What Is the Evidence Globally for Culturally Safe Strategies to Improve Breast Cancer Outcomes for Indigenous Women in High Income Countries? A Systematic Review

Abstract

The aim was to systematically assess the evidence on whether cultural safety affects breast cancer outcomes with regards to care for Indigenous women in high income countries. We conducted a systematic review in accordance with PRISMA guidelines of peer-reviewed articles in Medline, EMBASE, CINAHL, Scopus, Web of Science, Proquest Sociology and Informit Rural health database and Indigenous collection databases. Key inclusion criteria were: adult female patients with breast cancer; high income country setting; outcome measure, including screening, diagnosis, treatment and follow up care. A total of 15 were selected. We developed a Community Engagement assessment tool in consultation with aboriginal researchers, based on the National Health and Medical Research Councils’ community engagement guidelines, against which studies were appraised. This novel element allowed us to evaluate the literature from a new and highly relevant perspective. Thematic analysis of all 15 studies was also undertaken. Despite limited literature there are evidence-based strategies that are likely to improve outcomes for Indigenous women with breast cancer in high income countries and indicate that culture makes a positive difference. It is also clear that strong Indigenous community leadership and governance at all stages of the research including design is an imperative for feasibility.

“Everyone needs a Deb”: what Australian Indigenous women say about breast cancer screening and treatment services

“…Cultural safety can be experienced via physical surrounds, Indigenous support and sta ng, being in a group of Indigenous women only or being treated by someone with whom you have developed trust over a period of time. There is a growing body of literature about the ways health services can build and sustain cultural safety including through explicit welcome such signs of welcome and Aboriginal and Torres Strait Islander ags in the foyer; zero tolerance of racism; cultural safety training for all staff; employment of Indigenous staff at all levels of the organisation; and engagement with local Elders for advice and trust building (9,21,22). One service provider talked of "the most enormous, beautiful Indigenous artwork about women coming together, supporting each other.…”

“…The need for improved screening, diagnostic and care pathways for Indigenous women in Australia is well established in the literature (8)(9)(10)(11). The research over the past 20 plus years recognises a variety of barriers and enablers in accordance with more effective breast cancer screening and care for Indigenous women (11)(12)(13)(14)(15)(16)(17)(18)(19).…”

“…The voices of Indigenous women is largely absent in the literature (9). While there has been a body of research into the system and why the statistics are not changing, there are only two other studies about the perspectives of Indigenous women about breast cancer screening and treatment in Australia (14,18).…”

Improving breast cancer outcomes for Aboriginal women: a mixed-methods study protocol

“… 11 It is well established in the literature that this association likely contributes to difficulty in engaging Aboriginal women in regular and timely follow-up monitoring and care. 12 …”

“…While age is the greatest risk factor for breast cancer, Aboriginal women are more likely to be younger than non-Aboriginal women at the time of diagnosis10 and receive more invasive surgical treatment compared with their non-Aboriginal counterparts 11. It is well established in the literature that this association likely contributes to difficulty in engaging Aboriginal women in regular and timely follow-up monitoring and care 12…”