Routine screening of Indigenous cancer patients’ unmet support needs: a qualitative study of patient and clinician attitudes

Abstract

BackgroundIndigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care.MethodsForty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed.ResultsIndigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff.ConclusionsStaff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.

What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence

“…In contrast, Basch et al [27] reported that clinicians thought that patients overstated their symptoms, or believed patients had difficulty distinguishing between the levels of severity [56]. On this theme, other studies reported that HPs wanted what they considered to be more objective, valid and reliable information about symptoms [32,38].…”

“…Distress or embarrassment may also be experienced by staff administering the PROMs [30,33]. Only one study explored PROMs designed for Indigenous patients [56]; it highlighted the additional dimension of cultural sensitivity in the use of PROMs and professionals reported that the purpose-designed tool helped them to better connect with Indigenous patients [56].…”

Why validation is not enough: setting the scene for the implementation of the Kimberley Mum´s Mood Scale

“…Consistent with tool development within the wider population, briefness remains highly valued in the development of Aboriginal specific screening tools (25,26,43). The screening tools have also generally maintained a closed system approach to screening (21,22,(44)(45)(46)(47).…”

“…User acceptability lends itself to a methodological approach of phenomenology (18,26,31,32). We sought to understand the construction of narratives, experiences and perceptions (33) of health professionals as they relate to the KMMS via semi structured interviews and on line surveys.…”

“…This includes studies that are examining the validity of 'mainstream' screening tools with Aboriginal populations (18,19); adaptation studies which validate an 'Aboriginal version' of an existing tool (17,20,21); and the development and validation of new Aboriginal specific screening tools (22)(23)(24). These and other emerging endeavours Several studies detailing the development and validation of Aboriginal specific screening tools have been published (17,19,(21)(22)(23)(24)(25), few studies however, report on the process and outcomes of clinical implementation (26,27). Without this lens of enquiry it is impossible to understand if the overall objective for developing Aboriginal specific screening tools, namely health equity, is achieved.…”