Step 6: Strategies for enabling Aboriginal and Torres Strait Islander people to participate in cancer screening
This section covers the following steps:
|Step 6.1 Build a culturally-competent practice team|
|Step 6.2 Work in partnership with your local Aboriginal and Torres Strait Islander community|
|Step 6.3 Ensure your practice consistently asks patients if they identify as Aboriginal or Torres Strait Islander|
|Step 6.4 Provide health assessments that integrate cancer screening|
|Step 6.5 Make screening spaces comfortable|
|Step 6.6 Ensure appropriate follow-up of abnormal results|
|Step 6.7 Use your data effectively|
|Step 6.8 Use resources and programs designed for Aboriginal and Torres Strait Islander people|
The information below provides a range of suggestions on actions that can be taken to support increased participation in cancer screening by Aboriginal and Torres Strait Islander people.
These strategies should be used in addition to the strategies described in:
- Step 2: Use good practice strategies to increase participation in cancer screening
- Step 3: Address Health literacy as a barrier to screening
Use this template to implement the actions your team decides to undertake.
The strategies described below are guided by The National Aboriginal and Torres Strait Islander Cancer Framework 2015, Priority 3: “Increase access to and participation in cancer screening and immunisation for the prevention and early detection of cancers”. 25
Position statement on Aboriginal and Torres Strait Islander health
“We acknowledge the profound social and emotional impact of discriminatory policies and practices, including the forcible removal of children from their families and the years of failure of governments and health professionals to act effectively to protect and improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples.
“Over 200 years of loss and dispossession and the systematic disempowerment of Aboriginal and Torres Strait Islander people cannot be addressed without the genuine commitment of governments, non-government organisations and the wider Australian community.
“Health and medical professionals and their representative organisations have a clear role to play in this process. Solutions must draw on the strength and resilience present in Aboriginal and Torres Strait Islander communities today, and should be developed in partnership with Aboriginal and Torres Strait Islander people and communities.”
- Extract from the Royal Australian College of General Practitioners' Position statement on Aboriginal and Torres Strait Islander health.
It is important that your team has the knowledge, skills and attitudes required to provide appropriate care to Aboriginal and Torres Strait Islander people.
This includes understanding:
- the impact of discriminatory policies and practices on Aboriginal and Torres Strait Islander people’s health and interactions with the health system
- the diversity within the Aboriginal and Torres Strait Islander community in Australia
- how to provide culturally-appropriate and safe care
- how to communicate effectively with Aboriginal and Torres Strait Islander people
- the impact of ‘deficit discourse’ on perceptions, policy, practice and health outcomes for Aboriginal and Torres Strait Islander people.
What is ‘deficit discourse’?
Deficit discourse represents people in terms of deficiencies and failures. Deficit discourse places responsibility for problems with individuals or communities, overlooking the larger socioeconomic structures in which they are embedded.
Deficit discourse impacts educational attainment, health and wellbeing and contributes to external and internalised racism.
Step 6.1.1 Ensure your team has undertaken cultural awareness and cultural safety training
- Read the RACGP’s Cultural awareness training and cultural safety training guidelines for more information on training options.
- Talk with your PHN or appropriate local Aboriginal community organisation about training options.
- Queensland health provides guidance on communicating effectively with Aboriginal and Torres Strait Islander people. This guidance provides helpful information; however, it should be used in addition to cultural awareness and cultural safety training.
- Read the Australian Indigenous HealthInfoNet Cultural Safety for Health Professionals portal.
- RACGP has partnered with the Ministry of Health in developing an number of short education videos including Identifying Aboriginal patients in your general practice.
Success in practice:
“It’s like a lucky door prize if you get a good doctor and nursing staff who understand, respect your cultural background; explain things thoroughly and just respect you as a human being.” (Cairns)
- Excerpt from Consumer health information needs and preferences: Perspective of culturally and linguistically diverse and Aboriginal and Torres Strain Islander people, by the Australian Commission on Safety and Quality in Health Care.
Step 6.1.2 Recruit Aboriginal and Torres Strait Islander staff
Employing Aboriginal and Torres Strait Islander people in your practice can:
- enable Aboriginal and Torres Strait Islander to have input into your practice’s planning and provision of care
- improve the perception that Aboriginal and Torres Strait Islander people have of your practice as a safe place
- support linkages between your practice and the local Aboriginal and Torres Strait Islander community.
Working in partnership with your local Aboriginal and Torres Strait Islander community is a powerful way to increase cancer literacy and to encourage participation in screening. This can include partnering with25:
- key Aboriginal and Torres Strait Islander community members and health workers
- local Aboriginal and Torres Strait Islander community organisations
- cancer survivors who have had a positive experience with screening
- local cancer screening champions.
