P100: Exploring First Nations members emergency department experiences and concerns through participatory research methods

Abstract

Introduction: Emergency Departments (EDs) are frequently the first point of entry to access health services for First Nation (FN) members. In Alberta, FN members visit EDs at almost double the rate of non-FN persons. Furthermore, preliminary evidence demonstrates differences in ED experience for FN members as compared to the general population. The Alberta First Nations Information Governance Centre, Maskwacis Health Services, Yellowhead Tribal Council, Treaty 8 First Nations of Alberta, and Alberta Health Services are working together to research FN members ED experiences and concerns. Methods: This is participatory research guided by a two-eyed seeing approach that acknowledges the equal value of both Western and Indigenous worldviews. FN and non-FN leaders researchers are full partners in the development of the research project. Six sharing circles will be held in February 2018 across Alberta, with Elders, FN patients, FN and non-FN clinicians and FN and non-FN administrators. Sharing circles are similar to focus groups, but emphasize everyone having a turn to speak and demonstrating respect among participants in accordance with FN protocols. Elders will select the questions for discussion based on topics that arose in initial team meetings. Sharing circle discussions will be audio recorded and transcribed. Analysts will include both Western and Indigenous worldview researchers, who will collaboratively interpret findings. Elders will review, discuss, contextualize and expand upon study findings. The research is also guided by FN principles of Ownership, Control, Access, and Possession of FN information. It is through these principles that First Nation research projects can truly be classified as FN lead and driven. Results: Based on initial team meeting discussions, results of sharing circles are expected to provide insights on issues such as: healing, patient-provider communication (verbal and non-verbal), shared decision making, respect for patient preferences, experiences leading to trust or distrust, understandings of wait times and triage, times when multiple (repeat) ED presentations occur, distances travelled for care, choosing specific EDs when seeking care, impacts of stereotypes about FN patients, and racism and reconciliation. Conclusion: Understanding FN ED experience and bringing FN perspectives to Western conceptions of the goals and provision of ED care are important steps toward reconciliation.

Prevalence and characteristics of anti-Indigenous bias among Albertan physicians: a cross-sectional survey and framework analysis

“…Multiple studies report strong implicit preferences among physicians for white people compared with black people; similar to our study, implicit white preference has been measured as higher among white male physicians than female physicians 29. The high prevalence of anti-Indigenous bias measured in our study is supported by literature on the experiences of Indigenous patients; data from Alberta and Ontario suggest that Indigenous people commonly experienced discrimination in emergency departments 5 10 38. While the association between implicit bias and healthcare outcomes varies,31 increasing anti-black bias has been associated with use of more socially dominant language in physician–patient interactions,39 less appropriate pain management40 and diagnostic errors 18…”

“…While several studies examine the experiences of discrimination of Indigenous physicians, trainees14 15 and patients,5 38 there is a single study that measures anti-Indigenous bias among non-Indigenous Canadian physicians, which focuses on medical educators 4. Multiple studies report strong implicit preferences among physicians for white people compared with black people; similar to our study, implicit white preference has been measured as higher among white male physicians than female physicians 29.…”

“…This may be due to social desirability bias, small sample size or non-response bias, as white participants and cisgender men were under-represented among respondents in our survey. These self-reported explicit biases among physicians corroborate government reports,7 news media accounts,8 observational data10 and qualitative evidence5 of interpersonal anti-Indigenous racism in the Canadian healthcare system.…”

“…The effects of interpersonal anti-Indigenous racism among Alberta healthcare workers are seen in the lower triage scores assigned to First Nations patients presenting to emergency rooms with similar complaints as white patients 10. Interpersonal anti-Indigenous racism has been studied from the perspective of those on the receiving end of racism, including Indigenous patients in Alberta5 13 and Canadian university students,15 but there are few studies characterising the attitudes of healthcare workers who perpetuate this discrimination.…”

“…Anti-Indigenous racism in the Canadian healthcare system is alarmingly common. Examples of both interpersonal1 2 and structural3 4 anti-Indigenous racism abound in the medical literature,5 multiple government reports6 7 and news media without significant repercussions or interventions. Anti-Indigenous bias may be explicit and relational, as in the case of Joyce Echaquan, a First Nations woman who was openly mocked by healthcare professionals before her death in hospital,8 or implicit and systemic, as in the case of Lillian Vanasse, a First Nations woman who was assumed to be in methadone withdrawal but died of heart failure in an emergency department 9.…”