How clients choises influence cancer care in northern Aboriginal communities

Minore, Bruce; Boone, Margaret; Katt, Mae; Kinch, Peggy; Cromarty, Helen

doi:10.3402/ijch.v63i0.17872

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…Our findings do suggest possible differential use of the health care system by FN and non-FN women in Ontario. System and personal characteristics such as a lack of continuity of care, high health care worker turnover, 28 perceived care options, 29 low awareness of early symptoms, tardiness in seeking medical advice, 24 and a lack of culturally appropriate screening programs 30 have all been identified as barriers to cancer care in an Indigenous context. Health promotion programs may need to better target FN women, in particular those who are not accessing the health care system, to promote increased awareness and participation in screening programs in order to detect cancers when they are small and more curable.…”

Section: Discussionmentioning

confidence: 99%

Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada

Sheppard

Chiarelli

Marrett

et al. 2010

Can J Public Health

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B reast cancer is the most common cancer among women in Ontario, with an estimated 8,700 cases diagnosed in 2009. 1 The age-standardized incidence rate for breast cancer among Ontario women is 102 per 100,000. 1 While this rate has stabilized across the province, that is not the case for all populations within the province. In fact, while still significantly lower than in the general population, the incidence of breast cancer in Ontario's First Nations (FN) people is increasing, 2 and "survival following a diagnosis is significantly worse" (Dr. Loraine Marrett, April 27, 2009). Little research has been conducted investigating cancer patterns of Indigenous populations (including FN, Métis or Inuit populations) in Canada. When examined, lower incidence and mortality rates for Indigenous compared to non-Indigenous populations are found for all cancers combined and for many specific sites. 2-5 Increasingly, there is a growing literature outside of Canada on breast cancer prognosis comparing Indigenous to non-Indigenous populations within the same geographical area. All of these studies found poorer breast cancer survival among the Indigenous populations. 6-15 Some studies comparing the distribution of stage at diagnosis have found the Indigenous populations were more often diagnosed at a later stage than respective non-Indigenous reference groups, 6,9,10,12,14,15 however others have found no difference in the distribution of breast cancer stage. 7,8,13 Since the leading determinant of breast cancer survival is the stage in which cancer is detected, 16,17 it is important to understand this distribution in a population whose incidence is on the rise. 2 The purpose of this study was to compare the distribution of stage at breast cancer diagnosis between FN and non-FN women, and to investigate factors associated with later diagnosis in FN women.

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Section: Discussionmentioning

confidence: 99%

Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada

Sheppard

Chiarelli

Marrett

et al. 2010

Can J Public Health

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“…This is particularly concerning given that cancer stage at diagnosis has a significant impact on treatment options and cancer outcomes, and is an important indicator of the quality of, and access to screening and early detection services [35, 36]. FN people in Canada experience difficulty accessing primary care [37, 38] and diagnostic services [39, 40], which may be contributing to higher rates of stage III and IV diagnoses. Many FN communities are located in rural or remote areas characterized by low population density, poor transportation infrastructure, limited resources for diagnostics and high turnover of healthcare professionals.…”

Section: Discussionmentioning

confidence: 99%

“…Many FN communities are located in rural or remote areas characterized by low population density, poor transportation infrastructure, limited resources for diagnostics and high turnover of healthcare professionals. This results in limited or non-existent access to local healthcare services, poor continuity of care, and compromised quality of care [34, 40–44]. As such, many FN patients must travel to access basic diagnostic services, treatment and supportive care.…”

