<institution content-type="university">Illawarra Aboriginal Medical Service</institution>, <city>Wollongong</city>, <state>NSW</state> <postal-code>2500</postal-code>, <country>Australia</country>; and <institution content-type="university">University of Wollongong (UOW)</institution>, <city>Wollongong</city>, <state>NSW</state> <postal-code>2522</postal-code>, <country>Australia</country>.
<institution content-type="university">University of Sydney</institution>, <city>Sydney</city>, <state>NSW</state> <postal-code>2006</postal-code>, <country>Australia</country>.
Aust J Prim Health. 2024 Feb;30(1):NULL. doi: 10.1071/PY22181.
The Optimal Care Pathways (OCP) are a framework to promote high-quality and integrated cancer care for all Australians, from prevention through to end-of-life-care. Aboriginal and Torres Strait Islander people experience disproportionate cancer incidence and mortality, but little research has addressed whether cancer care for Aboriginal people meets the standards prescribed by the OCPs. This study aims to consider barriers and facilitators to quality cancer care for Aboriginal people.
Semi-structured interviews were conducted with 30 health professionals who deliver care to Aboriginal people with cancer in primary care and hospital settings in New South Wales, Australia. Health professionals included Aboriginal Health Workers, nurses, general practitioners, and community workers. Interviews were conducted in 2019-2020 and explored participant perspectives of barriers and facilitators of optimal cancer care, particularly related to prevention, early detection, diagnosis, and treatment for Aboriginal people. Data were qualitatively analysed using framework analysis.
In general, participants perceived Aboriginal patients to have good access to preventive care. In terms of early detection and diagnosis, access to primary care, pathology, radiology, and some specialists (e.g. respiratory physicians) was seen as optimal. However, access to hospital-based gastroenterologists for colonoscopy was perceived to be poor due to long wait times. Access to optimal care for cancer treatment was perceived to be hindered due to the lack of bulk-billing for bowel cancer, breast cancer, and cardiothoracic surgery. Other barriers to care identified by participants included unclear referral pathways, poor communication between patient and the treating team, and a lack of timely provision of discharge summaries.
Facilitators of optimal care during treatment and survivorship included: the Integrated Team Care and Close the Gap programs, and presence of key health workers to help patients navigate the health system. The major barriers to quality cancer care for Aboriginal people appeared to be to specialist and procedural access, demonstrating that the 'Inverse Care' law applied in reducing access for populations at higher risk of cancer.
优化护理路径（OCP）是一个框架，旨在为所有澳大利亚人提供高质量和综合的癌症护理，从预防到临终关怀。原住民和托雷斯海峡岛民的癌症发病率和死亡率不成比例，但很少有研究探讨原住民的癌症护理是否符合 OCP 规定的标准。本研究旨在探讨原住民获得优质癌症护理的障碍和促进因素。
在澳大利亚新南威尔士州的初级保健和医院环境中，对 30 名为癌症原住民患者提供护理的卫生专业人员进行了半结构式访谈。卫生专业人员包括原住民健康工作者、护士、全科医生和社区工作者。访谈于 2019-2020 年进行，探讨了参与者对原住民最佳癌症护理障碍和促进因素的看法，特别是与预防、早期发现、诊断和治疗相关的看法。使用框架分析对数据进行了定性分析。
一般来说，参与者认为原住民患者可以很好地获得预防保健。在早期发现和诊断方面，初级保健、病理学、放射学和一些专科医生（如呼吸科医生）的获得被认为是最佳的。然而，由于等待时间长，认为原住民患者获得结肠镜检查的医院胃肠病学家的途径较差。由于结直肠癌、乳腺癌和心胸外科手术缺乏批量计费，因此认为获得癌症治疗的最佳护理受到阻碍。参与者确定的其他护理障碍包括转诊途径不明确、患者与治疗团队之间沟通不畅以及缺乏及时提供出院总结。
治疗和生存期间最佳护理的促进因素包括：综合团队护理和缩小差距计划，以及关键卫生工作者的存在，以帮助患者在卫生系统中进行导航。原住民获得优质癌症护理的主要障碍似乎是专科和程序的获得，这表明“逆向护理”法则适用于减少癌症风险较高人群的获得。
