Abstract
BackgroundPoorer cancer outcomes of Indigenous Australians in Australia’s Northern Territory (NT) compared with their non-Indigenous counterparts are partially due to diminished access to cancer treatment services (CTS). Accessibility of health care is a multidimensional construct, including physical, logistical, psychosocial and cultural dimensions. While previous research has identified specific areas of reduced access to CTS for Indigenous Australians, the higher burden of cancer borne by Indigenous Australians warrants a more comprehensive understanding of access to CTS in the NT. The purpose of this study was to explore and map the accessibility of CTS for Indigenous Australians in the NT and to identify key access barriers.MethodsThis predominantly qualitative study, complemented by a descriptive quantitative component, explored and mapped the accessibility of one CTS (CTS-NT) that services a large number of Indigenous Australians in the NT. Patient perspectives were obtained via secondary analysis of data from 75 face-to-face interviews with Indigenous Australian adults attending the CTS-NT. Care provider perspectives were obtained via primary analysis of data from 29 face-to-face interviews with care providers and staff working at CTS-NT. Data were analysed to identify issues of accessibility informed by Leveque and colleagues’ conceptual framework of access to health care, which comprises five dimensions of accessibility of the health service and the ability of Indigenous patients to interact with these dimensions to generate access. Applied thematic analysis was conducted on the qualitative data and descriptive analysis was conducted on the quantitative data.ResultsThe analysis of the patient and care provider reports identified multiple access barriers across all dimensions including: inadequate preparation of Indigenous patients for treatment; delayed and complicated commencement of treatment; dislocation from home; competing priorities; scarcity of Indigenous care providers and staff; lack of culturally-relevant care; challenges associated with language, accommodation, transport and finance; and disjointed and fraught relationships with care providers. These barriers posed significant challenges to Indigenous patients maintaining their engagement with treatment.ConclusionsThis study provides a valuable snapshot of the barriers facing this population across the dimensions of health care access. Urgent action in addressing these issues is required at individual, service and state levels.
Highlights
Poorer cancer outcomes of Indigenous Australians in Australia’s Northern Territory (NT) compared with their non-Indigenous counterparts are partially due to diminished access to cancer treatment services (CTS)
Participants were asked closed and open-ended questions relating to their experiences of and views regarding access to CTS-NT [see Appendix 1 – Questions asked of patients included in this analysis] and this information was recorded by the interviewer on the data collection form, who was an employee of the cancer care centre and, for the interviews, employed by the project as a researcher officer
The majority of Indigenous patients were diagnosed with cancer within six months prior to the interview date (60%) and the most common cancer types were: breast cancer (23%), digestive system cancers (19%), head and neck cancer s (19%), and lung and other respiratory system cancers (17%)
Summary
Poorer cancer outcomes of Indigenous Australians in Australia’s Northern Territory (NT) compared with their non-Indigenous counterparts are partially due to diminished access to cancer treatment services (CTS). While previous research has identified specific areas of reduced access to CTS for Indigenous Australians, the higher burden of cancer borne by Indigenous Australians warrants a more comprehensive understanding of access to CTS in the NT. The burden of cancer for people living in the NT is substantial, with a higher overall cancer mortality rate than any other Australian jurisdiction [2,3,4]. Within the NT, the mortality rate for all cancers combined was significantly higher for Indigenous Territorians compared to non-Indigenous Territorians (340 deaths and 184 per 100,000 respectively) [5]. Indigenous Australians are less likely to access cancer screening [8]; have relatively fewer cancer-related hospitalisations [9]; are diagnosed at a later cancer stages [3, 9, 10]; and are less likely to receive cancer treatment compared to other Australians for the same primary site, age and diagnostic periods [11, 12]
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