Cultural safety is defined by the Australian Health Practitioner Regulation Agency and National Health Leadership Forum of Aboriginal and Torres Strait Islander health peak organisations (in consultation with the MBA and AMC) as follows:
‘Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practice is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practicing behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.’
‘Patient safety for Aboriginal and Torres Strait Islander Peoples is the norm. We recognise that patient safety includes the inextricably linked elements of clinical and cultural safety, and that this link must be defined by Aboriginal and Torres Strait Islander Peoples.’ (AHPRA, 2020)Cultural safety is defined in the New Zealand context as: 'The need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities'. (MCNZ, 2019)The following general resources have been collated to support clinical radiologists and radiation oncologists to enhance cultural competency and promote cultural safety. Definitions Cultural AwarenessThe first step, acknowledgement of difference. Recognising that your culture and behaviour are different. Cultural Sensitivity Being aware of cultural differences and understanding the need to respect cultural difference.Cultural CompetenceCultural competence has been defined as a clinician who 'has the attitudes, skills and knowledge needed to function effectively and respectively when working with and treating people of different cultural backgrounds'.Cultural Safety Cultural safety requires clinicians to examine themselves and the potential impact of their own culture on clinical interactions and service delivery. This required individuals and health care organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where health care workers and health care organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care. ReferencesTe Tahū Hauora. 2023. Health literacy, equity, cultural safety and competence. URL: Health literacy, equity, cultural safety and competence | Health Quality & Safety Commission (hqsc.govt.nz)Council of Medical Colleges New Zealand and Te ORA. 2023. Cultural Safety Training Plan for Vocational Medicine in Aotearoa. URL: cultural-safety-training-plan-for-vocational-medicine-in-aotearoa.pdf (cmc.org.nz) Websites The following are links to websites for news, information and resources about Aboriginal and Torres Strait Islander people and Maori people in relation to health. Health Promotion Forum of New Zealand – Maori Health Healing FoundationThe Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions like the forced removal of children from their families.Specific pages:Timeline of Trauma and Healing in Australia is well-presented and provides a concise overview of events, trauma, healing that occurred since colonisation – available in poster form.Information regarding the stolen generation Australian Institute of Health and Welfare (AIHW) – Snapshots on Indigenous healthThese short fact sheets provide useful overview of demographics and social determinants.Profile of Indigenous AustraliansHealth Risk Factors Among Indigenous AustraliansSocial determinants and Indigenous healthCulturally safe health care for Indigenous Australian Common groundShort articles (400-500 words) and accompanying YouTube videos on specific topics such as ‘What is country and the stolen generation.Some articles might help clinicians understand the perspectives of First Nations people. For example, Death and Sorry Business and protocols of bereavement. Lowitja InstituteAn Aboriginal and Torres Strait Islander organisation working for the health and wellbeing of Australia’s First Peoples through high impact quality research, knowledge translation, and by supporting Aboriginal and Torres Strait Islander health researchers. Australian Indigenous HealthInfoNet – Cultural Safety for Health ProfessionalsThe portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive healthcare that is free from racism. Links are provided here to Aboriginal and Torres Strait Islander health and cultural safety resources with links for specific medical disciplines. The LIME Network Leaders in Indigenous Medical Education resources hub was developed to enhance information sharing and develop deliver initiatives in Indigenous medical and health education and encourage the development of Indigenous health as a discipline. Ao Mai te Rā | The Anti-Racism KaupapaManatū Hauora published this website as part of Ao Mai te Rā | the Anti-Racism Kaupapa initiative to support the health system to better understand, react and respond to racism in health.Other sites Stop Institutional RacismSTIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.The site contains links to current news and includes a page of resources. Podcasts/Audio Getting Better – A year in the Life of a Maori Medical StudentA trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori. The episodes include hearing from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of “unequal outcomes”- in the real world, “unequal outcomes” means sickness and death. Katherine Hospital: Back from the brinkJust five years ago this Northern Territory hospital was facing closure, its doctors were out of their depth and indigenous patients were leaving the wards in droves. This is the remarkable story of how Katherine Hospital turned its fortunes around. It now ranks among Australia's best for its relationship with its indigenous patients. How did the hospital do it and what lessons does this have for the rest of the nation? Indigenous Health MeDTalkIndigenous Health MedTalk covers topics related to women's and men's health, family health and wellness, mental health, sexual health and community innovations related to and affecting Aboriginal and Torres Strait Islander people. Ask the SpecialistAsk the Specialist is a podcast for health professionals who work with Aboriginal patients. Created in the Northern Territory of Australia, doctors from Royal Darwin Hospital ask Larrakia, Tiwi and Yolngu leaders (the ‘Specialists’) to answer their questions which span clinical to philosophical issues. Ao Mai Te Rā: The Anti-Racism Kaupapa podcasts The Ministry has developed a video and podcast series to build collective understanding of the impacts of racism on health, while also exploring key levers in the health system that could be used for change Land of the Long White Cloud This podcast series from NZ Herald is about how Pakeha New Zealanders could learn to acknowledge the injustice of colonisation and do something practical about it. Videos The Journey of Health and WellbeingYou Tube resource developed by the Western Australia Department of Health, which explains some of the history of Aboriginal and Torres Strait Islander people and the effects of colonisation and oppression on health and wellbeing. Health Navigator - Maori health videosThis video series includes stories about engaging with healthcare services from a Maori perspective. Understanding Conscious BiasPresentation by Professor David Tipene Leach on why understanding bias contributes to anti-racism and promotes equity. The presentation was sponsored by Choosing Wisely and Eastern Institute of Technology Te Whare Takiura o Kahungunu, Hawke’s Bay. Online Modules The following online modules are available for completion. Some modules requirement payment of a fee. RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resourceThe Royal Australasian College of Physicians (RACP) have granted permission for RANZCR trainees to complete the RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource. This resource includes in-depth content, video scenarios, reflection and discussion activities and recommended further resources. This module is a Phase 2 requirement for Clinical Radiology trainees. Understanding bias in health careThree learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias MaurioraMauriora provides two courses:Cultural Competency (Maori) - developed specifically for the registered New Zealand workforce and provides a basic understanding of cultural competency in the New Zealand Health context. 