Service providers’ perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment

Abstract

Background In Saskatchewan, Canada, Indigenous cancer care services at the municipal, provincial, and federal levels are intended to improve quality care but can result in a complex, fragmented, and multi-jurisdictional health care system. A multi-phase needs assessment project was initiated to document Indigenous cancer care needs. Guided by Indigenous patient partners, clinicians, academics, and policy makers, the present study reflects a needs assessment of Indigenous cancer supports from the perspectives of cancer care service providers. Methods Qualitative data were collected through three focus groups with 20 service providers for cancer patients and their families at three Saskatchewan cities. Participants included chemotherapy and radiation nurses, social workers, a patient navigator, dieticians, and practicum students. A semi-structured interview guide was used to conduct the sessions to allow for freedom of responses. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. Results Service providers’ perspectives were categorized into five themes: 1) addressing travel-related issues, 2) logistical challenges, 3) improvements to Indigenous-specific health care supports, 4) cultural sensitivity in health care, and 5) consistency in care. Supports provided differed for the two Indigenous groups, First Nations and Métis. Service providers made recommendations regarding how needs could be met. They saw language translation providers and Elder supports as important. Recommendations for improving travel were for medical taxis to include breaks so that passengers may alleviate any uncomfortable side effects of their cancer treatment. Further, Indigenous-specific accommodations were recommended for those requiring medical travel. These recommendations aligned with supports that are available in four other Canadian provinces. Conclusions These results identified gaps in supports and outlined recommendations to address barriers to cancer care from the perspectives of service providers. These recommendations may inform evidence-based health system interventions for Indigenous cancer patients and ultimately aim to improve cancer care services, quality of life, and health outcomes of Indigenous patients throughout their cancer journey.

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

“…Two studies 18,19 focused on patient navigation in indigenous populations in Canada. Various barriers to care were reported, including finances, transportation, distance from service providers, language barriers, lack of indigenous representation in the health care system, and lack of culturally safe care, with ongoing perceptions of paternalism in current health care models 18,19 .…”

“…Various barriers to care were reported, including finances, transportation, distance from service providers, language barriers, lack of indigenous representation in the health care system, and lack of culturally safe care, with ongoing perceptions of paternalism in current health care models. 18,19 Furthermore, distance and extended travel times were more than just a risk factor for delayed diagnosis and treatment because they represented a loss of income, extended isolation from community and family, as well as an interruption in the grief process. 18,19 Participants suggested that indigenous navigators could potentially offer better culturally tailored support, linguistically tailored resources, and promote patientprovider trust.…”

“…18,19 Furthermore, distance and extended travel times were more than just a risk factor for delayed diagnosis and treatment because they represented a loss of income, extended isolation from community and family, as well as an interruption in the grief process. 18,19 Participants suggested that indigenous navigators could potentially offer better culturally tailored support, linguistically tailored resources, and promote patientprovider trust.…”

“…Because of several social determinants of health, including lack of health insurance coverage and other financial resources, the disparate outcomes across the cancer continuum may include reduced access to screening and follow‐up of abnormal findings, reduced adherence to treatment regimens, and less favorable outcomes in length of survival and quality of life 14,15 . From an international perspective, indigenous populations of Australia and Canada are also less likely to access cancer screening, 1,6 are diagnosed at a later cancer stage, 16,17 and are less likely to receive cancer treatment compared with their nonindigenous peers for the same primary site, age, and diagnostic periods 16–19 …”

“…14,15 From an international perspective, indigenous populations of Australia and Canada are also less likely to access cancer screening, 1,6 are diagnosed at a later cancer stage, 16,17 and are less likely to receive cancer treatment compared with their nonindigenous peers for the same primary site, age, and diagnostic periods. [16][17][18][19] As cancer care continues to improve, the treatment process for many cancers becomes more complex, with multistep evaluation methods for diagnosing screening abnormalities and cancer symptoms and for multimodal treatment regimens. 8 There is growing recognition that navigating the health care system as a person with cancer or an informal caregiver can be an overwhelming experience, especially for those facing multiple barriers to accessing health care.…”