Accessibility of Cancer Treatment Services for Indigenous Australians in the Northern Territory: Perspectives of Patients and Care Providers

Abstract

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.

Evaluating delays in patients treated with post‐operative radiation therapy for head and neck squamous cell carcinoma

“…Lyford et al 27 . and Anderson et al 28 . highlighted fear or lack of trust of mainstream health facilities, poor communication by healthcare providers, fatalistic beliefs about cancer, cultural insensitivity and lack of culturally relevant care, and difficulties navigating the health system as some reasons.…”

“…However, a few studies have explored the reasons for poorer access to cancer treatment services in Indigenous Australians. Lyford et al 27 and Anderson et al 28 highlighted fear or lack of trust of mainstream health facilities, poor communication by healthcare providers, fatalistic beliefs about cancer, cultural insensitivity and lack of culturally relevant care, and difficulties navigating the health system as some reasons. Numerous interventions for improving accessibility to cancer treatment services have been suggested in the literature, focusing mainly on the following three domains: providing culturally appropriate and safe care (e.g.…”