Background Poorer cancer outcomes of Indigenous Australians in Australia’s Northern Territory (NT) compared with their non-Indigenous counterparts are partially due to diminished access to cancer treatment services (CTS). Accessibility of health care is a multidimensional construct, including physical, logistical, psychosocial and cultural dimensions. While previous research has identified specific areas of reduced access to CTS for Indigenous Australians, the higher burden of cancer borne by Indigenous Australians warrants a more comprehensive understanding of access to CTS in the NT. The purpose of this study was to explore and map the accessibility of CTS for Indigenous Australians in the NT and to identify key access barriers. Methods This predominantly qualitative study, complemented by a descriptive quantitative component, explored and mapped the accessibility of one CTS (CTS-NT) that services a large number of Indigenous Australians in the NT. Patient perspectives were obtained via secondary analysis of data from 75 face-to-face interviews with Indigenous Australian adults attending the CTS-NT. Care provider perspectives were obtained via primary analysis of data from 29 face-to-face interviews with care providers and staff working at CTS-NT. Data were analysed to identify issues of accessibility informed by Leveque and colleagues’ conceptual framework of access to health care, which comprises five dimensions of accessibility of the health service and the ability of Indigenous patients to interact with these dimensions to generate access. Applied thematic analysis was conducted on the qualitative data and descriptive analysis was conducted on the quantitative data. Results The analysis of the patient and care provider reports identified multiple access barriers across all dimensions including: inadequate preparation of Indigenous patients for treatment; delayed and complicated commencement of treatment; dislocation from home; competing priorities; scarcity of Indigenous care providers and staff; lack of culturally-relevant care; challenges associated with language, accommodation, transport and finance; and disjointed and fraught relationships with care providers. These barriers posed significant challenges to Indigenous patients maintaining their engagement with treatment. Conclusions This study provides a valuable snapshot of the barriers facing this population across the dimensions of health care access. Urgent action in addressing these issues is required at individual, service and state levels.
Breast cancer (BC) is potentially a traumatic stressor which may be associated with negative outcomes, such as post-traumatic stress disorder (PTSD) or positive changes, such as post-traumatic growth (PTG). This study aims to identify the core issues of BC related PTSD, PTG and psychological distress by interrogating the literature in BC survivors. We have also highlighted issues related to the assessment, diagnosis and clinical management of PTSD and PTG. The authors systematically reviewed studies published from 1985 to 2014 pertaining to PTSD, psychological distress and PTG in BC survivors with particular attention paid to incidence rates and causative factors. Multiple studies intimated that women with BC have evidence of PTSD at the initial stages of diagnosis, whereas PTG develops once patients undergo treatment. Early diagnosis and treatment of PTSD/PTG is paramount from literature review but the previously mentioned relationship between PTSD and PTG in BC patients could not be verified. It is evident from the literature that a small percentage of BC patients experience PTSD, while the majority experience PTG after BC diagnosis and treatment. Future research should include prospective studies focusing on high-risk patients, causative factors and the development of psychological interventions.
Background: Health behaviors are becoming increasingly recognized as important for cancer survivors in optimizing health after diagnosis. The current study aims to describe adherence to health behaviour guidelines in a sample of Indigenous and non-Indigenous cancer patients in Australia's Northern Territory. Methods: A structured survey collecting self-reported sociodemographic and health behaviour data was administered to a sample of cancer patients within 1 year of their cancer diagnosis at a cancer care center in Darwin, Northern Territory. Clinical data were collected via medical chart review. Results: In 63 participants (median age 58 years; 32% Indigenous), most met guidelines for fruit (73%), red meat (76%), and alcohol (75%) intake, whereas adherence to vegetable (10%), processed meat (33%), and physical activity (25%) guidelines was low. Almost one-third (32%) reported being current smokers. Indigenous patients more frequently met guidelines than non-Indigenous patients for fruit intake and physical activity, and less for vegetable, red and processed meat, alcohol intake and smoking. Although there were some notable changes post-cancer diagnosis, about half of the participants reported no change in most behaviors. Conclusions: Adherence to some recommended health behaviors was poor in this sample, regardless of Indigenous status, reflecting previous cancer survivorship and general national reports. For some this may be due to changes resulting from their cancer and treatment, whereas for others this may reflect pre-diagnosis low adherence. Further investigation is needed to better understand health behaviour decision-making for cancer patients and survivors in Northern Territory, to inform public health messaging and interventions for this population.
Background: The poorer cancer outcomes of Indigenous Australians in Australia’s Northern Territory (NT) compared with their non-Indigenous counterparts is partially due to diminished access to cancer treatment services (CTS). The accessibility of health care is a multidimensional construct, including physical, logistical, psychosocial and cultural dimensions. While previous research has identified specific areas of reduced access to CTS for Indigenous Australians, the higher burden of cancer borne by Indigenous Australians warrants a more comprehensive understanding of access to CTS in the NT.Aim: The purpose of this study was to explore and map the accessibility of CTS for Indigenous Australians in the NT and to identify key access barriers.Methods: This study employed a mixed-methods convergent design to explore and map the accessibility of one CTS (CTS-NT) that services a large number of Indigenous Australians in the NT. Patient and care provider views were included. Patient perspectives were obtained via secondary analysis of data from open- and closed-questions from 75 face-to-face interviews with Indigenous Australian adults attending the CTS-NT. Care provider perspectives were obtained via primary analysis of data from 29 face-to-face semi-structured interviews with care providers and staff working at CTS-NT. Data were analysed to identify issues of accessibility informed by Leveque and colleagues’ conceptual framework of access to health care, which comprises five dimensions of accessibility of the health service and the ability of Indigenous patients to interact with these dimensions to generate access. Applied thematic analysis was conducted on the qualitative data and descriptive analysis was conducted on the quantitative data.Results: The analysis of the patient and care provider reports identified multiple access barriers across all five dimensions including: inadequate preparation of Indigenous cancer patients for treatment; delayed and complicated commencement of treatment; dislocation from home; competing priorities; a scarcity of Indigenous care providers and staff; a lack of culturally-relevant care; challenges associated with language, accommodation, transport and finance; and disjointed and fraught relationships with care providers. These barriers posed significant challenges to Indigenous patients maintaining their engagement with treatment.Conclusions: This study provides a valuable snapshot of the barriers facing this population across the five dimensions of health care access. Urgent action in addressing these issues is required at individual, service and state levels.
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