Indigenous Patient Research Articles

Exploring Genetic Counselors' Experiences with Indigenous Patient Populations.

This study investigates the preparedness of genetic counselors in addressing the potentially unique elements and considerations of Indigenous patients in the United States and Canada. Considering the healthcare disparities Indigenous populations face, particularly in specialty care, this study aims to assess the preparedness of genetic counselors in addressing the unique needs and cultural considerations of Indigenous patients. An online survey was utilized, and a subset of participants was selected to be interviewed. Results reveal genetic counselors felt less competent with Indigenous patients compared to non-Indigenous patients, especially in specific aspects of genetic counseling such as responding to cultural issues or identifying resources. Factors such as increased years of experience and more exposure to Indigenous populations during graduate training correlated with higher self-rated competency. Despite a patient population that is on average 7% Indigenous by self-report, genetic counselors lacked exposure to Indigenous encounters in graduate programs and professional training. These findings underscore the importance of enhancing genetic counseling education and exposure to Indigenous training opportunities such as voluntary events or Indigenous guest speakers to improve cultural competency and address healthcare disparities for Indigenous communities.

“My feelings and my thoughts are my lived experience, not the numbers they show me on a piece of paper”: Indigenous experiences of liver transplantation in British Columbia, Canada

ABSTRACT Indigenous Peoples in Canada face healthcare inequities impacting access to solid organ transplantation. The experiences of Indigenous patients during the liver transplant process, and how transplant professionals perceive challenges faced by Indigenous Peoples, has not been studied. Thirteen semi-structured qualitative interviews were conducted via telehealth with Indigenous liver transplant patients (n = 7) and transplant care providers (n = 6) across British Columbia, Canada between April 2021—May 2022. Themes were identified to inform clinical approaches and transplant care planning and validated by Indigenous health experts. Among patient participants: transplants occurred between 1992–2020; all were women; and the mean age at the time of interview was 60 years. Among transplant care provider participants: roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: Indigenous strengths and resources, systemic and structural barriers, and inconsistent care and cultural safety across health professions impact Indigenous patient care during liver transplantation. This study contributes insights into systemic barriers and Indigenous resilience in the liver transplant journey. Dismantling structural barriers to early linkage to care is needed, and training for transplant clinicians on Indigenous histories, cultural protocols, and cultural safety is strongly recommended.

Exploring medical students’ experiences with indigenous patient care: a phenomenological study

ABSTRACT Background Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. Method Phenomenology was used, guided by Goffman’s theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants’ experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. Results Four main themes emerged from students’ descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students’ clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. Conclusions In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.

"Somebody That can Meet you on Your Level:" Cancer Survivors' Perspectives on the Role of Indigenous Patient Navigators in Cancer Care.

Cancer incidence has increased for First Nations and Métis Peoples in Canada over recent years. Despite a growing cancer burden, there remain challenges to accessing culturally appropriate and quality care in Saskatchewan. The study aimed to explore, from cancer survivors' perspectives, the potential of Indigenous patient navigators to enhance the healthcare experiences of First Nations and Métis cancer survivors in Saskatchewan. We conducted semi-structured interviews with 19 First Nations and Métis cancer survivors. Participants were interviewed by phone between May 2022 to March 2023. Thematic analysis was conducted to generate themes, categories, and codes reflecting participants' experiences with patient navigators. Participants reported several supports to help patients with cancer through their cancer journey, including family, community, traditional ways, and First Nations and Métis health support services. Challenges to accessing care included language and communication barriers, logistical challenges, cultural differences, financial challenges, and gaps in care. Indigenous patient navigators may play a critical role in overcoming barriers by providing communication, translation, coordination, education, advocacy, and guidance to Indigenous cancer survivors. In participants' view, the tasks of Indigenous patient navigators could vary, ranging from helping schedule appointments to advocating for the patient's treatment preferences. In addition, Indigenous patient navigators could be helpful bridging Western medicine with traditional medicine when supporting patients seeking cancer care. According to study participants, Indigenous patient navigators could be beneficial to Indigenous cancer survivors in Saskatchewan.

Evaluating the Effectiveness of Indigenous Health Curricula: Validation and Application of the NOSM CAST Instrument.

