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Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: a qualitative study
- Source :
- BMJ Open
- Publication Year :
- 2016
- Publisher :
- BMJ Publishing Group, 2016.
-
Abstract
- Background/objectives Delayed presentation of symptomatic cancer is associated with poorer survival. Aboriginal patients with cancer have higher rates of distant metastases at diagnosis compared with non-Aboriginal Australians. This paper examined factors contributing to delayed diagnosis of cancer among Aboriginal Australians from patient and service providers' perspectives. Methods In-depth, open-ended interviews were conducted in two stages (2006–2007 and 2011). Inductive thematic analysis was assisted by use of NVivo looking around delays in presentation, diagnosis and referral for cancer. Participants Aboriginal patients with cancer/family members (n=30) and health service providers (n=62) were recruited from metropolitan Perth and six rural/remote regions of Western Australia. Results Three broad themes of factors were identified: (1) Contextual factors such as intergenerational impact of colonisation and racism and socioeconomic deprivation have negatively impacted on Aboriginal Australians' trust of the healthcare professionals; (2) health service-related factors included low accessibility to health services, long waiting periods, inadequate numbers of Aboriginal professionals and high staff turnover; (3) patient appraisal of symptoms and decision-making, fear of cancer and denial of symptoms were key reasons patients procrastinated in seeking help. Elements of shame, embarrassment, shyness of seeing the doctor, psychological ‘fear of the whole health system’, attachment to the land and ‘fear of leaving home’ for cancer treatment in metropolitan cities were other deterrents for Aboriginal people. Manifestation of masculinity and the belief that ‘health is women's domain’ emerged as a reason why Aboriginal men were reluctant to receive health checks. Conclusions Solutions to improved Aboriginal cancer outcomes include focusing on the primary care sector encouraging general practitioners to be proactive to suspicion of symptoms with appropriate investigations to facilitate earlier diagnosis and the need to improve Aboriginal health literacy regarding cancer. Access to health services remains a critical problem affecting timely diagnosis.
- Subjects :
- Adult
Male
Health Knowledge, Attitudes, Practice
Delayed Diagnosis
Native Hawaiian or Other Pacific Islander
diagnosis
Health Services Accessibility
health seeking behaviour
Neoplasms
Health Services, Indigenous
Humans
Aboriginal
Referral and Consultation
Qualitative Research
Early Detection of Cancer
Cancer
Indigenous health
Research
Western Australia
health service delivery
Female
Subjects
Details
- Language :
- English
- ISSN :
- 20446055
- Volume :
- 6
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- BMJ Open
- Accession number :
- edsair.pmid..........c23bb957935655b1d5235a0e5218c20c