3 modules.Te Tiritu o Waitangi and Maori Health – Four modules, takes 1-3 hours to complete. University of Sydney – Kinship ModuleOnline learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives. Guidelines and Frameworks Communicating Effectively with Aboriginal and Torres Strait Islander peopleGeneral guide developed by Queensland Health. Aboriginal and Torres Strait Islander Patient Care GuidelineReference tool to support healthcare staff in delivering safe, clinically and culturally responsive inpatient care to Aboriginal and Torres Strait Islander patients, developed by Queensland Health. Includes information on:Factors influencing access to healthcareProviding culturally capable patient careAspects of clinical care, such as medical examinations, pain management and end-of-life care Sad News, Sorry BusinessGuidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. This document aims to provide some insight into appropriate cultural practices and identify tools that will assist in providing culturally and clinically responsive care for Aboriginal and Torres Strait Islander patients and their families. Aboriginal and Torres Strait Islander – Cultural Safety Framework and Continuum of Cultural Safety Reflective ToolThe framework provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations, developed by the Victorian Department of Health. Guidelines for Research Health Research Council of New Zealand - Māori Health ResearchIf your study involves Māori participants or research on issues relevant to Māori health, you should undertake appropriate and relevant consultation with Māori communities that will be involved in the design, development and implementation of the research. This webpage provides links to guidelines for researchers. National Health and Medical Research CouncilGuidelines on ethical conduct of research with Aboriginal and Torres Strait Islander peoples and communities. Articles Sharing the true stories: improving communication between Aboriginal patients and healthcare workersCass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia. 2002 May;176(10):466-70. Transforming institutional racism at an Australian hospitalBourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Australian Health Review. 2018 Nov 21;43(6):611-8.The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communicationJennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health. 2018 May 8;24(2):109-15.By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definitionCurtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health. 2019 Dec;18(1):1-7.A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia.Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health. 2021 Jan;18(6):3014.This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Six themes were identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiencesJones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International journal for equity in health. 2020 Dec;19(1):1-1.It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. To search for articles specific to medical specialties … Lowitja InstituteSearch tool which provides easy access to Aboriginal and Torres Strait Islander health literature on the PubMed database. Books and e-Books Overview of Aboriginal and Torres Strait Islander Health Status 2021Australian Indigenous HealthInfoNet (2022). Overview of Aboriginal and Torres Strait Islander health status 2021. Perth: Australian Indigenous HealthInfoNet.The Overview aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Telethon Kids Institute, Kulunga Aboriginal Research Development Unit, Department of the Prime Minister and Cabinet (Australia); 2014 May 1. Culture, Diversity and Health in Australia: Towards Culturally Safe Health CareDune T, McLeod K, Williams R, editors. Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care. Routledge; 2021 May 30. Indigenous Australian health and cultures: an introduction for health professionals.Scott K. Indigenous Australian health and cultures: an introduction for health professionals. Pearson; 2010. Cultural awareness and cultural safety training Individuals can complete the following courses. Check the websites for registration and fee information.University of OtagoMIHI 501 Health Professionals Course: Application of the Hui Process / Meihana Model to Clinical PracticeThis course comprises on-line learning modules, one on-site training seminar and an assessment module. The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, with a special focus on the application of the Hui Process and Meihana Model. Understanding bias in health care (a certificate of completion can be issued)Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias RACGP - Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practiceIt aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing the cultural awareness of GPs, general practice staff, primary healthcare staff and other healthcare providers. This 6 hour activity aims to help participants to:extend their knowledge about Aboriginal and Torres Strait Islander history and cultureexplore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical settingdiscuss key issues facing the practice team and Aboriginal and Torres Strait Islander peopleconsider ways to address these issues. RACS - Aboriginal and Torres Strait Islander Health and Cultural Safety eLearning programTwo courses, which take around 10 hours each, designed to be completed over 12 months.Small individual modules of 30 minutes each Introduction to providing Culturally Safe Care for Aboriginal and Torres Strait Islander PeoplesVictoria University – Future Learn4 weeks, 3 hours per week, available at selected times. Not specifically health related SBS Cultural Competence ProgramNot specific to health care – designed more for relationships in the workplace University of Sydney – National Centre for Cultural CompetenceCultural Competence Online Modules4 hours, with a maximum of 90 days to complete. Reports Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives. Final Report. Allen + Clarke 2020, Baseline Data Capture: Medical Council of New Zealand and Te Ohu Rata o Aotearoa, Wellington. ISBN 978-0-473-54688-5 (Epub) Medical Council of New Zealand – Statement on Cultural SafetyOctober 2019.This statement outlines what cultural safety means, why it is important and how doctors need to reflect on their own biases and attitudes to understand how these can impact on how patients receive their care. Medical Council of New Zealand - He Ara Hauora Māori: A Pathway to Māori Health EquityOctober 2019This document outlines the Medical Council of New Zealand’s position on how doctors can support the achievement of best health outcomes for Māori. It also provides guidance for healthcare organisations to support achieving cultural safety and Māori health equity1. It has been developed in partnership with Te Ohu Rata O Aotearoa, the Māori Medical Practitioners Association (Te ORA). Partnership for Justice in Health: Scoping paper on Race, Racism and the Australian Health SystemWatego, C., Singh, D. & Macoun, A. 2021, Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, DOI: 10.48455/sdrt-sb97 Indigenous Health and Engagement The College is committed to supporting the professions of Clinical Radiology and Radiation Oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and is reflected in the College’s Strategic Plan.This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.To view the RANZCR Statement of Intent in its entirety, click here. Radiation Oncology Specific ResourcesThe following resources are specific to Radiation Oncology. National Indigenous Cancer Network (NiCAN) National Indigenous Cancer Network (NiCAN) is a partnership between the Menzies School of Health Research, the Australian Indigenous HealthInfoNet, the Lowitja Institute and Cancer Council Australia.NICaN was established