One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people.
Christy E. Newman , Rebecca Gray , Loren Brener , L. Clair Jackson , Priscilla Johnson , Veronica Saunders , Magdalena Harris , Phyllis Butow & Carla Treloar (2013)
Why is this research important?
Little was known about Aboriginal people’s cancer experiences prior to this research. Cancer is the second most common cause of death for Aboriginal people, with Aboriginal people 60% more likely to die from their cancer than non-Aboriginal people. In an era of anti-discrimination, health professionals may be fearful of misrepresenting the experiences of a cultural group. They can be over-reliant on discursive frames which either ‘elide’ or ‘facilitate’ talk about difference. This research is important in understanding whether improving relationships between Aboriginal patients and their care providers could improve their cancer outcomes.
How was this research done?
This research formed the qualitative arm of the Aboriginal Patterns of Cancer Care Project (APOCC) and was conducted by a team of Aboriginal and non-Aboriginal researchers with expertise in qualitative health research. Qualitative research gathers in depth understanding of human behavior and investigates the ‘why’ and ‘how’ of decision making.
For this research interviewers invited 22 Aboriginal people who had been diagnosed with cancer, their carers and 16 health professionals.
To ensure that appropriate cultural protocols were followed, a senior Aboriginal member was employed to act as cultural advisor and mentor to the research team.
What were the results?
This study found that there is limited understanding of cultural difference among cancer care professionals who care for Aboriginal people.
The two most common ways that health workers thought about cultural difference was firstly that everyone is the same, and secondly that everyone is different. Both of these approaches were found to have the same effect – silencing discussion about why some patients may want or need different cancer care based on their cultural background.
Some health workers that we interviewed had an awareness of the different priorities Aboriginal people have due to their socio-economic situation as well as their different spiritual and cultural beliefs. These health workers were able to recognise cultural difference, but not how that impacts cancer care.
Others were able to acknowledge the importance of cultural safety in the health care system as well as the need for more appropriate treatment of Aboriginal people with cancer.
We know that the cancer care workforce can typically recognise the need to respond differently to patients from non-English speaking backgrounds, but found that they are less likely to shift their thinking when treating Aboriginal people. There is an assumption that they can fit into the default western health model because they are not from another country, even though they are from another culture.
- In order to improve the experience of Aboriginal people using mainstream health services, we need to understand what cultural difference means to health workers and how they treat Aboriginal cancer patients.
- Recognising cultural difference is not the responsibility of the patient, especially when they are from a minority cultural background. It is essential that health care workers recognise and respond to cultural difference and address their assumptions about Aboriginal people in order to provide adequate and culturally safe care.
- Actively facilitating talk about cultural difference has the potential to promote a more inclusive culture in cancer care.
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Cultural difference & Aboriginal cancer care (PDF 137Kb)
This work was produced by the Centre for Social Research in Health, University of New South Wales (UNSW) as part of the Aboriginal Patterns of Cancer Care Project (APOCC) which was funded by a National Health and Medical Research Council Health Services grant.