Aboriginal and Torres Strait Islander peoples are nearly twice as likely to receive a diagnosis of lung cancer and twice as likely to die from their lung cancer as non-Indigenous Australians. Studies have shown Aboriginal and Torres Strait Islander peoples with lung cancer are less likely to receive the full range of cancer treatments and this can potentially contribute to poorer lung cancer outcomes. Remoteness of residence, culture, health literacy and difficulty accessing appropriate lung cancer diagnostic treatment and support services are thought to be factors which influence people’s decisions to seek cancer care, and commence or complete treatments.
The aim of this research study is to
• survey the level of lung cancer awareness in Aboriginal and Torres Strait Islander communities.
• identify cultural influences on health beliefs, health service utilisation and resources that contribute to barriers for the early diagnosis and treatment of lung cancer.
• identify where knowledge gaps for health professionals exist in the current pathway for suspicious lung cancer which potentially impact on access to health services.
Using a mixed method research design, interviews were conducted in three Aboriginal communities involving three target population groups (1) patients referred for medical treatment with symptoms suspicious of lung cancer or confirmed lung cancer, (2) Indigenous health workers, and (3) Indigenous community members aged 18 years and over. Demographics, current health status, access to and utilisation of health services were analysed by frequency distributions and cross tabulated with age, education attainment, socio-economic characteristics, cultural influences, lung cancer awareness and knowledge. Themes which arose from the narrative responses were analysed and merged with the quantitative data to further validate and assess relationships.
Fifty-one community members aged 18 years and older, 14 Indigenous health workers and two patients were recruited. One patient was from an outer regional community (referred to as non- urban) and one patient was recruited from a major city (referred to as urban).
Of 51 community members and 14 Indigenous health workers 46 (90%) and 14 (100%) respectively cited smoking as the cause of lung cancer. Nearly 80% of participants would seek health care early if they developed symptoms c o n s i d e r e d a warning sign. All participants use conventional medicine when they are ill and over 65% of community participants have a regular general practitioner (GP). Participants access traditional medicine or other alternative treatments but not in place of conventional medicine.
Culturally targeted health information were preferred by 25 (49%) community participants and 10 (71%) Indigenous health workers however 26 (51%) community members, 4 (26%) Indigenous health workers and one patient did not think it important to them personally that the resource was culturally targeted. Of 51 community participants and 14 Indigenous health workers 29 (83%) and 8 (73%) respectively found generic health resources received were somewhat to extremely useful in meeting their information needs.
The two patients recruited had similarities in their lung cancer journey. Both needed to leave home to access radiation treatment and also used traditional medicine complementary to prescribed cancer treatment.
A small proportion (15%) of participants reflected that there should be improved communication between patients, families and health providers a n d 1 4 % believed Indigenous health workers could be more involved in preventative health and health promotion in the community. Indigenous health workers believed a lung cancer training resource would be helpful to increase their knowledge of the pathway a patient would follow for a lung cancer diagnosis.
The awareness of lung cancer risk factors and early diagnosis and treatment in Aboriginal and Torres Strait Islander communities are very important strategies to improve the lung cancer disparity between Indigenous and non-Indigenous Australians. Health professionals involved in the care of the lung cancer patient including Indigenous health workers need adequate resources to ensure the patient is supported through the journey from diagnosis, treatment and follow-up.
Culturally targeted health information can raise health literacy and sometimes aids in changing health behaviours, however, generic health information can also be effective for Indigenous Australians. This study found the use of culturally targeted versus generic health information was largely a personal choice and not necessarily associated with level of education or culture.
The Aboriginal and Torres Strait Islander culture (e.g. traditional medicine practices) marginally impacted on access to health care for participants of the research. Research participants did not choose traditional medicine over conventional medicine and attend the hospital or GP when ill.
Sub-optimal communication between doctors, local and regional health services, Indigenous health workers and patients was a common issue raised by participants from all communities. Effective, communication processes between health professionals and health services involved in the care of the Indigenous lung cancer must be sustained if lung cancer awareness strategies are to be successful in helping to improve lung cancer outcomes.