In recent years, Indigenous health curricula have been integrated into medical education in response to international calls to improve Indigenous health care. Instruments to evaluate Indigenous health education are urgently needed. We set out to validate a tool to measure self-reported medical student preparedness to provide culturally safe care to Indigenous Peoples. We then applied the tool to evaluate the effectiveness of the Northern Ontario School of Medicine University's (NOSM U) Indigenous health curriculum. We conducted psychometric testing of a 46-item draft NOSM Cultural Competency and Safety Tool (CAST). Testing included principal components analysis, subscale and item analysis, and the use of paired sample t-tests to examine pre- and posttest change to measure learner outcomes. The NOSM CAST was transposed to create a retrospective pre-posttest survey with single-point-in-time scoring. Respondents included five cohorts of first-year undergraduate medical students, with 305 of 320 participating (response rate of 95.3%). The validated survey subscales included knowledge, confidence/preparedness, attitudes, intentions for advocacy, antidiscrimination, and self-reflective practice, measured using 36 scale items. Cronbach's alpha showed good to excellent internal consistency for the scales (α range = 0.82-0.91). Composite reliability values were acceptable. The pre-posttest analysis showed statistically significant increases on four scales: knowledge [t(254) = 15.10, P < .001], confidence/preparedness [t(254) = 15.85, P < .001], intentions for advocacy [t(251) = 3.32, P = .001], and self-reflective practice [t(254) = 8.04, P < .001]. The largest mean increases were for knowledge (d = 1.07) and confidence/preparedness (d = 1.15). The NOSM CAST tracks student progress in Indigenous health curricula. NOSM U's classroom and immersion-based Indigenous health curriculum enhanced students' self-reported preparedness for culturally safe care. NOSM CAST implemented together with an assessment of Indigenous patient experiences with the same learners constitutes a rigorous evaluation approach to Indigenous health curricula.

Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training

BackgroundHealth care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits.MethodUsing a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment.ResultsClinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians.ConclusionsPatient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.Trial registrationClinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Storytelling of Indigenous patient and family advocates engaged in patient-oriented research initiatives in the field of inflammatory bowel disease.

The history of colonization and its ongoing impact poses significant health disparities among Indigenous communities. We aimed to centre the voices and stories of Indigenous patients and family advocates (IPFAs-Indigenous patients living with inflammatory bowel disease [IBD] and family members of Indigenous individuals with IBD) engaged in patient-oriented research projects and who are part of the IBD among Indigenous Peoples Research Team (IBD-IPRT). IPFAs and Indigenous and non-Indigenous researchers of the IBD-IPRT followed a storytelling research methodology to let IPFAs share their stories as research team members. Four IPFAs documented their experiences as IBD patients, advocates, and research partners. The stories were analyzed for themes. The identified themes were collaboratively verified with the IPFAs. The full stories shared by the IPFAs were transcribed and presented in this paper. Following a background analysis of themes in the 4 narratives, we were also able to identify 4 key themes that could be relevant to improving patient-oriented research initiatives: (1) health promotion, (2) leadership and voice, (3) community engagement, and (4) disease awareness and access to care. Trust building, strong relationships, and effective partnerships are core components for conducting patient-oriented research with Indigenous community members. Indigenous patient engagement in health research is crucial to ensure that lived experiences, knowledge, and cultural values are adequately adopted to improve research outcomes. Centering IPFAs in IBD research can promote cultural awareness and actionable recommendations to improve health outcomes for individuals with IBD and their families and caregivers.

Access, Relationships, Quality and Safety (ARQS): a qualitative study to cocreate an Indigenous patient experience tool for virtual primary care

BackgroundPerspectives from Indigenous peoples and their primary care providers about the quality and impacts of virtual primary care for Indigenous patients are currently limited. This study engaged Indigenous patients and...

The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations

Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD. The "Rainbow model” is a modified framework to help illustrate how complex environmental and social forces impact both AD presentation and therapeutic success. However, practical applications and outcome metrics for health promotion are limited.1 An inter- and transdisciplinary approach is paramount to address the complex challenges associated with AD care, as well as multistakeholder approach integrating culturally-competent equitable health frameworks. This review underscores the importance of expanding the focus of AD management beyond basic science and clinical trials to recognize and address health disparities and to promote optimal health and well-being in patients with AD, and contributes a working approach to mapping the complex interventions and patient-oriented research needed using a focus on remote North American Indigenous patients affected by AD.

Indigenous Support Services: A National Survey of Canadian Cardiac Centres.

Cardiovascular disease (CVD) has declined in Canada due to lifestyle improvements and medical advancements. However, Indigenous CVD morbidity and mortality rates have increased (1). Indigenous patient support services facilitate healthcare access and improve CVD management. We assessed whether services are being accessed appropriately by surveying physicians' self-reported experiences with their centre's Indigenous support services as outcomes. Evidently, Indigenous patient support services exist, but gaps in consistently accessing culturally specific services are evident. Recognition of protective factors such as culturally specific support services are crucial to address disparities and provide competent CVD care for Indigenous people in Canada (Supplementary Material 1).