Your PHN, local health district’s Aboriginal Health Unit and/or local Aboriginal Community Controlled Health Service (ACCHO) can support your practice to strengthen community linkages.
Success in practice: Helen’s story
Aunty Helen Archibald-Simmons wanted to use her experience with breast cancer to encourage other women, especially Aboriginal women, to attend screening.
Aunty Helen approached the Mid-North Coast Local Health District to make a short video that can be:
- used in waiting rooms
- shown to women who have been diagnosed with breast cancer to help them understand what to expect
- shared with health professionals to improve their understanding of the cancer journey from the perspective of an Aboriginal woman.
‘Helen’s story’ is a great example of using community champions to promote screening.
"About 50% of Aboriginal and Torres Strait Islander people access Indigenous-specific primary health care services, but the other 50% access general primary health care services. Asking all of your clients about Indigenous status is particularly important because GPs have a really big role to play in regards to prevention and early detection of cancer.”
- Professor Gail Garvey, Kamilaroi woman, Senior Principal Research Fellow and Deputy Division Leader, Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research.
Understanding who among your patients identifies as Aboriginal or Torres Strait Islander is an important step in the provision of care. Visit the RACGP’s ‘Identification of Aboriginal and Torres Strait Islander people in Australian general practice’ for further information.
A significant number of Aboriginal and Torres Strait Islander people access health care in mainstream practices, but relatively few health assessments are provided by these services.26
Providing health assessments for Aboriginal and Torres Strait Islander people and incorporating cancer screening into health assessment templates (see Module 3 for more information) is an important step in supporting improved cancer screening participation.25
Ensure your screening service is comfortable, and culturally safe and appropriate.
This includes ensuring gender-appropriate screening facilities, staff and approaches.25
Seek advice from Aboriginal and Torres Strait Islander people, or local community organisations, to better understand how to ensure a comfortable, safe service.
It is important that Aboriginal and Torres Strait Islander people who have an abnormal cancer screening result are followed up in a way that ensures a timely diagnosis and treatment.25
Aboriginal and Torres Strait Islander people may need specific types of support to engage in diagnostic and treatment processes. Your practice can seek advice from Aboriginal and Torres Strait Islander health and community services in your area to develop your policy and processes for supporting and engaging Aboriginal and Torres Strait Islander people with abnormal cancer screening results.
Maintaining, analysing and applying lessons from your practice data is an important part of high quality care.
Consider how you can use data to deepen your understanding of Aboriginal and Torres Strait Islander people’s engagement with bowel, breast and cervical cancer screening, diagnosis and treatment.
There are a range of resources and programs that your practice can use which are designed to support Aboriginal and Torres Strait Islander people to participate in bowel, breast and cervical cancer screening:
Bowel cancer screening
Visit indigenousbowelscreen.com.au for a comprehensive range of educational and promotional materials for both consumers and health professionals, including the following:
Information for health professionals:
- An information sheet for GPs: Talking with Aboriginal and Torres Strait Islander patients about bowel cancer screening
- An information sheet for health workers
- A video overview of the National Bowel Cancer Screening Program for health professionals
- Webinar: How to encourage Aboriginal and Torres Strait Islander patients to do a bowel screening test
Resources for Aboriginal and Torres and Strait Islander people that can be printed or downloaded:
- Postcard: Bowel screening is women’s business
- Postcard: Bowel screening is men’s business
- A flip chart to assist health workers to talk with Aboriginal and Torres Strait Islander people about bowel cancer and bowel cancer screening
- A poster to encourage patients to do the National Bowel Cancer Screening Program test when it arrives in the mail, or check when their test will arrive.
- A range of videos, music clips and links to further information
Bowel screening can save your life is available in six Aboriginal languages from the National Bowel Cancer Screening Program.
- Posters and brochures designed for Aboriginal and Torres Strait Islander people can be downloaded or ordered for free from BreastScreen NSW.
- Robin’s breast screening story is a powerful video that encourages Aboriginal and Torres Strait Islander people to screen. This video can be shown in waiting rooms and at education and awareness events.
- Information for Aboriginal women about BreastScreen NSW.
Cervical cancer screening
- Posters and brochures designed for Aboriginal and Torres Strait Islander women that can be downloaded or ordered for free from the National Cervical Screening Program.
- Cervical screening information for Aboriginal women from the Cancer Institute NSW.
- Toolkit for engaging under-screened and never-screened women in the National Cervical Screening Program. This toolkit has been developed to assist health care providers to engage under-screened and never-screened people in cervical screening, and to support them should they choose to participate.