Barriers and facilitators to adherence to Optimal Care Pathways for diagnosis and treatment of cancer for Aboriginal and Torres Strait Islander people

Rowena Ivers; Michelle Dickson; Kathleen Taylor; Trish Levett; Kyla Wynn; Janelle Trees; Emma Webster; Gail Garvey; Joan Cunningham; Lisa Whop; Abbey Diaz

doi:10.1071/PY22181

RESEARCH ARTICLE (Open Access)

Barriers and facilitators to adherence to Optimal Care Pathways for diagnosis and treatment of cancer for Aboriginal and Torres Strait Islander people

Rowena Ivers ^A ^B ^* , Michelle Dickson ^C , Kathleen Taylor ^B , Trish Levett ^A , Kyla Wynn ^B , Janelle Trees ^B , Emma Webster ^C , Gail Garvey ^D ^E , Joan Cunningham ^E , Lisa Whop ^F and Abbey Diaz ^D ^E

+ Author Affiliations

- Author Affiliations

^A Illawarra Aboriginal Medical Service, Wollongong, NSW 2500, Australia.

^B University of Wollongong (UOW), Wollongong, NSW 2522, Australia.

^C University of Sydney, Sydney, NSW 2006, Australia.

^D First Nations Cancer and Wellbeing Research Team, School of Public Health, University of Queensland, Herston, Qld 4006, Australia.

^E Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia.

^F National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2600, Australia.

^* Correspondence to: rivers@uow.edu.au

Australian Journal of Primary Health 30, PY22181 https://doi.org/10.1071/PY22181

Submitted: 1 February 2023 Accepted: 21 August 2023 Published: 5 September 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

The Optimal Care Pathways (OCP) are a framework to promote high-quality and integrated cancer care for all Australians, from prevention through to end-of-life-care. Aboriginal and Torres Strait Islander people experience disproportionate cancer incidence and mortality, but little research has addressed whether cancer care for Aboriginal people meets the standards prescribed by the OCPs. This study aims to consider barriers and facilitators to quality cancer care for Aboriginal people.

Methods

Semi-structured interviews were conducted with 30 health professionals who deliver care to Aboriginal people with cancer in primary care and hospital settings in New South Wales, Australia. Health professionals included Aboriginal Health Workers, nurses, general practitioners, and community workers. Interviews were conducted in 2019–2020 and explored participant perspectives of barriers and facilitators of optimal cancer care, particularly related to prevention, early detection, diagnosis, and treatment for Aboriginal people. Data were qualitatively analysed using framework analysis.

Results

In general, participants perceived Aboriginal patients to have good access to preventive care. In terms of early detection and diagnosis, access to primary care, pathology, radiology, and some specialists (e.g. respiratory physicians) was seen as optimal. However, access to hospital-based gastroenterologists for colonoscopy was perceived to be poor due to long wait times. Access to optimal care for cancer treatment was perceived to be hindered due to the lack of bulk-billing for bowel cancer, breast cancer, and cardiothoracic surgery. Other barriers to care identified by participants included unclear referral pathways, poor communication between patient and the treating team, and a lack of timely provision of discharge summaries.

Conclusions

Facilitators of optimal care during treatment and survivorship included: the Integrated Team Care and Close the Gap programs, and presence of key health workers to help patients navigate the health system. The major barriers to quality cancer care for Aboriginal people appeared to be to specialist and procedural access, demonstrating that the ‘Inverse Care’ law applied in reducing access for populations at higher risk of cancer.

Keywords: Aboriginal and Torres Strait Islander peoples, Australia, cancer, Indigenous peoples, integrated care, oncology, primary health care.

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