Cystic lung disease in adult Indigenous Australians in the Northern Territory of Australia.

Indigenous Australians have a high prevalence of chronic lung diseases. However, no previous studies have reported on cystic lung disease in an Indigenous patient cohort. This report describes 20 adult Indigenous patients noted to have incidental lung cysts on chest computed tomography (CT) while being referred to undergo lung function tests in the Northern Territory of Australia. Of the total 20 Indigenous patients demonstrating presence of pulmonary cysts on chest CT scan, 13/20 (65%) were males with a mean age of 49.9 years (range 24-74 years), with no significant difference in age between males and females. The majority reported a smoking history and spirometry demonstrated moderate reduction in lung function parameters. While there was no pattern in the size or location of cysts, most demonstrated multiple cysts (55% had ≥5 cysts) with bilateral involvement (65%), alongside a range of concurrent pulmonary radiological abnormalities. The aetiology for lung cysts was largely unknown. This is the first report to illustrate cystic lung disease within an Indigenous population. Further radiology studies are required to investigate the causes and prognostications of cystic lung disease in Indigenous patients.

Indigenous and Disruptive Remote Patient Monitoring Devices - A Case Study on AI in Healthcare

The evolution of Industry 4.0 technologies has facilitated the growth of technologically driven healthcare solutions, disrupting, and significantly challenging the way the sector works and moving towards Healthcare 4.0. The global interest in Artificial Intelligence (AI) in the healthcare sector is increasing tremendously in comparison to other sectors. A rapidly ageing population with increasing health complications has led to the rise of AI-driven Remote Patient Monitoring (RPM) devices, where a patient can be monitored in the comfort of a home, using the latest communication and sensor technologies. This study aims to understand the usage of Artificial Intelligence (AI) as a healthcare disruptor, capturing the ever-increasing demands concerning the remote patient monitoring industry, making huge improvements, and redefining the way how healthcare can be provided, for timely and cost-effective solutions. The analysis of these remote monitoring devices has been done through a case study approach. For this purpose, two AI-enabled remote patient monitoring devices Dozee.ai and Qure.ai, have been taken which have been assisting patients and doctors in the diagnosis of health vitals remotely. Data has been taken from secondary sources to analyze the concept of indigenous and disruptive innovations. Both the apps have been quite successful in their diagnosis of Covid positive patients and have assisted both patients and healthcare personnel during critical times. Despite the huge advantages of AI-enabled RPM devices, they are vulnerable to data hacking and privacy issues. Any errors in these devices can pose potential risks to patients’ health.

H - 27 TBI and PTSD in an Indigenous Patient: It's Complicated.

Neuropsychological assessment of American Indian/Alaska Native (AI/AN) patients presents challenges due to limited normative data, stigma, possible differential validity of measures, and limited access to healthcare. Additionally, differentiating traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) is increasingly important for proper diagnosis and treatment of indigenous patients. This case study describes the use of comprehensive neuropsychological testing across two timepoints to assist with treatment planning. The patient was a 38-year-old Native American male referred by primary care to assist in educational, career, and treatment planning. His history was remarkable for TBI status post craniotomy and craniectomy. The patient completed initial and follow-up comprehensive neuropsychological evaluations. Follow-up was completed at 9-months following cranioplasty. On initial evaluation, the patient demonstrated deficits in immediate learning, delayed recall, executive functioning, processing speed, and fine motor abilities consistent with major neurocognitive impairment due to TBI. On follow-up evaluation, the patient demonstrated variable processing speed and executive functioning. Follow-up testing showed improvements in encoding of verbal information and immediate learning of visual information. Modest improvements were noted in processing speed, executive functioning, and fine motor skills. Follow-up testing evidenced declines in immediate learning, spontaneous recall, verbal fluency, and worsening PTSD symptoms. While TBI and PTSD can co-occur, understanding how to differentiate cognitive profiles of each, while considering linguistic, sociocultural, and educational differences, is vital for proper diagnosis and treatment. Adherence to treatments following TBI can promote physical and cognitive improvements, though certain symptoms may worsen due to psychological symptoms, which may present differently across cultures.

