Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study

Abstract

Purpose To investigate the successful strategies of health workers who support and regularly communicate with Aboriginal and Torres Strait Islander people about cancer and its treatment. Methods Semi-structured interviews were conducted face-to face or via telephone and audio-recorded with twenty-three health professionals (medical and radiation oncologists, oncology nurses and Aboriginal Health Workers), 5 identifying as Aboriginal or Torres Strait Islander in the Northern Territory and South Australia. When data saturation was reached, thematic analysis using a bottom up, essentialist/realist approach was used. Results Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves considering the physical environment and allowing time in interviews to establish a relationship. (2) Employ specific communication strategies to explain cancer, treatment and its side effects through language choices and employing visual aids such as drawings, metaphors and relatable analogies. (3) Obtain support from Aboriginal and Torres Strait Islander staff and patient escorts who can assist in communication. ( 4) Consider culture which involves collective decision making, strong connection to country and community, with cultural obligations and a unique understanding of cancer. ( 5) Anticipate the contextual complexities of conflicts between Western medicine and Aboriginal culture, practitioner bias and difficulty maintaining contact with patients. (6) Develop personal qualities of good communicators, including being patient-centred, showing respect, patience, empathy and honesty. Conclusion These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal and Torres Strait Islander people with cancer.

Partnering with support persons and clinicians to improve the health care experiences of patients with cirrhosis

“…pictures, models of the liver that can be pulled apart) was seen to be beneficial in the provision of cirrhosis information and care. In other settings, the use of culturally appropriate language and visual aids were identified as key to improving communication and patients’ health literacy among Indigenous patients with viral hepatitis, cancer and dementia (Bryant et al, 2021; Davies et al, 2014; Olver et al, 2021).…”

“…Communication between Indigenous patients and health professionals has been identified as a potential impediment to good health outcomes in other chronic disease settings such as cancer (Olver et al, 2021; Shahid et al, 2013). While many participants included in this study recounted positive interactions with the health system, others described negative experiences where attention was needed to improve health professionals’ language, communication style, and use of medical terminology.…”

PENS approach for breaking bad news in the oncology outpatient setting: a real-world report

“…In the long run, this workplace distress may lead to burnout of oncologists [ 23 ]. Each patient and situation is distinct, and BBN requires dynamic assessment of the problem and contextual adaptation of the available communication protocols [ 12 ]. A brief and pragmatic approach like PENS may be acceptable to most oncologists.…”

“…However, the pattern of care and the patient profile is heterogeneous in different countries and even within the same country. Hence, it is essential to adapt the protocols and develop locally suitable protocols for the common problems faced in daily clinical practice [11,12,21,43,44]. PENS, an abbreviated approach to BBN, is one such protocol specially designed for use in the Indian OP setting.…”

“…The Indian family system is collectivistic, with primarily joint families, compared to the individualistic approach from the West [5]. Cancer patients differ in their outlook and preference regarding receiving information about their illness, requiring distinct communication models in different parts of the world [6][7][8][9][10][11][12]. The ethical principles of medicine and patient autonomy require the patient to know the diagnosis and play a role in the decision-making [13].…”