“We Just Get Whispers Back”: Perspectives of Primary and Hospital Health Care Providers on Between-Service Communication for Aboriginal People with Cancer in the Northern Territory

TL;DR

This study explores communication challenges between health services in caring for Aboriginal cancer patients in remote Australia and suggests improvements like better IT systems and dedicated staff.

Contribution

The study provides new insights into communication barriers in cancer care for Aboriginal people in remote areas and proposes targeted solutions to improve coordination.

Findings

Poor communication between health services negatively affects care for Aboriginal cancer patients.

Fragmented IT systems and lack of staff knowledge are major barriers to effective communication.

Designated roles and telehealth can support better communication and coordination.

Abstract

Aboriginal and Torres Strait Islander people have worse outcomes from cancer compared to non-Aboriginal people, particularly in remote areas. In the Northern Territory (NT), Australia’s third largest state/territory, cancer is one of the main causes of death for Aboriginal people. Primary health clinics play an important role in cancer screening, diagnosis and cancer care, particularly in remote communities, so accurate, timely communication between clinics, hospitals and specialists is essential. This qualitative study interviewed 50 staff from 15 health services across the NT and found that poor or delayed communication between health services negatively affected patient care and support. This research highlights the need for more timely communication and improved health care IT systems to enable better information sharing between services. It also identifies the need for designated clinic staff to support patients with cancer and dedicated Aboriginal cancer roles to improve the coordination and delivery of care for Aboriginal cancer patients.

Background/Objectives: Cancer is a leading cause of death for Aboriginal and Torres Strait Islander people, with remoteness increasing the risk for poorer outcomes. Primary health care (PHC) clinics have an important role in cancer screening, diagnosis, and post-discharge cancer care, particularly in remote communities, so accurate, timely communication between hospitals, specialists and PHC clinics is vital. This paper analyses the perspectives of Northern Territory health care professionals on communication between PHC and hospital services related to providing care for Aboriginal people with cancer and recommends strategies for improving communication between services. Methods: A qualitative study was undertaken in which semi-structured interviews were conducted with fifty staff from 15 health services (8 regional, remote, and very remote PHC clinics; 3 hospitals; one cancer centre and 3 cancer support services) between 2016 and 2019. Transcripts were thematically analysed, with findings categorized into barriers and enablers to communication. Results: Deficiencies in communication impeded patient care and support. A major barrier was fragmented, inefficient information systems; IT systems across health services were unable to interface, resulting in delayed/missing patient information that impacted discharge and follow up. Other barriers included PHC staff with limited knowledge of cancer, high turnover of PHC staff and tertiary hospital staff with limited understanding of remote health care challenges. Individuals used workarounds to overcome system failures and made substantial efforts around individual patients to improve communication. Specific roles and the use of telehealth between services and centralised cancer care services supported better between-service communication. Conclusions: Communication between hospital services and remote PHC clinics is essential to care for Aboriginal cancer patients; our research identified communication as inadequate in terms of consistency and timeliness. Commitment to more timely communication, health care IT systems that facilitate sharing information, designated staff in PHC clinics to support patients with cancer, dedicated Aboriginal cancer roles and additional resourcing to coordinate telehealth appointments could improve communication and sharing of patient information between services.

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