Sharing the true stories: improving communication between Aboriginal patients and healthcare workers

Abstract

Objectives: To identify factors limiting the effectiveness of communication between Aboriginal patients with end‐stage renal disease and healthcare workers, and to identify strategies for improving communication. Design: Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in‐depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication. Setting: A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001. Participants: Aboriginal patients from the Yolngu language group of north‐east Arnhem Land and their medical, nursing and allied professional carers. Main outcome measures: Factors influencing the quality of communication. Results: A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters. Conclusions: Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.

Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients

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End-stage kidney disease among indigenous peoples of Australia and New Zealand

“…10 Communication issues are important in many settings, with empiric evidence suggesting problems in sharing a mutual understanding during nephrological consultations. 11 …”

Māori patients' experiences and perspectives of chronic kidney disease: a New Zealand qualitative interview study

“…Inequities in provision of preventative care, delayed specialist referral and lower life expectancy among indigenous peoples have been extensively quantified and explored using epidemiological methods, but remain incompletely explained by conventional individual and community risk factors for worse health outcomes, including socioeconomic opportunity and comorbidity 11. Previous international research has highlighted specific issues for indigenous groups in chronic kidney disease (CKD) such as providing culturally competent care,12 13 the need for flexible family-focused care, managing patient fear of mainstream services12 and miscommunication;14 however, these issues have not been explored among Māori patients with CKD. This study aims to describe Māori patients' beliefs and experiences of CKD which may elucidate additional contextual, social and organisational factors that contribute to the persistent inequities in health outcomes among Māori with CKD.…”