attributed to a lack of accessible primary health care services and access to cancer specialists.1 This makes it difficult for Indigenous women to receive screening, diagnosis and treatment for gynaecological cancers. …