Access to oncology care among Indigenous Peoples and the role of nurses
Horrill, Tara Courtney
Background: Indigenous Peoples’ health and healthcare access are of growing interest to researchers, decision-makers and practitioners alike as access to healthcare remains a complex and challenging issue. Indigenous Peoples in Canada face considerable challenges in accessing healthcare and reported differences in cancer outcomes between Indigenous Peoples and other Canadians appear, in part, to be associated with inequitable access to care. However, limited research has explored access to oncology care specifically. In particular, the perspectives of oncology nurses have yet to be explored. Purpose: The aim of this thesis was to critically examine access to oncology care among Indigenous Peoples in Canada, and the perspectives of nurses on access to oncology care. A paper-based thesis addressed the following objectives: 1) to identify, summarize and analyze what is currently known about access to oncology care among Indigenous Peoples in Canada; 2) to theorize the role of nurses in improving access to care among Indigenous Peoples; 3) to explore how nurses understand the barriers, facilitators and complexities of access to oncology care among Indigenous Peoples; and 4) to explore how nurses understand their role in delivering oncology care to Indigenous Peoples and in improving access to care for this population. Methods: A sequential multiple-methods qualitative research design was used. Phase 1 involved a scoping review of the literature. Simultaneously, phase 2 involved the development of a conceptual framework based on a critical review and analysis of literature. Informed by phases 1 and 2, and using interpretive descriptive and critical discourse analysis methodologies, phases 3 and 4 involved an online survey of oncology nurses in Canada and follow-up in-depth interviews. Findings: Results from the multiple methods study indicate a predominant focus on individual and sometimes systems level influences on access to oncology care, and a corresponding lack of attention to structural influences. Nurses’ work in addressing access is similarly focused primarily at the individual patient level. Biomedical discourses significantly impact access to oncology care, and exert a strong influence on how access is framed in both research and nursing practice. Conclusions: Action to address inequities in access to oncology care is urgently needed. Nurses can play an important role in this work, which should address individual, systems and structural influences on access to oncology care.
Indigenous Peoples, Healthcare access, Oncology, Cancer, Nurses, Qualitative research