Putting Policy into Practice: How Three Cancer Services Perform against Indigenous Health and Cancer Frameworks

Abstract

Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.

Barriers and facilitators to adherence to Optimal Care Pathways for diagnosis and treatment of cancer for Aboriginal and Torres Strait Islander people

“…A major barrier to integrated, quality OCP-adherent cancer care was cumbersome referral processes to and communication from specialists and hospitals, supporting the finding by de Witt et al (2022) in Queensland and the findings by Taylor et al (2022) in Western Australia. Electronic referral and receipting systems, triage systems and electronic communication of discharge summaries and cancer care plans back to primary care, are technically possible, yet not implemented for many services.…”

“…A key barrier identified in this study was poor communication from hospital settings. Taylor et al (2022) conducted interviews with service providers and consumers in Western Australia, finding that prevention and diagnosis components of OCPs were not seen as priorities in tertiary care centres and noted the need to reduce barriers to tertiary care.…”

“A Huge Gap”: Health Care Provider Perspectives on Cancer Screening for Aboriginal and Torres Strait Islander People in the Northern Territory

“…The views of the PHC providers aligned with the perceptions of screening by hospital staff. However, there was minimal data about screening from regional hospital and cancer centre staff, possibly reflecting that prevention and early detection are not considered a core part of the role of tertiary health service staff [33].…”