Although the incidence of cancer in Indigenous peoples is similar to its incidence in the overall Australian population, Indigenous peoples are less likely to access early detection and medical interventions resulting in higher mortality and morbidity rates. To explore and address this discrepancy, the National Health and Medical Research Council funded a research study to examine Indigenous peoples' views of cancer and cancer treatments with an end goal of developing an innovative model of Indigenous Palliative Care. Seventy-two participants were interviewed from four geographical areas within the Northern Territory (Australia) including patients, caregivers, Indigenous and non-Indigenous health care workers, and interpreters. Indigenous peoples' views of cancer have to be examined within a historical, socio-political, and cultural context. There is no Indigenous word for cancer and the Western biomedical language that semantically constructs the notion of cancer is not widely understood. Additionally, for many Indigenous people, the aetiology of cancer is embedded in beliefs about the spiritual world of curses and payback from perceived misdeeds. The paper advocates for cross-cultural education initiatives, stressing the importance of a two way education strategy incorporating a process whereby medical and nursing personnel would improve their understanding of Indigenous peoples' view of cancer and Indigenous peoples would learn more about prevention and treatment of cancer from a biomedical perspective.

staff need to be aware of a myriad of crosscultural issues. Although anecdotal evidence indicates that the quality of communication to Aborigines in the health care setting can be extremely varied, there seems to be very little research in this area. This article seeks to address the dearth of information in this area by presenting recent findings from Australian research that developed a model for Indigenous palliative care.The research that has been undertaken on the topic has mostly focused on communication issues from the perspective of Western medical practitioners. One such study 2 outlines frustrations felt by medical practitioners at being unable to relate to Indigenous patients and when faced with patients who were reluctant to talk. Although these issues are indeed pertinent, so too are the communication challenges faced by an Aboriginal patient and his or her family. This paper explores some communication issues faced by health care workers and Indigenous patients and their families in a health care What does this study add?This study provides the perspectives of Aboriginal people and health care workers on the important communication issues, including communicating difficult news, cultural shyness, information being taken literally, difficulty in understanding Western medical concepts, language barriers and talking to the right person. What are the implications for practice? This paper highlights the importance of communicating the right story (full and culturally appropriate information, appropriately translated and with opportunity for feedback to ensure comprehension) to the right person (recognising the importance of relationship, family and community).

Objectives: The findings are drawn from a 2-year research project, funded by the National Health and Medical Research Council (NHMRC), which aimed to develop an innovative model for Indigenous palliative care. The findings presented in this article explore one important strategy for putting Aboriginal families and their communities at the centre of the model: that is, the employment of Aboriginal Health Workers (AHWs) in relation to the provision of palliative care in the Northern Territory. Methods:The data were collected from 72 qualitative interviews conducted throughout the regional, rural and remote areas of the Northern Territory with Indigenous patients and carers in the Northern Territory and the health professionals who care for them.Results: While highlighting the valuable role of AHWs, the findings emphasise that the current lack of availability of such workers for palliative care provision for Indigenous peoples needs seri-

Mental health psychiatric advance directives, advance statements, and similar documents are designed to convey a person's treatment preferences to their treating clinicians at times when, due to their mental health, their ability to communicate or make decisions might be impaired. This paper explores the current debates in the literature and presents the findings of a small qualitative study that explored the experiences of people who had completed advance statements in Victoria, Australia. Data was collected through interviews with participants and analysis of their advance statement. Participants completed their advance statements for two main reasons; to authorise future treatment or to limit the power of their treating team. Participants also included non-treatment preferences that were linked to their recovery and pragmatic considerations, such as contact details and dietary requirements. Participants who had used their advance statement reported a lack of acceptance or inclusion from clinicians. Further consideration of the legal enforceability of advance statements is necessary, and if they are to continue to lack legal force, much work remains to be done to support acceptance by clinicians.

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