Satisfaction with cancer care among American Indian and Alaska Natives in Oregon and Washington State: a qualitative study of survivor and caregiver perspectives

Abstract

Purpose To better understand satisfaction with care among American Indian and Alaska Native (AI/AN) persons with cancer, we explored dimensions of the provider relationship that contributed to satisfaction among caregivers and survivors who received cancer treatment in Oregon and Washington State. Methods Between November 2011 and April 2013, the project team interviewed 11 caregivers and 71 AI/AN cancer survivors residing in Oregon and Washington State. Interview questions aimed to elicit participant experiences with care providers and factors associated with cancer care satisfaction. Interviews were analyzed using an inductive content analysis approach in which concepts were identified and themes derived from interview data. Results Three overarching themes, each with two sub-themes, emerged from the data: (1) universal factors: bolstering understanding, involvement, and empathy in care; (2) minority-specific factors: incorporating culture and community into care; and (3) AI/AN-unique factors: interacting with Indian health clinics and Indian Health Service (IHS). Conclusions The results of our study suggest that satisfaction with care among survivors and their caregivers must be examined within the context of culture and community, particularly among minority patients. Our study demonstrates providers’ critical role in ensuring AI/AN patients emerge satisfied with cancer treatment by honoring their AI/AN-specific needs, such as respect for integration of traditional healing modalities and navigation of specialty care coordination.

Traditional and Complementary Medicine Use Among Indigenous Cancer Patients in Australia, Canada, New Zealand, and the United States: A Systematic Review

“…The 21 articles represented 18 individual studies: 3 were conducted in Australia, 25 - 29 4 in Canada, 30 - 33 3 in New Zealand, 34 - 36 and 8 in the United States. 37 - 45 Most were qualitative, 26 - 33 , 35 - 42 , 44 , 45 (n = 15, 83%), including 2 case studies, 32 , 38 and all 3 quantitative studies were cross-sectional. 25 , 34 , 43 All quantitative studies assessed TM as a subset of CM, where the qualitative studies differed in their focus, with 10 (75%) exclusively examining TM and/or TM healers; 2 from Australia, 4 from the United States, 3 from Canada, and 1 from New Zealand.…”

“…Fifteen qualitative studies were conducted: 2 Australian, 26 - 29 4 Canadian, 30 - 33 2 New Zealand, 35 , 36 and 7 United States studies. 37 - 42 , 44 , 45 Following meta-aggregation, thematic analysis revealed 4 broad themes: ( a ) perceived efficacy and benefits of T&CM, ( b ) integrating T&CM with conventional treatments, ( c ) T&CM use as connection to culture, and ( d ) impact of health professionals’ views of T&CM ( Table 4 ).…”

“…The terms used to describe efficacy and benefits of T&CM are often ambiguous, such as believing in it , 40 healing , 30 , 33 , 40 , 45 and protection . 41 Three studies reported patients’ belief in T&CM as a cancer treatment, 35 , 44 , 45 with 2 studies reporting patients’ belief that efficacy depends on the strength of their confidence in T&CM. 28 , 29 The reported benefits of T&CM included: helping to cope; stress relief; cleansing and strengthening the body; increasing strength, energy, healing and recovery; and improving well-being.…”

“… 28 , 29 The reported benefits of T&CM included: helping to cope; stress relief; cleansing and strengthening the body; increasing strength, energy, healing and recovery; and improving well-being. 26 - 29 , 33 , 38 , 40 , 41 , 44 , 45 . .…”

“…When conventional healthcare providers respected and had knowledge of TM, Indigenous patients’ satisfaction reportedly increased, 28 , 39 , 41 and they had confidence and trust in conventional medical services. 28 , 39 Participants who used CM and/or TM were reportedly more actively engaged in their treatment plans.…”