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NAIDOC Week - Spotlight on collaboration

Chris_McNamara
Community Manager
Community Manager
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NAIDOC Week: Spotlight on collaborative care

In observing NAIDOC Week, (4-11th July 2021), it seems fitting as a point of departure to acknowledge the impediments Indigenous Australians may encounter in engaging with treatment and receiving optimal health care in general (and cancer care in particular). Some of these factors include: difficulties communicating with health professionals; a lack of patient navigators; lower health literacy; lack of access to support from an Indigenous care provider; logistical barriers; and inadequate linkages with primary care. Respect for individual patients and their cultural perspectives have also been identified as key drivers of Indigenous patients’ engagement with treatment1.

Within this context, in comparison with non-Indigenous men, reported prostate cancer incidence rates for Indigenous Australian men appear to be lower, possibly due to lower uptake of PSA testing. Limited research suggests that post diagnosis survival is poorer for Indigenous men, which could possibly be attributable to differences in the timing of diagnosis and access to prostate cancer treatment between Indigenous and non-Indigenous men. In a study focusing on Indigenous Australian men resident in NSW, 33% of Indigenous men diagnosed with localised prostate cancer received neither surgery nor radiotherapy early in the disease course2. Researchers also found that Indigenous men had more aggressive disease at diagnosis (average PSA 10.9ng/ml) putting them at a higher risk of mortality. This study was however limited by its small sample size. Hall et al from the University of Western Australia reinforce the findings of the above study, showing that Indigenous men had lower rates of prostatectomy than non-Indigenous men3.

Those men who do undergo treatment may have unmet needs such as financial concerns, dealing with sadness and maintaining a strong spirit, which differs to the needs of non-Indigenous Australians. General surgeon Phillip Carson from the Royal Darwin Hospital says the experience of Indigenous peoples in secondary and tertiary health facilities can also be characterised by intimidation and alienation4. On the positive side it was inferred that living in rural areas offers close‐knit community support, positive cultural experiences, and a sense of greater autonomy in daily life which perhaps helped Indigenous cancer patients feel more supported and with less needs5.

In light of the above findings, it would appear that policy responses at all levels of government to improve the health of Indigenous Australian males could therefore benefit from a holistic and decolonised approach, without which, illness and reduced health outcomes will remain pervasive. Further, applying these aspects to the bio-medical model will improve the health of Indigenous Australian males. Despite evidence of this success, there is a lack of specifically allocated funding for the group with the worst health outcomes in Australia. By providing specific funding to progress the issue, Indigenous Australian men will have the means to improve their health. Further research needs to be undertaken, with a greater emphasis on preventative health measures, adequate specific funding, culturally and gender appropriate responses to health, and government policy development and implementation covering Indigenous Australian male health6.

The National Aboriginal and Torres Strait Islander Male Health Framework was developed by consulting leaders in this area7.

The framework has 11 guiding principles that were developed by the National Aboriginal and Torres Strait Islander Male Health Leadership Group. These principles have been devised to help inform governments, service providers and other bodies and individuals to improve Indigenous Australian male health. These 11 principles are: - reconstructing male empowerment and self-determination; - a holistic approach; - continuity of care; - shared, integrated, collaborative and responsible processes; - partnership approach; - strategy and policy development; - access and support; - the health workforce; - the evidence base; - allocation of funding; and - governance.

The 11 guiding principles present a strong foundation to consider when developing policies, strategies, programmes or other means of improving Indigenous Australian male health.

The poor health outcomes outlined above are acknowledged in federal government policies, but no clear plan of improvement has been discussed. Several models of male intervention to improve health outcomes have been identified, including men’s groups, men’s sheds, men’s health camps, fathering groups and mentoring programs6.

Indigenous men’s groups have existed at a local level for many years. These groups attempt to work with Indigenous men to address the many issues facing them and their families8. They have many common principles and aims: empowerment, social and emotional support, sharing culture, yarning and being a culturally safe space9. Mens’s sheds provide a useful and practical model for Indigenous Australian men’s health promotion, prevention programs, informal counselling, cultural connections, relationship building and teamwork10.

Numerous studies (including McCoy et al) have found that having male Indigenous health workers and clinical staff encourages Indigenous men to visit and feel comfortable discussing health issues11. Other initiatives identified by Taylor et al include offering outdoor consultations, providing a shorter treatment program, providing access to clinical staff of the appropriate gender and grouping Indigenous patient appointments together12. Patient accessibility to treatment can also be facilitated by providing telemedicine or outreach services and by improving accommodation and transport.

It is essential that training programs ensure health staff understand the importance of acknowledging and working with local cultural protocols, that they cover the wide range of beliefs that Indigenous people have around cancer, emphasise differences in communication styles, focus on the need for person-centred care, and encourage the involvement of the patient’s family where appropriate. Involving local Elders and/or Indigenous health professionals in developing and/or delivering training programs is recommended. Within this framework, non-Indigenous health care providers must understand their shared responsibility in ensuring that Indigenous patients and families feel culturally safe and welcome.

To this end, a welcome innovation is the Cancer Data and Aboriginal Disparities (CanDAD) project, which will develop and test an integrated, comprehensive cancer monitoring and surveillance system for Indigenous people in South Australia, which is likely to have relevance to other regions13. This Advanced Cancer Data System (ACaDs) will be developed explicitly

with Indigenous people, to identify prevention strategies and improve the quality of cancer care provided to Indigenous people.

