Ha Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities

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Ha Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities

Abstract

Background: Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities.

Methods: This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whanau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed.

Results: Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whanau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whanau journey focused on agency and the impact on whanau.

Conclusions: The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whanau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whanau as carers to foster health literacy in future generations.

Background

Lung cancer is one of the most common causes of death from cancer worldwide. It is the leading cause of cancer deaths in Aotearoa New Zealand with approximately one thousand six hundred fifty deaths per year. In particular, Māori (Indigenous peoples of New Zealand) account for sixteen point five percent of the New Zealand population, and have both higher incidence and poorer survival rates for lung cancer compared to non-Māori. For instance, mortality rates for Māori from lung cancer are two point six times greater than in New Zealand Europeans. The persisting health disparities between Māori and non-Māori in New Zealand are of particular concern.

Diagnosis of lung cancer at an early stage can allow for curative treatment; however, lung cancer is typically diagnosed at a late stage when treatment tends to be palliative. Barriers to early diagnosis can occur at various stages throughout the diagnostic pathway. Barriers in primary care for Māori in particular are primarily related to General Practitioner (GP) - patient relationships, the health literacy of patients and health providers, and factors such as cost, symptom presentation and delayed diagnosis. Consequently, previous New Zealand research indicates that many lung cancer patients initially present to secondary care through the emergency department (ED) rather than by referral from GP to a respiratory specialist. However, this pathway also presents barriers to patients. Walton and colleagues indicate that barriers to early diagnosis for patients (both Māori and non-Māori) presenting directly to a hospital ED involved disparities in access to services, and disparities and delays relating to processes of care. Māori lung cancer patients in particular, are more likely to be admitted via ED and tend to have different treatment plans to non-Māori. However, further research is needed to identify the barriers to early diagnosis of lung cancer in secondary care for Māori.

This article discusses the findings from a broader project entitled Ha Ora: Improving early access to lung cancer diagnosis for Māori and rural communities. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, as identified by Māori patients, whanau (families) and primary healthcare providers in the Midland region of New Zealand. This paper reports on additional findings from the Ha Ora project that relate to the barriers and enablers to early diagnosis and treatment of lung cancer that are specific to the secondary care setting.

Methods

Results

Specialist services and treatment

Access to care

Engagement with specialists

Communication within specialist services

Cultural values and respect

Whanau journey

Agency

Impact on whanau

Discussion

Conclusion

Supplementary Information Funding

Availability of data materials

Ethics approval and consent to participate

Competing interests. The authors declare that they have no competing interests.

Overview

The study investigates the challenges faced by Māori communities in Aotearoa New Zealand regarding early diagnosis and treatment of lung cancer, highlighting significant barriers in healthcare delivery and the cultural context affecting patient experiences.

Key Points

1Lung cancer has the highest mortality rate in Aotearoa New Zealand, particularly among Māori communities
2Early diagnosis is crucial for improving treatment outcomes, but barriers exist in accessing care
3The study utilized kaupapa Māori methodologies to gather insights from community hui and healthcare providers
4Key barriers included long wait times, lack of communication, and cultural misunderstandings in healthcare interactions
5Findings underscore the need for improved healthcare communication and a culturally responsive health system for Māori.

Details

Authors: Jacquie Kidd, Shemana Cassim, Anna Rolleston, Lynne Chepulis, Brendan Hokowhitu, Rawiri Keenan, Janice Wong, Melissa Firth, Karen Middleton, Denise Aitken, Ross Lawrenson
Category: Health and Medicine

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