Section: Discussionmentioning

confidence: 99%

Comparing cancer incidence, stage at diagnosis and outcomes of First Nations and all other Manitobans: a retrospective analysis

et al. 2019

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BackgroundGlobally, epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern. Although historically cancer among First Nations (FN) peoples in Canada was relatively unknown, recent epidemiological evidence reveals a widening of cancer related disparities. However evidence at the population level is limited. The aim of this study was to explore cancer incidence, stage at diagnosis, and outcomes among status FN peoples in comparison with all other Manitobans (AOM).MethodsAll cancers diagnosed between April 1, 2004 and March 31, 2011 were linked with the Indian Registry System and five provincial healthcare databases to compare differences in characteristics, cancer incidence, and stage at diagnosis and mortality of the FN and AOM cohorts. Cox proportional hazard regression models were used to examine mortality.ResultsThe FN cohort was significantly younger, with higher comorbidities than AOM. A higher proportion of FN people were diagnosed with cancer at stages III (18.7% vs. 15.4%) and IV (22.4% vs. 19.9%). Cancer incidence was significantly lower in the FN cohort, however, there were no significant differences between the two cohorts after adjusting for age, sex, income and area of residence. No significant trends in cancer incidence were identified in either cohort over time. Mortality was generally higher in the FN cohort.ConclusionsDespite similar cancer incidence, FN peoples in Manitoba experience poorer survival. The underlying causes of these disparities are not yet understood, particularly in relation to the impact of colonization and other determinants of health.

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“…Most literature exploring concepts relating to SDM, health decisions, and Aboriginal peoples, (internationally referred to as Indigenous peoples b ), concentrates on describing health decision-making [26-28], health equity issues and the role of Indigenous peoples within cancer care [29-31] or advanced care planning [32-34]. Studies have suggested that patient decision aids can improve decision quality and empower immigrant women to make informed decisions based on personal values [35] or have narrowed the gap between racially distinct groups through engaging clients in a process to make decisions about healthcare services [36].…”

Section: Methodsmentioning

confidence: 99%

Shared decision-making and health for First Nations, Métis and Inuit women: a study protocol

Jull

Stacey

Giles

et al. 2012

BMC Med Inform Decis Mak

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BackgroundLittle is known about shared decision-making (SDM) with Métis, First Nations and Inuit women (“Aboriginal women”). SDM is a collaborative process that engages health care professional(s) and the client in making health decisions and is fundamental for informed consent and patient-centred care. The objective of this study is to explore Aboriginal women’s health and social decision-making needs and to engage Aboriginal women in culturally adapting an SDM approach.MethodsUsing participatory research principles and guided by a postcolonial theoretical lens, the proposed mixed methods research will involve three phases. Phase I is an international systematic review of the effectiveness of interventions for Aboriginal peoples’ health decision-making. Developed following dialogue with key stakeholders, proposed methods are guided by the Cochrane handbook and include a comprehensive search, screening by two independent researchers, and synthesis of findings. Phases II and III will be conducted in collaboration with Minwaashin Lodge and engage an urban Aboriginal community of women in an interpretive descriptive qualitative study. In Phase II, 10 to 13 Aboriginal women will be interviewed to explore their health/social decision-making experiences. The interview guide is based on the Ottawa Decision Support Framework and previous decisional needs assessments, and as appropriate may be adapted to findings from the systematic review. Digitally-recorded interviews will be transcribed verbatim and analyzed inductively to identify participant decision-making approaches and needs when making health/social decisions. In Phase III, there will be cultural adaptation of an SDM facilitation tool, the Ottawa Personal Decision Guide, by two focus groups consisting of five to seven Aboriginal women. The culturally adapted guide will undergo usability testing through individual interviews with five to six women who are about to make a health/social decision. Focus groups and individual interviews will be digitally-recorded, transcribed verbatim, and analyzed inductively to identify the adaptation required and usability of the adapted decision guide.DiscussionFindings from this research will produce a culturally sensitive intervention to facilitate SDM within a population of urban Aboriginal women, which can subsequently be evaluated to determine impacts on narrowing health/social decision-making inequities.

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How clients choises influence cancer care in northern Aboriginal communities

Abstract: The study underlines the interdependence between personal choice and the health care system; "bad" experiences with the system cause clients to disengage from care, while client disengagement results in reduced care options.

Cited by 7 publications

References 6 publications

Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada

Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada

Comparing cancer incidence, stage at diagnosis and outcomes of First Nations and all other Manitobans: a retrospective analysis

Shared decision-making and health for First Nations, Métis and Inuit women: a study protocol

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