Envisioning Indigenous and biomedical healthcare collaboration at Stanton Territorial Hospital, Northwest Territories

ABSTRACT Background: To improve the quality of care for Indigenous patients, local Indigenous leaders in the Northwest Territories, Canada have called for more culturally responsive models for Indigenous and biomedical healthcare collaboration at Stanton Territorial Hospital. Objective: This study examined how Indigenous patients and biomedical healthcare providers envision Indigenous healing practices working successfully with biomedical hospital care at Stanton Territorial Hospital. Methods: We carried out a qualitative study from May 2018 – June 2022. The study was overseen by an Indigenous Community Advisory Committee and was made up of two methods: (1) interviews (n = 41) with Indigenous Elders, patient advocates, and healthcare providers, and (2) sharing circles with four Indigenous Elders. Results: Participants’ responses revealed three conceptual models for Indigenous and biomedical healthcare collaboration: the (1) integration; (2) independence; and (2) revisioning relationship models. In this article, we describe participants’ proposed models and examine the extent to which each model is likely to improve care for Indigenous patients at Stanton Territorial Hospital. By surfacing new models for Indigenous and biomedical healthcare collaboration, the study findings deepen and extend understandings of hospital-based Indigenous wellness services and illuminate directions for future research.

Closing the gap in Indigenous Australian cancer care: Initiatives to foster cultural safety and improve access to radiation therapy

IntroductionAboriginal and Torres Strait Islander peoples receive a poorer cancer prognosis compared to non-Indigenous Australians. Indigenous access to cancer care is limited by several factors, including differences in cultural understanding surrounding cancer and distrust of mainstream health institutions. It is believed that radiation therapy is being under-utilised by the Indigenous community. In response, several strategies were implemented to increase presentation and attendance by Indigenous Australians at a rural, private radiation therapy practice. MethodsA local Indigenous health service, Traditional Owners and Elders and the clinic's Reconciliation Action Plan Working Group were consulted to implement initiatives to reduce barriers to engaging in healthcare. One of these initiatives involved community consultation to select a culturally safe, Indigenous word to name one of the clinic's linear accelerators. Indigenous patient referrals into the clinic were tracked using an oncology information system. It is expected that by implementing several culturally safe strategies, there would be an increase in utilisation of the radiation therapy service and therefore, a decrease in Indigenous cancer burden across the local region. If strategies were yielding positive outcomes, there would be scope to implement these at other sites across a broader monitored network. ResultsCurrently, service utilisation is being monitored to determine whether initiatives have been successful. Initial data evaluation has been conducted and results are showing increased service utilisation by the Indigenous community. ConclusionWork has been undertaken to implement strategies to improve cultural safety and improve access to radiation therapy for Indigenous cancer patients. Preliminary results show an increase in the number of presentations to the clinic for radiation therapy treatment.

Effects of a Decolonizing Training on Mental Health Professionals' Indigenous Knowledge and Beliefs and Ethnocultural Empathy.

Indigenous communities suffer from the highest rates of mental health disparities of any ethnic group in the United States, as well as experience significant amounts of historical and contemporary trauma including violence, racism, and childhood abuse. Unfortunately, the mental health workforce is unprepared to effectively work with this population due to the influence of stereotypes, bias, and lack of training. A 90-minute training for mental health agency employees using decolonizing methods was delivered to improve knowledge of and empathy for Indigenous patient populations (N = 166). Results indicated that the training increased participants' Indigenous knowledge and beliefs across demographic variables and may increase aspects of empathy including awareness. This training was feasible for a wide variety of mental health employees and resulted in increased learning about Indigenous people, which is a critical starting point for mental health professionals working with this population. Suggestions are offered to train mental health providers to deliver culturally responsive care to Indigenous clients and families and for decolonizing mental health professions.

Polypoidal choroidal vasculopathy in an Indigenous Australian patient

Polypoidal choroidal vasculopathy in an Indigenous Australian patient

A240 "MY FEELINGS AND MY THOUGHTS ARE MY LIVED EXPERIENCE, NOT THE NUMBERS THEY SHOW ME ON A PIECE OF PAPER”: INDIGENOUS EXPERIENCES OF LIVER TRANSPLANTATION IN BRITISH COLUMBIA, CANADA

