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The journey

Addressing cultural safety in Indigenous cancer care


By Michelle Osmond

Cancer has become increasingly prevalent in First Nations, Inuit and Métis populations in recent decades in Canada.

In fact, it’s one of the leading causes of death for Indigenous Peoples.

Dr. Jennifer Shea, Community Health and Humanities, Faculty of Medicine, along with a team of community partners, hopes to make cancer care delivery more culturally responsive and more respectful.

Supported by the Canadian Partnership for Cancer at $866,000 for four years, the project is led by the Nunatsiavut Government, in partnership with Memorial University, the NunatuKavut Community Council, Sheshatshiu Innu First Nation and the Mushuau Innu First Nation.

Their project, Courage, Compassion, and Connection, The Journey to Healing: Exploring Cancer Pre-diagnosis for Indigenous Peoples in Labrador, came from a stakeholder session held in Happy Valley-Goose Bay in 2018.

The session included Indigenous governments, survivors and caregivers, as well as representatives from Labrador Grenfell Health and the provincial cancer care program.

Two main themes emerged: Challenges during both pre-diagnosis and transitions in care.

Cultural safety

Participants in the session expressed concerns about the high costs of travel for tests; continuity in care due to a high turnover of health professionals and communities without a physician; and delays in getting test results.

One participant noted: “Where you live shouldn’t impact quality of care.”

“Culturally safe care then requires building trust with Indigenous patients and recognizing the role of socioeconomic conditions, history and politics in health.” — Dr. Jennifer Shea

They also brought up transitions in care around discharge planning, such as patients being released without awareness of the remoteness of their community and expectations on family/caregivers to provide palliative care once they return.

“For First Nations, Inuit and Métis, a cancer diagnosis has obvious health implications, but also social, financial and interpersonal challenges,” said Dr. Shea.

“Often people living in rural and remote communities have to leave their homes and familiar surroundings for health services in unfamiliar territory. Add to that language barriers and misunderstandings of cultural practices and beliefs, which can make communication difficult.”

‘Communicating respect’

According to Dr. Shea, cultural safety is critical in Indigenous health care.

It’s a step beyond cultural sensitivity (being accepting of difference), to understanding that there are inherent power imbalances and possible institutional discrimination from historical relationships with people of different origins.

It implies that the care provider has reflected on their own identity and the perceptions of them that others from different cultures may hold.

“Culturally safe care then requires building trust with Indigenous patients and recognizing the role of socioeconomic conditions, history and politics in health. It requires communicating respect for a patient’s beliefs, behaviours and values and ensures the client or patient is a partner in decision-making,” said Dr. Shea.

Shining a light

Based on the experiences of patients and family members, Dr. Shea and the team are hoping their project will bring to light the challenges and opportunities in the pre-diagnosis journey for Labrador’s Indigenous communities and identify tools and resources to make the journey more seamless.

Community liaisons for the cancer care research project gathered for a community planning session in Happy Valley-Goose Bay in December 2019.
Photo: Submitted

In December 2019 the team held a community planning session, but Dr. Shea says that COVID-19 has had a significant impact on project. They’d hoped to start community visits in the spring, but they were put on hold.

Weather delays and a recent COVID-19 case in Labrador held things up this fall. But they’re ready now to start community sharing circle sessions.

Kathy Michelin is the policy analyst leading the work. Ms. Michelin managed to visit two communities on the North Coast recently.

“Kathy has kept the communication and momentum going with constant communication and exploration into potential alternate approaches despite delays,” Dr. Shea said.

While the project is cancer specific, the team anticipates the responses, including the resources and tools, will be applicable to other aspects of health care, as well.

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