in 2013 and aims to improve health services for Indigenous people with cancer. NICaN brings together Indigenous audiences, consumers, service providers, researchers and health professionals from a broad range of disciplines, as well as private sector and government organisations.The NiCaN online portal is now accessed via the HealthInfoNet site, it was originally on the Menzies School of Health Research website.Key documents:Review of cancer among Aboriginal and Torres Strait Islander people (2020)The purpose of this review is to provide a comprehensive synthesis of key information on cancer among Aboriginal and Torres Strait Islander people in Australia to: (1) inform those involved or interested in Aboriginal and Torres Strait Islander health; and (2) provide the evidence for those involved in policy, strategy and program development and delivery.The review provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people. It provides detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation. This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people. It concludes by discussing possible future directions for combatting cancer in Australia. Guide to Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander People With CancerEach Optimal Care Pathway is underpinned by principles such as multidisciplinary care and care coordination. The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) incorporates additional concepts to support the delivery of culturally appropriate and responsive cancer care. It is the responsibility of the healthcare system and all people within its employment to address the needs of Aboriginal and Torres Strait Islander people in a culturally appropriate and responsive way. Patient Information Cancer Information for PatientsCancer Information for Aboriginal and Torres Strait Islander Peoples Websites/Webpages Australian Indigenous Doctors’ AssociationAustralian Indigenous Doctors’ Association (AIDA) offer an online Cultural Awareness course and face to face Cultural Safety training.Cancer Australia – For Aboriginal and Torres Strait Islander peopleThe site includes Aboriginal and Torres Strait Islander cancer statistics, Breast Cancer Awareness, Resources for Health Professionals and Resources for people with cancer.Culturally safe communication skills for non-Indigenous health professionalsThe resource comprises a series of short videos and a key messages tip sheet providing practical advice for cancer care specialists to optimise culturally safe and responsive communication with Aboriginal and Torres Strait Islander patients, their families and carers.The videos feature medical oncologists, cancer care co-ordinators, Aboriginal and Torres Strait Islander Liaison Officers and Health Workers, as well as Aboriginal and Torres Strait Islander people with cancer. The videos include delivering a diagnosis, staging and treatment, care after treatment and recover, and managing recurrent, residual and metastatic.There is also a summary Tip Sheet.Our Mob and Cancer This website provides culturally safe support and information for patients, their families, communities and health professionals. Information for health professionals is available here. Articles Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Services Research. 2013 Dec;13(1):1-3.A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal Cancer Service Providers (CSPs) from across WA and CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. The support has been brilliant: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services.Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. “The support has been brilliant”: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC health services research. 2021 Dec;21(1):1-5.Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience.This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples.Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Current opinion in supportive and palliative care. 2021 Sep 1;15(3):162-8.Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.
'The need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities'. (MCNZ, 2019)The following general resources have been collated to support clinical radiologists and radiation oncologists to enhance cultural competency and promote cultural safety. Definitions Cultural AwarenessThe first step, acknowledgement of difference. Recognising that your culture and behaviour are different. Cultural Sensitivity Being aware of cultural differences and understanding the need to respect cultural difference.Cultural CompetenceCultural competence has been defined as a clinician who 'has the attitudes, skills and knowledge needed to function effectively and respectively when working with and treating people of different cultural backgrounds'.Cultural Safety Cultural safety requires clinicians to examine themselves and the potential impact of their own culture on clinical interactions and service delivery. This required individuals and health care organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where health care workers and health care organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care. ReferencesTe Tahū Hauora. 2023. Health literacy, equity, cultural safety and competence. URL: Health literacy, equity, cultural safety and competence | Health Quality & Safety Commission (hqsc.govt.nz)Council of Medical Colleges New Zealand and Te ORA. 2023. Cultural Safety Training Plan for Vocational Medicine in Aotearoa. URL: cultural-safety-training-plan-for-vocational-medicine-in-aotearoa.pdf (cmc.org.nz) Websites The following are links to websites for news, information and resources about Aboriginal and Torres Strait Islander people and Maori people in relation to health. Health Promotion Forum of New Zealand – Maori Health Healing FoundationThe Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions like the forced removal of children from their families.Specific pages:Timeline of Trauma and Healing in Australia is well-presented and provides a concise overview of events, trauma, healing that occurred since colonisation – available in poster form.Information regarding the stolen generation Australian Institute of Health and Welfare (AIHW) – Snapshots on Indigenous healthThese short fact sheets provide useful overview of demographics and social determinants.Profile of Indigenous AustraliansHealth Risk Factors Among Indigenous AustraliansSocial determinants and Indigenous healthCulturally safe health care for Indigenous Australian Common groundShort articles (400-500 words) and accompanying YouTube videos on specific topics such as ‘What is country and the stolen generation.Some articles might help clinicians understand the perspectives of First Nations people. For example, Death and Sorry Business and protocols of bereavement. Lowitja InstituteAn Aboriginal and Torres Strait Islander organisation working for the health and wellbeing of Australia’s First Peoples through high impact quality research, knowledge translation, and by supporting Aboriginal and Torres Strait Islander health researchers. Australian Indigenous HealthInfoNet – Cultural Safety for Health ProfessionalsThe portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive healthcare that is free from racism. Links are provided here to Aboriginal and Torres Strait Islander health and cultural safety resources with links for specific medical disciplines. The LIME Network Leaders in Indigenous Medical Education resources hub was developed to enhance information sharing and develop deliver initiatives in Indigenous medical and health education and encourage the development of Indigenous health as a discipline. Ao Mai te Rā | The Anti-Racism KaupapaManatū Hauora published this website as part of Ao Mai te Rā | the Anti-Racism Kaupapa initiative to support the health system to better understand, react and respond to racism in health.Other sites Stop Institutional RacismSTIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.The site contains