Abstract Background Indigenous peoples in Canada face inequities in healthcare access due to historic and ongoing colonial systems and structures of oppression. Indigenous peoples face greater health challenges including acute/chronic disease and may require consideration for transplantation including liver, kidney, heart, and lung. In a renal transplant study, Indigenous patients were less likely to undergo transplantation compared to non-Indigenous patients on dialysis; the reasons for this disparity are not known. The experiences of Indigenous patients during the liver transplant process in British Columbia, and how transplant professionals perceive challenges faced by Indigenous people, has not been studied. Purpose The purpose of this study is to explore experiences of Indigenous patients during the liver transplant process in British Columbia, and how transplant professionals perceive challenges faced by Indigenous people. This work will provide foundational evidence for improving Indigenous patient care in the transplant process in British Columbia, in response to recommendations made to address systemic and interpersonal racism documented in the In Plain Sight report in 2020. Method Thirteen semi-structured qualitative interviews were conducted with Indigenous patients (n=7) and transplant care providers (n=6) across British Columbia, Canada. Interpretive description identified themes to inform clinical approaches and transplant care planning. Themes and related recommendations were validated by Indigenous health experts prior to contextualization. Result(s) Interviews were conducted via Zoom from April 2021-May 2022. Among liver transplant patient participants: transplants had occurred between 1992-2020; all were women; and the median age at the time of their interview was 58 years. Among transplant care provider participants, roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: 1) Indigenous transplant patient participants had strong familial, cultural, and financial supports that were essential to accessing liver transplantation; 2) colonialism has created and perpetuated structural barriers preventing many more Indigenous peoples from being considered eligible for liver transplant; 3) anti-Indigenous racism and a lack of cultural safety and humility are barriers for Indigenous peoples who require timely care for liver disease and for establishing trusting relationships with care providers. Conclusion(s) To our knowledge, this study is the first to explore experiences of Indigenous liver transplant recipients and transplant care providers’ understanding of inequities uniquely experienced by Indigenous peoples. Addressing structural barriers to early linkage to care is needed and training for transplant clinicians on Indigenous histories, complex and intergenerational trauma, and cultural safety is strongly recommended. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Culturally Safe Practices in the Co-creation of Medical Education Curriculum with Indigenous Animators: Outcomes From an Indigenous Learning Circle.

To explore the experiences of Indigenous patient actors who co-created and enacted Indigenous patient scenarios in collaboration with medical school faculty. We critically examine the structures and systems in a medical school that mediate cultural safety for Indigenous patient actors. The Truth and Reconciliation Commission of Canada has called on medical schools and healthcare institutions to help address the intergenerational harms inflicted on Indigenous people by the Indian residential school (IRS) system. Institutions are striving to incorporate cultural competency, conflict resolution, human rights, and anti-racism education into their curricula. However, the structural inequities within undergraduate, postgraduate, and continuing medical education practices must be identified and challenged to ensure that medical education is authentic and culturally safe for those involved in the development and delivery of the Indigenous health curriculum. To explore potential structural inequities in the co-creation process of simulated cultural communication scenarios (SCCS), the Indigenous animators at Debajehmujig Storytellers and collaborating faculty and professional staff at the Northern Ontario School of Medicine University (NOSM U) examined cultural safety in their curriculum design and delivery process. We utilized the qualitative Indigenous research methodology of the Learning Circle to deconstruct the co-creation process and to explore the experience of cultural safety from the Indigenous animators' perspective throughout the curriculum design and delivery process. A framework for culturally safe co-creation practices with Indigenous people, rooted within Indigenous teachings of the Medicine Wheel, emerged from the qualitative data. This framework has the potential to guide the practice of culturally safe co-creation of Indigenous patient simulations in medical education and healthcare workplace learning. While the Medicine Wheel teachings are held by specific Indigenous nations, we anticipate that the results and recommendations of this study will apply to Indigenous co-creators and academic medical educators internationally.

Abstract IA017: Two-row wampum &amp; Indigenous cancer care services: Building respectful parallels of sovereignty along the cancer care continuum.

Abstract Quality-improvement (QI) roundtables collected shared voice of Indigenous and non-Indigenous cancer care providers working in and around ancestrally related Native Nations—Canada—USA. Findings were coupled with triangulated, aggregated, and de-identified Centers for Disease Control, Indian Health Services, and New York state information. Collectively, results spoke to the journey of Indigenous communities across the cancer care continuum, translating QI initiatives into community change via Indigenous patient navigation services wrapped in a framework of historical Wampum agreements between Indigenous Nations, Canada, and the United States. Outcomes discuss building cancer care collectives, translational QI methods towards in-person and virtual health care, and innovative grass-roots partnerships towards creative community outreach, engagement, and education. A short video documenting this QI journey was co-created with Indigenous film makers and US-based cancer center media and will be screened. Citation Format: Rodney Haring. Two-row wampum &amp; Indigenous cancer care services: Building respectful parallels of sovereignty along the cancer care continuum. [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA017.