The significance of relational continuity of care for Māori patient engagement with predominantly non‐Māori doctors: findings from a qualitative study

Reid, Jennifer; Cormack, Donna; Crowe, Marie

doi:10.1111/1753-6405.12447

Cited by 13 publications

(24 citation statements)

References 27 publications

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“…Contributing factors to general practitioner (GP) related delay were a lack of clinical examinations and the non-specific presentation of CRC symptoms. Recent research with Māori communities has indicated continuity of care with a trusted GP is needed for general practice to engage better with Māori patients [8].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

et al. 2020

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Background New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. Methods Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). Results Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. Conclusions The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

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Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

et al. 2020

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“…Patients may delay presenting to a GP if there are access barriers, and also if their experience or expectation is that the practitioner will only arrange investigations or referrals with difficulty or with reluctance (Maclean et al, 2015). Access to a familiar doctor is important for Maori (Reid, Cormack, & Crowe, 2016). Thus, limitations of the GPs access to investigations and specialist referral may impact indirectly on the patients' willingness to seek help.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership

et al. 2017

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A national internet-based survey of New Zealand (NZ) primary care physicians (n = 192) used the survey instrument developed by the International Cancer Benchmarking Partnership (ICBP). Practitioners were recruited by a range of methods assisted by NZ general practice networks and contacts. Compared to 11 other ICBP jurisdictions, direct access to diagnostic tests was more limited and took more time than in most other areas; the average wait for a test to be done and reported was 3.0 weeks for X-rays and 8.0 for ultrasound, compared to ICBP averages of 1.6 and 4.7 weeks respectively. Forty-five per cent of respondents could get specialist advice within 48 hr. Sixty-six per cent were aware of NZ guidelines for cancer in primary care, and of those 44% consulted them sometimes or often. Access to tests was greater, and time required much less, in the private than the public care system. NZ respondents each answered two of five clinical vignettes, with results similar to other ICBP areas. The survey also included general practice trainees (N = 42); their results were similar to the main group. The results suggest that improvements in prompt access to diagnostic tests and referrals for suspected cancer need to be given priority in NZ.

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“…Health practitioners need to understand and acknowledge these considerations if they are to facilitate and improve health care access for M aori. Recent research with M aori patients in primary care has indicated continuity of care with a trusted GP is an important determinant of access to care and is needed if M aori patients are to engage with general practice (Reid et al 2015). Other influences include the fact that M aori are more likely to live outside main urban areas and are more likely to have to travel for cancer care, so have greater physical barriers to accessing health care.…”

Section: Opportunities For Equitymentioning

confidence: 99%

Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand

et al. 2016

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Māori women have one of the highest incidences of breast cancer in the world. This high incidence is generally unexplained although higher rates of obesity and alcohol intake are modifiable risk factors that may be important. Māori women are less likely to attend mammographic breast screening and are likely to be diagnosed with more advanced disease. This is one of the reasons for the excess mortality. Another factor is differences in the treatment pathway. Māori women are more likely to experience delay in receiving treatment, are less likely to receive radiotherapy, are more likely to be treated with a mastectomy and are less likely to adhere to long-term adjuvant endocrine therapy. However, genetic factors in Māori women do not seem to impact significantly on mortality. This review looks at the inequity between Māori and non-Māori women and addresses the causes. It proposes ways of reducing inequity through primary prevention, increased participation in breast screening and greater standardisation of the treatment pathway for women newly diagnosed with breast cancer. We believe that health system improvements will decrease barriers to health care participation for Māori women and suggest that further research into identifying and modifying obstacles within health systems is required.

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The significance of relational continuity of care for Māori patient engagement with predominantly non‐Māori doctors: findings from a qualitative study

Cited by 13 publications

References 27 publications

Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership

Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand

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