links to current news and includes a page of resources. Podcasts/Audio Getting Better – A year in the Life of a Maori Medical StudentA trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori. The episodes include hearing from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of “unequal outcomes”- in the real world, “unequal outcomes” means sickness and death. Katherine Hospital: Back from the brinkJust five years ago this Northern Territory hospital was facing closure, its doctors were out of their depth and indigenous patients were leaving the wards in droves. This is the remarkable story of how Katherine Hospital turned its fortunes around. It now ranks among Australia's best for its relationship with its indigenous patients. How did the hospital do it and what lessons does this have for the rest of the nation? Indigenous Health MeDTalkIndigenous Health MedTalk covers topics related to women's and men's health, family health and wellness, mental health, sexual health and community innovations related to and affecting Aboriginal and Torres Strait Islander people. Ask the SpecialistAsk the Specialist is a podcast for health professionals who work with Aboriginal patients. Created in the Northern Territory of Australia, doctors from Royal Darwin Hospital ask Larrakia, Tiwi and Yolngu leaders (the ‘Specialists’) to answer their questions which span clinical to philosophical issues. Ao Mai Te Rā: The Anti-Racism Kaupapa podcasts The Ministry has developed a video and podcast series to build collective understanding of the impacts of racism on health, while also exploring key levers in the health system that could be used for change Land of the Long White Cloud This podcast series from NZ Herald is about how Pakeha New Zealanders could learn to acknowledge the injustice of colonisation and do something practical about it. Videos The Journey of Health and WellbeingYou Tube resource developed by the Western Australia Department of Health, which explains some of the history of Aboriginal and Torres Strait Islander people and the effects of colonisation and oppression on health and wellbeing. Health Navigator - Maori health videosThis video series includes stories about engaging with healthcare services from a Maori perspective. Understanding Conscious BiasPresentation by Professor David Tipene Leach on why understanding bias contributes to anti-racism and promotes equity. The presentation was sponsored by Choosing Wisely and Eastern Institute of Technology Te Whare Takiura o Kahungunu, Hawke’s Bay. Online Modules The following online modules are available for completion. Some modules requirement payment of a fee. RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resourceThe Royal Australasian College of Physicians (RACP) have granted permission for RANZCR trainees to complete the RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource. This resource includes in-depth content, video scenarios, reflection and discussion activities and recommended further resources. This module is a Phase 2 requirement for Clinical Radiology trainees. Understanding bias in health careThree learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias MaurioraMauriora provides two courses:Cultural Competency (Maori) - developed specifically for the registered New Zealand workforce and provides a basic understanding of cultural competency in the New Zealand Health context. 3 modules.Te Tiritu o Waitangi and Maori Health – Four modules, takes 1-3 hours to complete. University of Sydney – Kinship ModuleOnline learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives. Guidelines and Frameworks Communicating Effectively with Aboriginal and Torres Strait Islander peopleGeneral guide developed by Queensland Health. Aboriginal and Torres Strait Islander Patient Care GuidelineReference tool to support healthcare staff in delivering safe, clinically and culturally responsive inpatient care to Aboriginal and Torres Strait Islander patients, developed by Queensland Health. Includes information on:Factors influencing access to healthcareProviding culturally capable patient careAspects of clinical care, such as medical examinations, pain management and end-of-life care Sad News, Sorry BusinessGuidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. This document aims to provide some insight into appropriate cultural practices and identify tools that will assist in providing culturally and clinically responsive care for Aboriginal and Torres Strait Islander patients and their families. Aboriginal and Torres Strait Islander – Cultural Safety Framework and Continuum of Cultural Safety Reflective ToolThe framework provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations, developed by the Victorian Department of Health. Guidelines for Research Health Research Council of New Zealand - Māori Health ResearchIf your study involves Māori participants or research on issues relevant to Māori health, you should undertake appropriate and relevant consultation with Māori communities that will be involved in the design, development and implementation of the research. This webpage provides links to guidelines for researchers. National Health and Medical Research CouncilGuidelines on ethical conduct of research with Aboriginal and Torres Strait Islander peoples and communities. Articles Sharing the true stories: improving communication between Aboriginal patients and healthcare workersCass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia. 2002 May;176(10):466-70. Transforming institutional racism at an Australian hospitalBourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Australian Health Review. 2018 Nov 21;43(6):611-8.The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communicationJennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health. 2018 May 8;24(2):109-15.By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definitionCurtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health. 2019 Dec;18(1):1-7.A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia.Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health. 2021 Jan;18(6):3014.This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Six themes were identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiencesJones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International journal for equity in health. 2020 Dec;19(1):1-1.It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. To search for articles specific to medical specialties … Lowitja InstituteSearch tool which provides easy access to Aboriginal and Torres Strait Islander health literature on the PubMed database. Books and e-Books Overview of Aboriginal and Torres Strait Islander Health Status 2021Australian Indigenous HealthInfoNet (2022). Overview of Aboriginal and Torres Strait Islander health status 2021. Perth: Australian Indigenous HealthInfoNet.The Overview aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Telethon Kids Institute, Kulunga Aboriginal Research Development Unit, Department of the Prime Minister and Cabinet (Australia); 2014 May 1. Culture, Diversity and Health in Australia: Towards Culturally Safe Health CareDune T, McLeod K, Williams R, editors. Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care. Routledge; 2021 May 30. Indigenous Australian health and cultures: an introduction for health professionals.Scott K. Indigenous Australian health and cultures: an introduction for health professionals. Pearson; 2010. Cultural awareness and cultural safety training Individuals can complete the following courses. Check the websites for registration and fee information.University of OtagoMIHI 501 Health Professionals Course: Application of the Hui Process / Meihana Model to Clinical PracticeThis course comprises on-line learning modules, one on-site training seminar and an assessment module. The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, with a special focus on the application of the Hui Process and Meihana Model. Understanding bias in health care (a certificate of completion can be issued)Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias RACGP - Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practiceIt aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing the cultural awareness of GPs, general practice staff, primary healthcare staff and other healthcare providers. This 6 hour activity aims to help participants to:extend their knowledge about Aboriginal and Torres Strait Islander history and cultureexplore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical settingdiscuss key issues facing the practice team and Aboriginal and Torres Strait Islander peopleconsider ways to address these issues. RACS - Aboriginal and Torres Strait Islander Health and Cultural Safety eLearning programTwo courses, which take around 10 hours each, designed to be completed over 12 months.Small individual modules of 30 minutes each Introduction to providing Culturally Safe Care for Aboriginal and Torres Strait Islander PeoplesVictoria University – Future Learn4 weeks, 3 hours per week, available at selected times. Not specifically health related SBS Cultural Competence ProgramNot specific to health care – designed more for relationships in the workplace University of Sydney – National Centre for Cultural CompetenceCultural Competence Online Modules4 hours, with a maximum of 90 days to complete. Reports Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives. Final Report. Allen + Clarke 2020, Baseline Data Capture: Medical Council of New Zealand and Te Ohu Rata o Aotearoa, Wellington. ISBN 978-0-473-54688-5 (Epub) Medical Council of New Zealand – Statement on Cultural SafetyOctober 2019.This statement outlines what cultural safety means, why it is important and how doctors need to reflect on their own biases and attitudes to understand how these can impact on how patients receive their care. Medical Council of New Zealand - He Ara Hauora Māori: A Pathway to Māori Health EquityOctober 2019This document outlines the Medical Council of New Zealand’s position on how doctors can support the achievement of best health outcomes for Māori. It also provides guidance for healthcare organisations to support achieving cultural safety and Māori health equity1. It has been developed in partnership with Te Ohu Rata O Aotearoa, the Māori Medical Practitioners Association (Te ORA). Partnership for Justice in Health: Scoping paper on Race, Racism and the Australian Health SystemWatego, C., Singh, D. & Macoun, A. 2021, Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, DOI: 10.48455/sdrt-sb97 Indigenous Health and Engagement The College is committed to supporting the professions of Clinical Radiology and Radiation Oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and is reflected in the College’s Strategic Plan.This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.To view the RANZCR Statement of Intent in its entirety, click here. Radiation Oncology Specific ResourcesThe following resources are specific to Radiation Oncology. National Indigenous Cancer Network (NiCAN) National Indigenous Cancer Network (NiCAN) is a partnership between the Menzies School of Health Research, the Australian Indigenous HealthInfoNet, the Lowitja Institute and Cancer Council Australia.NICaN was established in 2013 and aims to improve health services for Indigenous people with cancer. NICaN brings together Indigenous audiences, consumers, service providers, researchers and health professionals from a broad range of disciplines, as well as private sector and government organisations.The NiCaN online portal is now accessed via the HealthInfoNet site, it was originally on the Menzies School of Health Research website.Key documents:Review of cancer among Aboriginal and Torres Strait Islander people (2020)The purpose of this review is to provide a comprehensive synthesis of key information on cancer among Aboriginal and Torres Strait Islander people in Australia to: (1) inform those involved or interested in Aboriginal and Torres Strait Islander health; and (2) provide the evidence for those involved in policy, strategy and program development and delivery.The review provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people. It provides detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation. This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people. It concludes by discussing possible future directions for combatting cancer in Australia. Guide to Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander People With CancerEach Optimal Care Pathway is underpinned by principles such as multidisciplinary care and care coordination. The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) incorporates additional concepts to support the delivery of culturally appropriate and responsive cancer care. It is the responsibility of the healthcare system and all people within its employment to address the needs of Aboriginal and Torres Strait Islander people in a culturally appropriate and responsive way. Patient Information Cancer Information for PatientsCancer Information for Aboriginal and Torres Strait Islander Peoples Websites/Webpages Australian Indigenous Doctors’ AssociationAustralian Indigenous Doctors’ Association (AIDA) offer an online Cultural Awareness course and face to face Cultural Safety training.Cancer Australia – For Aboriginal and Torres Strait Islander peopleThe site includes Aboriginal and Torres Strait Islander cancer statistics, Breast Cancer Awareness, Resources for Health Professionals and Resources for people with cancer.Culturally safe communication skills for non-Indigenous health professionalsThe resource comprises a series of short videos and a key messages tip sheet providing practical advice for cancer care specialists to optimise culturally safe and responsive communication with Aboriginal and Torres Strait Islander patients, their families and carers.The videos feature medical oncologists, cancer care co-ordinators, Aboriginal and Torres Strait Islander Liaison Officers and Health Workers, as well as Aboriginal and Torres Strait Islander people with cancer. The videos include delivering a diagnosis, staging and treatment, care after treatment and recover, and managing recurrent, residual and metastatic.There is also a summary Tip Sheet.Our Mob and Cancer This website provides culturally safe support and information for patients, their families, communities and health professionals. Information for health professionals is available here. Articles Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Services Research. 2013 Dec;13(1):1-3.A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal Cancer Service Providers (CSPs) from across WA and CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. The support has been brilliant: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services.Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. “The support has been brilliant”: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC health services research. 2021 Dec;21(1):1-5.Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience.This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples.Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Current opinion in supportive and palliative care. 2021 Sep 1;15(3):162-8.Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.
