Indigenous Australians are 30% more likely to die from preventable cancers than non-Indigenous Australians but fear, stigma and shame mean the disease is rarely discussed.
Indigenous Australians are also more likely to be diagnosed with advanced cancers and about a third are less likely to receive appropriate medical care, according a draft report that will form part of a new program to improve the delivery of cancer care to Aboriginal and Torres Strait Islander people.
The Expert Working Group, comprising Aboriginal and Torres Strait Islander health experts, clinicians and consumers, was established by Cancer Australia and Cancer Victoria to develop the Optimal Care Pathway (OCP) for Aboriginal and Torres Strait Islander people with cancer.
The draft OCP released for public consultation highlights the importance of a ‘culturally competent workforce’ for improving outcomes in Indigenous people with cancer.
“This means ensuring that all health professionals, health managers, receptionists and administrative workers working with Aboriginal and Torres Strait Islander patients have adequate ongoing training and skills in delivering culturally safe healthcare and medical advice.”
The Group said it was essential that a multidisciplinary healthcare team include either an Aboriginal and Torres Strait Islander Hospital Liaison Officer or a medically trained interpreter.
Patients should also have access to both male and female health professionals for ‘men’s business’ and ‘women’s business’ – a fundamental to many Aboriginal and Torres Strait Islander cultures that could otherwise prevent some patients from discussing certain aspects of their care.
The OCP also makes several practical recommendations for creating a safe and culturally inclusive practice such as displaying an acknowledgement of the traditional custodians of the land, promoting Aboriginal and Torres Strait Islander culture via artwork and signage, and encouraging the inclusion of multiple family or community members such as elders at appointments.
Offering a Question Prompt List ahead of a consultation and audio recordings or written summaries of their consultations afterwards would also help, the Group added. The report noted that hearing impairment, which disproportionately affects Indigenous people, could contribute to disengagement from healthcare.
Meanwhile, the report advised that some patients might use traditional bush medicine not just for cancer treatment or symptom relief but to maintain a connection with their culture, ancestors and spirituality. Doctors should discuss and document any such therapies and be alert for potential toxicity or drug interactions
“It is an advantage to all concerned if patients are able to discuss CAM therapies openly, secure in the knowledge that they will continue to receive support and understanding from their treatment team,” the Group added.
The Group has also pushed for renewed focus on improving notoriously low participation rates in cancer prevention and screening programs among Indigenous people. They recommended that the annual Medicare health assessment for Aboriginal and Torres Strait Islander people be used as “an ideal opportunity to discuss prevention and early detection, and to assess cancer risk”.
It suggested having dedicated personnel and systems to set up regular referrals and follow-up appointments to improve participation levels in screening programs.
The OCP also covers culturally appropriate approaches to pain management, post treatment follow up care, and end of life care. The Working Group is now calling on health professionals and the general public to comment on the draft OCP, which can be found on Cancer Council Victoria website
Public consultation will close on 27 October 2017.