Providing culturally safe cancer survivorship care with Indigenous communities: study protocol for an integrated knowledge translation study

Abstract

Background Cancer among Indigenous people is increasing faster than overall Canadian rates. Lack of survivorship support, including screening and follow-up for recurrences, contributes to poor health outcomes and low 5-year survival rates. Historical trauma from colonization and lack of culturally safe and responsive healthcare has negatively affected Indigenous peoples’ access to survivorship supports. Nurses are typically the sole practitioners of health services in rural and remote Indigenous communities and can enhance the development, implementation, and delivery of culturally safe survivorship supports. However, the implementation of culturally safe healthcare in Indigenous communities is not well developed. This is the third study in a larger program of research with an overarching goal to improve healthcare delivery and outcomes with Indigenous people in Canada. In this study, we will field test nurses’ implementation of cancer survivorship care with Indigenous people in Ontario, Canada. Methods The study is a descriptive participatory mixed methods research design involving a systematic review, field testing implementation of cancer survivorship supports in two communities, focus groups, and qualitative interviews. Outcomes include feasibility of implementation, acceptability of the strategies, and perceived impact on healing and psychosocial support. Discussion Results will advance knowledge about implementing culturally safe cancer survivorship supports with Indigenous people in Ontario. A toolkit will be developed to inform nursing practices, programs, and policies to improve cancer survivorship supports and strategies with Indigenous people. Findings will inform a large-scale implementation study to reduce healthcare disadvantages and disparities within Indigenous communities across Canada.

The experiences of Indigenous people with cancer in Saskatchewan: a patient-oriented qualitative study using a sharing circle

“…As reported in other studies, 12 spiritual beliefs, being strong for family and knowing Indigenous survivors were important to participants. This research supports other findings that Indigenous patients and families have distinct needs throughout cancer care 26 and survivorship 11,12,29 and amplifies the need for culturally safe practices among service providers. 29 There is much yet to be learned about the complex connections between trust and world view and how they affect the decision-making of Indigenous patients with cancer.…”

“…known about the experiences of Indigenous patients with cancer is limited to epidemiological studies 7 or focused on spirituality. 11,12 Past research does not necessarily provide insight into how to improve their experiences. Although access issues have been identified as obstacles in some provinces, 13 little is known about how Indigenous patients with cancer encounter the health care system in Saskatchewan, Canada.…”

“…14 Reciprocal respect, perception of world view acceptance and culturally appropriate knowledge translation influence level of trust. 11 Indigenous patients often hold different world views from those of providers and the health care system. 15 Building on our literature-derived theory of shared decision-making for Indigenous patients, 14 our study explores the perceptions and experiences of Indigen ous patients with cancer and their families to understand how trust and world view influence their cancer care decisions.…”

The Two Great Healing Traditions: Issues, Opportunities, and Recommendations for an Integrated First Nations Healthcare System in Canada

“…Where this is not feasible for any reason, healthcare systems directors, managers and other decision makers could recruiting FN healthcare practitioners in Indigenous healthcare contexts precisely because they have shared cultural knowledge or backgrounds and may be the closest option to ensure culturally sensitive care. [65][66][67][68] Lack of funding is identified to be a barrier in accessing traditional healthcare options, especially when the traditional medicines or healers are not available in the community and patients have to travel to access the care elsewhere. Some patients may not be able to afford associated costs such as transportation, accommodation, meals and payments or gifts for the practitioners.…”

Interventions to improve cancer survivorship among Indigenous Peoples and communities: a systematic review with a narrative synthesis

“…Cancer survivorship interventions that have been used by Indigenous Peoples have not been systematically described, particularly their relevance to Indigenous communities and Indigenous wellness. As part of a larger study to improve healthcare deliver with Indigenous Peoples in Canada [28], the purpose of this systematic review was to synthesize the research evidence on cancer survivorship strategies that have been used by Indigenous Peoples. The research objectives are to:…”