In Australia, the National Aboriginal and Torres Strait Islander Cancer Framework has identified that “culturally safe services and a culturally competent workforce . . . are core requirements for improving cancer outcomes”, highlighting the essential role that cancer service providers have in encouraging and maintaining Indigenous Australians’ attendance at cancer services to gain the benefits of modern cancer treatments14.

According to Canuto et al’s study Indigenous Australian men’s decision to access/choose a primary health care service to attend were: convenience; the perceived quality of the service; feeling culturally safe; and rapport with the health staff and service15. Factors that foster cultural safety include cross-cultural/cultural competency training, employing Indigenous staff and gender specific staff and services.

This research also found some men are not disclosing or discussing all their health concerns due to feeling uncomfortable or shameful about their condition, feeling culturally unsafe, fearing the unknown, or that they will receive bad news. Lack of transport can be a limiting factor, therefore providing transport may increase access. Primary health centres could also do more to promote their services so that men know where they are and what services they provide. Participants in this study also felt that they needed to have access to more information about when to go to the doctors for check-ups. Many men in the study supported the idea of gender specific services and/or times when a clinic is opened for men only and is staffed by men.

Surgeons can make a difference here by both personal example in their treatment of Indigenous patients and through advocacy and support for institutional initiatives to create a culturally safe and welcoming environment. Increasing the number of Indigenous health workers, including doctors and surgeons will also contribute to this end. The Royal Australasian College of Surgeons via the Indigenous Health Committee is currently developing a comprehensive plan to address the recruitment, training, and support of Indigenous surgeons in Australia and New Zealand4. Finally, finding innovative ways of providing high-level prostate cancer services through smaller, less specialised facilities will provide dividends for those men living in remote and rural locations where Indigenous Australian men are over-represented. This includes but involves more than, outreach services from specialised centres. Collaboration, integration with and support for the local, less specialised workforce is likely to increase the safety, range, and accessibility of prostate cancer services.

References:
1. Green M, Andersen K, Griffiths K, Garvey Gail, Cunningham J. Understanding Indigenous Australians’ experiences of cancer care: stakeholders’ views on what to measure and how to measure it. BMC Health Serv. Res. 2018. 18(982).
2. Rodger JC et al. Prostate cancer mortality outcomes and patterns of primary treatment for Aboriginal men in New South Wales, Australia. BJU Int 2015; 115(s5); 16-23.
3. Hall SE, Bulsara CE, Bulsara MK et al. Treatment patterns for cancer in Western Australia: does being Indigenous make a difference? Med J Aust2004; 181: 191–4
4. Carson PJ. Survival after the diagnosis of prostate cancer for Australian Aboriginal and Maori men. BJU Int 2015; 115, s5, 14–15.
5. Bernardes CM, Beesley V, Martin J, et al. Unmet supportive care needs among people with cancer: A cross‐cultural comparison between Indigenous and Non‐Indigenous Australians. Eur J Cancer Care. 2019;28:e13080.
6. Prehn J, Douglas E. Decolonising the health and well-being of Aboriginal men in Australia. Journal of sociology 2020. 56(2) 151-166.
7. Australian Department of Health and Ageing (2010a) National Aboriginal and Torres Strait Islander Male Health Framework: Revised Guiding Principles. Canberra: Australian Department of Health and Ageing.
8. Wenitong M. Aboriginal and Torres Strait Islander male health, wellbeing and leadership. MJA 2006. 185 (8): 466-7.
9. Arney, F.M. and M. Westby (2012) Men’s Places: Literature Review. Darwin: Menzies School of Health Research.
10. Sergeant, P. (2010) Men’s Sheds – A Catalyst for Indigenous Men’s Health. Canberra: Men’s Sheds Australia
11. McCoy, B.F. (2008) Holding Men: Kanyirninpa and the Health of Aboriginal Men. Canberra: Aboriginal Studies Press.
12. Taylor EV, Haigh MM, Shahid S, Garvey G, Cunnigham J, Thompson SC. Cancer services and their initiatives to improve the care of indigenous Australians. Int. J. Environ. Res. Public Health 2018. 15(717)
13. Yerrell PH, Roder D, Cargo M, et al. Cancer Data and Aboriginal Disparities (CanDAD)—developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol. BMJ Open 2016;6:e012505. doi:10.1136/bmjopen-2016-012505.
14. Cancer Australia. National Aboriginal and Torres Strait Islander Cancer Framework. Available online: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/nationalabor....
15. Canuto K, Wittert G, Harfield S, Brown A. “I feel more comfortable speaking to a male”: Aboriginal and Torres Strait Islander men’s discourse on utilizing primary health care services. Int J Equity Health 2018. 17(185).

 

About the Author

Kalli Spencer
MBBCh, FC Urol (SA), MMed (Urol), Dip.Couns (AIPC)

Kalli is an internationally renowned Urological Surgeon, specialising in oncology and robotic surgery. He trained and worked in South Africa, before relocating to Australia where he has worked at Macquarie University Hospital and Westmead Hospital. His passion for what he does extends beyond the operating room, through public health advocacy, education and community awareness of men’s health, cancer and sexuality.

Kalli has been involved with the Prostate Cancer Foundation of Australia for many years, advocating for improved cancer care and facilitating community prostate cancer support groups.

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ATSI Resources:

The PCFA has many resources including prostate cancer educational flipcharts designed in consultation with Aboriginal & Torres Strait Islander men located HERE. These resources are designed to be accessible on most tech devices to increase access and engagement within these communities.

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