The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities'. (MCNZ, 2019)The following general resources have been collated to support clinical radiologists and radiation oncologists to enhance cultural competency and promote cultural safety. Definitions Cultural AwarenessThe first step, acknowledgement of difference. Recognising that your culture and behaviour are different. Cultural Sensitivity Being aware of cultural differences and understanding the need to respect cultural difference.Cultural CompetenceCultural competence has been defined as a clinician who 'has the attitudes, skills and knowledge needed to function effectively and respectively when working with and treating people of different cultural backgrounds'.Cultural Safety Cultural safety requires clinicians to examine themselves and the potential impact of their own culture on clinical interactions and service delivery. This required individuals and health care organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where health care workers and health care organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care. ReferencesTe Tahū Hauora. 2023. Health literacy, equity, cultural safety and competence. URL: Health literacy, equity, cultural safety and competence | Health Quality & Safety Commission (hqsc.govt.nz)Council of Medical Colleges New Zealand and Te ORA. 2023. Cultural Safety Training Plan for Vocational Medicine in Aotearoa. URL: cultural-safety-training-plan-for-vocational-medicine-in-aotearoa.pdf (cmc.org.nz) Websites The following are links to websites for news, information and resources about Aboriginal and Torres Strait Islander people and Maori people in relation to health. Health Promotion Forum of New Zealand – Maori Health Healing FoundationThe Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions like the forced removal of children from their families.Specific pages:Timeline of Trauma and Healing in Australia is well-presented and provides a concise overview of events, trauma, healing that occurred since colonisation – available in poster form.Information regarding the stolen generation Australian Institute of Health and Welfare (AIHW) – Snapshots on Indigenous healthThese short fact sheets provide useful overview of demographics and social determinants.Profile of Indigenous AustraliansHealth Risk Factors Among Indigenous AustraliansSocial determinants and Indigenous healthCulturally safe health care for Indigenous Australian Common groundShort articles (400-500 words) and accompanying YouTube videos on specific topics such as ‘What is country and the stolen generation.Some articles might help clinicians understand the perspectives of First Nations people. For example, Death and Sorry Business and protocols of bereavement. Lowitja InstituteAn Aboriginal and Torres Strait Islander organisation working for the health and wellbeing of Australia’s First Peoples through high impact quality research, knowledge translation, and by supporting Aboriginal and Torres Strait Islander health researchers. Australian Indigenous HealthInfoNet – Cultural Safety for Health ProfessionalsThe portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive healthcare that is free from racism. Links are provided here to Aboriginal and Torres Strait Islander health and cultural safety resources with links for specific medical disciplines. The LIME Network Leaders in Indigenous Medical Education resources hub was developed to enhance information sharing and develop deliver initiatives in Indigenous medical and health education and encourage the development of Indigenous health as a discipline. Ao Mai te Rā | The Anti-Racism KaupapaManatū Hauora published this website as part of Ao Mai te Rā | the Anti-Racism Kaupapa initiative to support the health system to better understand, react and respond to racism in health.Other sites Stop Institutional RacismSTIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.The site contains links to current news and includes a page of resources. Podcasts/Audio Getting Better – A year in the Life of a Maori Medical StudentA trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori. The episodes include hearing from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of “unequal outcomes”- in the real world, “unequal outcomes” means sickness and death. Katherine Hospital: Back from the brinkJust five years ago this Northern Territory hospital was facing closure, its doctors were out of their depth and indigenous patients were leaving the wards in droves. This is the remarkable story of how Katherine Hospital turned its fortunes around. It now ranks among Australia's best for its relationship with its indigenous patients. How did the hospital do it and what lessons does this have for the rest of the nation? Indigenous Health MeDTalkIndigenous Health MedTalk covers topics related to women's and men's health, family health and wellness, mental health, sexual health and community innovations related to and affecting Aboriginal and Torres Strait Islander people. Ask the SpecialistAsk the Specialist is a podcast for health professionals who work with Aboriginal patients. Created in the Northern Territory of Australia, doctors from Royal Darwin Hospital ask Larrakia, Tiwi and Yolngu leaders (the ‘Specialists’) to answer their questions which span clinical to philosophical issues. Ao Mai Te Rā: The Anti-Racism Kaupapa podcasts The Ministry has developed a video and podcast series to build collective understanding of the impacts of racism on health, while also exploring key levers in the health system that could be used for change Land of the Long White Cloud This podcast series from NZ Herald is about how Pakeha New Zealanders could learn to acknowledge the injustice of colonisation and do something practical about it. Videos The Journey of Health and WellbeingYou Tube resource developed by the Western Australia Department of Health, which explains some of the history of Aboriginal and Torres Strait Islander people and the effects of colonisation and oppression on health and wellbeing. Health Navigator - Maori health videosThis video series includes stories about engaging with healthcare services from a Maori perspective. Understanding Conscious BiasPresentation by Professor David Tipene Leach on why understanding bias contributes to anti-racism and promotes equity. The presentation was sponsored by Choosing Wisely and Eastern Institute of Technology Te Whare Takiura o Kahungunu, Hawke’s Bay. Online Modules The following online modules are available for completion. Some modules requirement payment of a fee. RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resourceThe Royal Australasian College of Physicians (RACP) have granted permission for RANZCR trainees to complete the RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource. This resource includes in-depth content, video scenarios, reflection and discussion activities and recommended further resources. This module is a Phase 2 requirement for Clinical Radiology trainees. Understanding bias in health careThree learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias MaurioraMauriora provides two courses:Cultural Competency (Maori) - developed specifically for the registered New Zealand workforce and provides a basic understanding of cultural competency in the New Zealand Health context. 3 modules.Te Tiritu o Waitangi and Maori Health – Four modules, takes 1-3 hours to complete. University of Sydney – Kinship ModuleOnline learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives. Guidelines and Frameworks Communicating Effectively with Aboriginal and Torres Strait Islander peopleGeneral guide developed by Queensland Health. Aboriginal and Torres Strait Islander Patient Care GuidelineReference tool to support healthcare staff in delivering safe, clinically and culturally responsive inpatient care to Aboriginal and Torres Strait Islander patients, developed by Queensland Health. Includes information on:Factors influencing access to healthcareProviding culturally capable patient careAspects of clinical care, such as medical examinations, pain management and end-of-life care Sad News, Sorry BusinessGuidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. This document aims to provide some insight into appropriate cultural practices and identify tools that will assist in providing culturally and clinically responsive care for Aboriginal and Torres Strait Islander patients and their families. Aboriginal and Torres Strait Islander – Cultural Safety Framework and Continuum of Cultural Safety Reflective ToolThe framework provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations, developed by the Victorian Department of Health. Guidelines for Research Health Research Council of New Zealand - Māori Health ResearchIf your study involves Māori participants or research on issues relevant to Māori health, you should undertake appropriate and relevant consultation with Māori communities that will be involved in the design, development and implementation of the research. This webpage provides links to guidelines for researchers. National Health and Medical Research CouncilGuidelines on ethical conduct of research with Aboriginal and Torres Strait Islander peoples and communities. Articles Sharing the true stories: improving communication between Aboriginal patients and healthcare workersCass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia. 2002 May;176(10):466-70. Transforming institutional racism at an Australian hospitalBourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Australian Health Review. 