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Objectives. To illustrate how personal choice, or client self-reliance, is a determining factor in the management of cancer patients’ care in northern Aboriginal communities. Study design. Multiple-site study done in the northwestern part of the Canadian Province of Ontario. Method. In-depth interviews with professionals and paraprofessionals involved in community-based delivery of cancer care. Results. Study details how perceived care options, gender, awareness of disease and treatment, reaction to system-linked problems in care delivery, as well as cultural preferences influence clients’ choices and care outcomes. Conclusion. The study underlines the interdependence between personal choice and the health care system; "bad" experiences with the system cause clients to disengage from care, while client disengagement results in reduced care options. Keywords: Aboriginal health. Cancer care, Client self-reliance

The Northwestern Ontario Regional Cancer Centre (NWORCC) has created outreach services that provide chemotherapy and supportive care to clients in thirteen small, remote communities. Located 100-600 km from the NWORCC, these satellite oncology services are staffed by local physicians, specially prepared nurses and support staff. The present paper reports selected findings from an evaluation of the service, based on two rounds of site visits, interviews and surveys of providers and clients. Although the consensus was that quality care was being delivered, local hospitals and other organizations had to address a variety of challenges. Those discussed in the paper include: maintaining provider competency, strengthening supportive care networks, and adjusting staffing and other resources to meet increased demands for care.