The experiences of Indigenous people with cancer in Saskatchewan: a patient-oriented qualitative study using a sharing circle.

BACKGROUND: Although disparities in cancer rates, later diagnoses and lower survival rates between Indigenous and non-Indigenous people have been documented, little is known about how Indigenous patients with cancer encounter the health care system. We explored perceptions and experiences of Indigenous patients with cancer and their families to understand better how 2 key concepts - trust and world view - influence cancer care decisions. METHODS: In this patient-oriented study that included participation of 2 patient partners, qualitative data were collected from Indigenous patients with cancer and their families using an Indigenous method of sharing circles. The sharing circle occurred at a culturally appropriate place, Wanuskewin Heritage Park, Saskatoon, on Sept. 22, 2017. The first patient partner started the sharing circle by sharing their cancer journey, thus engaging the Indigenous methodology of storytelling. This patient partner was involved in selecting the data collection method and recruiting participants through snowballing and social media. Trust and world view were employed as meta themes to guide our examination of the data. In keeping with Indigenous methodology, interview transcripts were analyzed using narrative analysis. The themes were reviewed and verified by a second Indigenous patient partner. RESULTS: There were 14 participants in the sharing circle. The 2 meta themes, trust and world view, comprised 8 subthemes. The meta theme trust included mistrust with diagnosis and Western treatment after cancer therapy, protection of Indigenous medicine and physician expertise with treatment recommendations. The world view meta theme included the following subthemes: best of both worlds, spiritual beliefs, required to be strong for family and importance of knowing Indigenous survivors. INTERPRETATION: This study displayed complex relations between trust and world view in the cancer journeys of Indigenous patients and their families. These findings may assist health care providers in gaining a better understanding of how trust and world view affect the decision-making of Indigenous patients regarding cancer care.

Decisions on cancer care by Indigenous peoples in Alberta and Saskatchewan: a narrative analysis.

INTRODUCTION: The prevalence of cancer is increasing among Indigenous peoples in Canada. To enhance quality of life of those Indigenous people affected by cancer, their decision-making experiences must be understood. This article presents the findings of a qualitative study exploring the treatment decision-making practices among Indigenous peoples with cancer in rural and remote Alberta and Saskatchewan, Canada. METHODS: This study employed a qualitative narrative-based approach using the Indigenous research method of storytelling. Seventeen Indigenous participants (14 women, three men) with various forms of cancer were interviewed. Open-ended questions were used that were designed to understand participants' decision-making processing regarding their cancer treatment. RESULTS: Keeping with Indigenous methodology, the interview transcripts were analysed by a narrative method, with the intent that the data would be presented in story format. Eight vignettes relating to decision making were created: being strong for family; family support; strength and independence; denial and not wanting to know; fear-based decision making; finding the blessing; the spiritual journey; and traditional medicine and doctors. Participants were involved in validating the analysis to ensure that data were accurately interpreted. CONCLUSION: The vignettes demonstrate the similarities and differences among Indigenous people with cancer from other countries. A primary feature is that family members play a central role in participants' cancer treatment decisions. While some participants embraced and relied upon traditional medicines, others were supported by the providers of Western health care. A healthcare system that provides access to both traditional and Western medicine can be essential to culturally safe, high-quality cancer care for Indigenous peoples.

Reconceptualizing determinants of health: barriers to improving the health status of First Nations peoples.

Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health status of First Nations people in Canada, it is important that the Agency incorporate the guiding principles of the Four Worlds: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. Reconceptualizing the key determinants of health to encompass the worldview expressed by the Four Worlds acknowledges the cultural wisdom of First Nations people and offers the potential to develop more inclusive public health services.