2018 Nov 21;43(6):611-8.The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communicationJennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health. 2018 May 8;24(2):109-15.By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definitionCurtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health. 2019 Dec;18(1):1-7.A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia.Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health. 2021 Jan;18(6):3014.This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Six themes were identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiencesJones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International journal for equity in health. 2020 Dec;19(1):1-1.It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. To search for articles specific to medical specialties … Lowitja InstituteSearch tool which provides easy access to Aboriginal and Torres Strait Islander health literature on the PubMed database. Books and e-Books Overview of Aboriginal and Torres Strait Islander Health Status 2021Australian Indigenous HealthInfoNet (2022). Overview of Aboriginal and Torres Strait Islander health status 2021. Perth: Australian Indigenous HealthInfoNet.The Overview aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Telethon Kids Institute, Kulunga Aboriginal Research Development Unit, Department of the Prime Minister and Cabinet (Australia); 2014 May 1. Culture, Diversity and Health in Australia: Towards Culturally Safe Health CareDune T, McLeod K, Williams R, editors. Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care. Routledge; 2021 May 30. Indigenous Australian health and cultures: an introduction for health professionals.Scott K. Indigenous Australian health and cultures: an introduction for health professionals. Pearson; 2010. Cultural awareness and cultural safety training Individuals can complete the following courses. Check the websites for registration and fee information.University of OtagoMIHI 501 Health Professionals Course: Application of the Hui Process / Meihana Model to Clinical PracticeThis course comprises on-line learning modules, one on-site training seminar and an assessment module. The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, with a special focus on the application of the Hui Process and Meihana Model. Understanding bias in health care (a certificate of completion can be issued)Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias RACGP - Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practiceIt aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing the cultural awareness of GPs, general practice staff, primary healthcare staff and other healthcare providers. This 6 hour activity aims to help participants to:extend their knowledge about Aboriginal and Torres Strait Islander history and cultureexplore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical settingdiscuss key issues facing the practice team and Aboriginal and Torres Strait Islander peopleconsider ways to address these issues. RACS - Aboriginal and Torres Strait Islander Health and Cultural Safety eLearning programTwo courses, which take around 10 hours each, designed to be completed over 12 months.Small individual modules of 30 minutes each Introduction to providing Culturally Safe Care for Aboriginal and Torres Strait Islander PeoplesVictoria University – Future Learn4 weeks, 3 hours per week, available at selected times. Not specifically health related SBS Cultural Competence ProgramNot specific to health care – designed more for relationships in the workplace University of Sydney – National Centre for Cultural CompetenceCultural Competence Online Modules4 hours, with a maximum of 90 days to complete. Reports Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives. Final Report. Allen + Clarke 2020, Baseline Data Capture: Medical Council of New Zealand and Te Ohu Rata o Aotearoa, Wellington. ISBN 978-0-473-54688-5 (Epub) Medical Council of New Zealand – Statement on Cultural SafetyOctober 2019.This statement outlines what cultural safety means, why it is important and how doctors need to reflect on their own biases and attitudes to understand how these can impact on how patients receive their care. Medical Council of New Zealand - He Ara Hauora Māori: A Pathway to Māori Health EquityOctober 2019This document outlines the Medical Council of New Zealand’s position on how doctors can support the achievement of best health outcomes for Māori. It also provides guidance for healthcare organisations to support achieving cultural safety and Māori health equity1. It has been developed in partnership with Te Ohu Rata O Aotearoa, the Māori Medical Practitioners Association (Te ORA). Partnership for Justice in Health: Scoping paper on Race, Racism and the Australian Health SystemWatego, C., Singh, D. & Macoun, A. 2021, Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, DOI: 10.48455/sdrt-sb97 Indigenous Health and Engagement The College is committed to supporting the professions of Clinical Radiology and Radiation Oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and is reflected in the College’s Strategic Plan.This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.To view the RANZCR Statement of Intent in its entirety, click here. Radiation Oncology Specific ResourcesThe following resources are specific to Radiation Oncology. National Indigenous Cancer Network (NiCAN) National Indigenous Cancer Network (NiCAN) is a partnership between the Menzies School of Health Research, the Australian Indigenous HealthInfoNet, the Lowitja Institute and Cancer Council Australia.NICaN was established in 2013 and aims to improve health services for Indigenous people with cancer. NICaN brings together Indigenous audiences, consumers, service providers, researchers and health professionals from a broad range of disciplines, as well as private sector and government organisations.The NiCaN online portal is now accessed via the HealthInfoNet site, it was originally on the Menzies School of Health Research website.Key documents:Review of cancer among Aboriginal and Torres Strait Islander people (2020)The purpose of this review is to provide a comprehensive synthesis of key information on cancer among Aboriginal and Torres Strait Islander people in Australia to: (1) inform those involved or interested in Aboriginal and Torres Strait Islander health; and (2) provide the evidence for those involved in policy, strategy and program development and delivery.The review provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people. It provides detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation. This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people. It concludes by discussing possible future directions for combatting cancer in Australia. Guide to Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander People With CancerEach Optimal Care Pathway is underpinned by principles such as multidisciplinary care and care coordination. The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) incorporates additional