Principles of optimal cancer care

Patient- or consumer-centred care is healthcare that is respectful of, and responsive to, the preferences, needs and values of patients and consumers. For Aboriginal and Torres Strait Islander people, optimal patient-centred care includes acknowledging the philosophies of holistic health and wellbeing, and the role of Aboriginal and Torres Strait Islander knowledge, values, beliefs, cultural needs and health history in decision making about treatment and ongoing care. Patient-centred care also considers the impact of family structures and responsibilities including kinship.  

Impacts of trauma on Aboriginal and Torres Strait Islander people 

In practising patient-centred care, the impacts of trauma across generations of Aboriginal and Torres Strait Islander people must be acknowledged and addressed. Health services and programs should practise trauma-informed care, understanding that trauma can influence the way people approach the health system and that the biological impact of stress and trauma can be an underlying cause of poor health.  

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Safe and quality care is provided by appropriately trained and credentialled clinicians, hospitals and clinics that have the equipment, staffing capacity and service evaluation programs to support safe and high-quality care.  

All health services should prioritise creating a culturally competent workforce. This means ensuring that all health professionals, health managers, receptionists and administrative workers working with Aboriginal and Torres Strait Islander patients have adequate ongoing training and skills in delivering culturally safe healthcare and medical advice.  

• National best practice guidelines for collecting Indigenous status in health data sets AIHW 
• Consumer’s Perspective of the Quality of Care Survey Protocol 2015 - Menzies 

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Multidisciplinary care is considered the cornerstone of best practice cancer care, and all patients should have the benefit of multidisciplinary treatment planning. This is an integrated team approach to healthcare in which medical and allied health professionals including Aboriginal and Torres Strait Islander health professionals consider all relevant treatment options and collaboratively develop an individual treatment and care plan for each patient.  

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Supportive care is an umbrella term used to refer to services, both generalist and specialist, that may be required by those affected by cancer. Supportive care addresses a wide range of needs across the continuum of care and is increasingly seen as a core component of evidence-based clinical care. Palliative care can be part of supportive care processes.  

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Care coordination is a comprehensive approach to achieving continuity of care for patients. This approach seeks to ensure care is delivered in a logical, connected and timely manner so the medical and personal needs of the patient are met.  

Effective care coordination for Aboriginal and Torres Strait Islander people requires building relationships and trust, and ensuring the workforce is culturally competent (through additional training, skills and knowledge attainment). Gender, kinship and family ties, language barriers and socioeconomic issues should be addressed to provide individualised care coordination for all patients.  

• Interpretive guide to the RACGP Standards for general practices (4th edition) for Aboriginal community controlled health services  
• National Aboriginal Community Controlled Health Service  

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It is the responsibility of the healthcare system and all people within its employ to ensure the communication needs of patients, their families, supporters and carers are met. Effective communication is essential at every step of the care pathway and may be affected by language barriers or cultural differences when a patient, family member, support person or carer identifies as an Aboriginal and/or Torres Strait Islander person. 

Communication with patients should be: 

• respectful 

• individualised 

• truthful and transparent 

• consistent 

• in plain language (avoiding complex medical terms and jargon) 

• culturally sensitive and appropriate – that takes account of gender (Men’s and Women’s Business), family ties, language barriers, health literacy and socioeconomic issues 

• active, interactive and proactive 

• ongoing 

• delivered in an appropriate setting and context 

• inclusive of patients and their families (with their consent). 

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Where practical, patients should be offered the opportunity to participate in research or clinical trials at any stage of the care pathway while being reassured that opting not to participate in research will not affect the standard of care they receive.  

A requirement of clinical trials conducted in Australia is adherence to a set of national standards that protect the cultural needs of Aboriginal and Torres Strait Islander people.  

• National Health and Medical Research Council’s Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research 
• Australian Cancer Trials 

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