Improving Services for Māori

Closed doors’ … ‘wrong name’ … ‘wrong date, come back another day’ … ‘I couldn’t understand what they were saying’ ….

These are some of the responses researchers found when they asked Māori cancer survivors and sufferers, their carers and supporters what it was like going for cancer treatment and to other cancer-related services.

The research was commissioned by the Ministry of Health as part of implementing the Cancer Control Strategy and was carried out by two Māori primary health organisations – Te Kupenga O Hotorua and Tamaki PHOs. The project covered the Auckland and Counties Manukau District Health Board areas.

Guy Naden, who undertook the work as chief executive of Tamaki PHO, says many of the stories that surfaced during the course of four hui and interviews with individuals were deeply moving. They highlighted why Māori often mistrust and fear health services.

“Often the messages that were given to people were too complex – they couldn’t understand the language. They found the environment oppressive, rushed and pressured and there was no cultural appreciation whatsoever,” he says.

Barriers

Barriers included a lack of Māori staff to make people feel welcome, no transport to get to appointments, GPs not telling people the importance of outpatient clinic appointments, no room for people’s whānau and the need to see to other priorities on the day, eg older women needing to take care of their mokopuna.

The project looked at nine best practice guidelines for cancer treatment and found six of them made no reference to cultural responsiveness or tikanga. The other three included cultural responsiveness to varying degrees.

Dr Naden, who also is a member of the Cancer Control Council, says improving these guidelines is critical as they are a key way of conveying important messages to GPs.

Researchers also found ethnicity recording was poor for cancer patients accessing services. For example, they could not analyse ‘did-not-attend’ rates for outpatient appointments for Māori because ethnicity and cancer type were not recorded.

The project made a number of recommendations for new services as well as for changes to mainstream services.

These included:

• establishing a range of community-based services for Māori in the two DHB areas with the following: health education and early access to screening, diagnosis and treatments, education about service entitlements and access, and whānau support
• setting up a comprehensive information service particularly for Māori
• identifying all Māori at entry to hospital
• following up Māori who do not attend cancer-related appointments with community outreach
• ensuring all staff in cancer services, both hospital and community, are trained to communicate effectively with Māori and whānau
• ensuring all cancer-related services embrace the importance of supporting Māori to die well
• making clinic and hospital environments and staff more ‘Māori friendly’
• strengthening existing cancer-related services by employing Māori staff, eg kaitiaki.

Dr Naden says involving Māori in designing better cancer-related services is critical. “Māori have high rates of cancer and do poorly once they are diagnosed with cancer. We must address the current lack of service.”

The two PHOs have now submitted a proposal to the Ministry of Health for creating a community support service for Māori affected by cancer, where lay people will help other lay people.

To find out more

Ministry of Health - Improving the Journey for Māori and Pacific Cancer Patients, their Families, and Whānau.