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.
| Original language | English |
|---|---|
| Article number | PY22181 |
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | Australian Journal of Primary Health |
| Volume | 30 |
| Issue number | 1 |
| Early online date | 5 Sept 2023 |
| DOIs | |
| Publication status | Published - 5 Sept 2023 |
Bibliographical note
Funding Information:The study showed that ACCHOs provide a culturally safe and familiar base for cancer support activities including prevention. The annual health check available for Aboriginal and Torres Strait Islander people provides an evidence -based vehicle for screening for and delivering preventive care for cancer; for example, through reviewing family history, asking about smoking, alcohol and measuring body mass index, and provides an opportunity to ask about participation in cancer screening programs (). ITC workers were able to support Aboriginal people who attended mainstream primary care as well as ACCHOs. Facilitators of OCP-adherent cancer care included familiar, geographically close primary care services, routine provision of annual health checks funded by Medicare, CTG funding for prescriptions, and financially accessible (bulk billed) diagnostic testing. The importance of the familiarity and continuity of primary care, and strong therapeutic relationships was also noted in the review by of perspectives of Aboriginal and Torres Strait Islander cancer survivors. A survey of Victorian health professionals conducted by also confirmed that Aboriginal primary health services were appropriate locations for support outside of hospital.
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