concepts to support the delivery of culturally appropriate and responsive cancer care. It is the responsibility of the healthcare system and all people within its employment to address the needs of Aboriginal and Torres Strait Islander people in a culturally appropriate and responsive way. Patient Information Cancer Information for PatientsCancer Information for Aboriginal and Torres Strait Islander Peoples Websites/Webpages Australian Indigenous Doctors’ AssociationAustralian Indigenous Doctors’ Association (AIDA) offer an online Cultural Awareness course and face to face Cultural Safety training.Cancer Australia – For Aboriginal and Torres Strait Islander peopleThe site includes Aboriginal and Torres Strait Islander cancer statistics, Breast Cancer Awareness, Resources for Health Professionals and Resources for people with cancer.Culturally safe communication skills for non-Indigenous health professionalsThe resource comprises a series of short videos and a key messages tip sheet providing practical advice for cancer care specialists to optimise culturally safe and responsive communication with Aboriginal and Torres Strait Islander patients, their families and carers.The videos feature medical oncologists, cancer care co-ordinators, Aboriginal and Torres Strait Islander Liaison Officers and Health Workers, as well as Aboriginal and Torres Strait Islander people with cancer. The videos include delivering a diagnosis, staging and treatment, care after treatment and recover, and managing recurrent, residual and metastatic.There is also a summary Tip Sheet.Our Mob and Cancer This website provides culturally safe support and information for patients, their families, communities and health professionals. Information for health professionals is available here. Articles Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Services Research. 2013 Dec;13(1):1-3.A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal Cancer Service Providers (CSPs) from across WA and CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. The support has been brilliant: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services.Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. “The support has been brilliant”: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC health services research. 2021 Dec;21(1):1-5.Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience.This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples.Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Current opinion in supportive and palliative care. 2021 Sep 1;15(3):162-8.Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.
The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities'. (MCNZ, 2019)The following general resources have been collated to support clinical radiologists and radiation oncologists to enhance cultural competency and promote cultural safety. Definitions Cultural AwarenessThe first step, acknowledgement of difference. Recognising that your culture and behaviour are different. Cultural Sensitivity Being aware of cultural differences and understanding the need to respect cultural difference.Cultural CompetenceCultural competence has been defined as a clinician who 'has the attitudes, skills and knowledge needed to function effectively and respectively when working with and treating people of different cultural backgrounds'.Cultural Safety Cultural safety requires clinicians to examine themselves and the potential impact of their own culture on clinical interactions and service delivery. This required individuals and health care organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where health care workers and health care organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care. ReferencesTe Tahū Hauora. 2023. Health literacy, equity, cultural safety and competence. URL: Health literacy, equity, cultural safety and competence | Health Quality & Safety Commission (hqsc.govt.nz)Council of Medical Colleges New Zealand and Te ORA. 2023. Cultural Safety Training Plan for Vocational Medicine in Aotearoa. URL: cultural-safety-training-plan-for-vocational-medicine-in-aotearoa.pdf (cmc.org.nz) Websites The following are links to websites for news, information and resources about Aboriginal and Torres Strait Islander people and Maori people in relation to health. Health Promotion Forum of New Zealand – Maori Health Healing FoundationThe Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions like the forced removal of children from their families.Specific pages:Timeline of Trauma and Healing in Australia is well-presented and provides a concise overview of events, trauma, healing that occurred since colonisation – available in poster form.Information regarding the stolen generation Australian Institute of Health and Welfare (AIHW) – Snapshots on Indigenous healthThese short fact sheets provide useful overview of demographics and social determinants.Profile of Indigenous AustraliansHealth Risk Factors Among Indigenous AustraliansSocial determinants and Indigenous healthCulturally safe health care for Indigenous Australian Common groundShort articles (400-500 words) and accompanying YouTube videos on specific topics such as ‘What is country and the stolen generation.Some articles might help clinicians understand the perspectives of First Nations people. For example, Death and Sorry Business and protocols of bereavement. Lowitja InstituteAn Aboriginal and Torres Strait Islander organisation working for the health and wellbeing of Australia’s First Peoples through high impact quality research, knowledge translation, and by supporting Aboriginal and Torres Strait Islander health researchers. Australian Indigenous HealthInfoNet – Cultural Safety for Health ProfessionalsThe portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive healthcare that is free from racism. Links are provided here to Aboriginal and Torres Strait Islander health and cultural safety resources with links for specific medical disciplines. The LIME Network Leaders in Indigenous Medical Education resources hub was developed to enhance information sharing and develop deliver initiatives in Indigenous medical and health education and encourage the development of Indigenous health as a discipline. Ao Mai te Rā | The Anti-Racism KaupapaManatū Hauora published this website as part of Ao Mai te Rā | the Anti-Racism Kaupapa initiative to support the health system to better understand, react and respond to racism in health.Other sites Stop Institutional RacismSTIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.The site contains links to current news and includes a page of resources. Podcasts/Audio Getting Better – A year in the Life of a Maori Medical StudentA trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori. The episodes include hearing from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of “unequal outcomes”- in the real world, “unequal outcomes” means sickness and death. Katherine Hospital: Back from the brinkJust five years ago this Northern Territory hospital was facing closure, its doctors were out of their depth and indigenous patients were leaving the wards in droves. This is the remarkable story of how Katherine Hospital turned its fortunes around. It now ranks among Australia's best for its relationship with its indigenous patients. How did the hospital do it and what lessons does this have for the rest of the nation? Indigenous Health MeDTalkIndigenous Health MedTalk covers topics related to women's and men's health, family health and wellness, mental health, sexual health and community innovations related to and affecting Aboriginal and Torres Strait Islander people. Ask the SpecialistAsk the Specialist is a podcast for health professionals who work with Aboriginal patients. Created in the Northern Territory of Australia, doctors from Royal Darwin Hospital ask Larrakia, Tiwi and Yolngu leaders (the ‘Specialists’) to answer their questions which span clinical to philosophical issues. Ao Mai Te Rā: The Anti-Racism Kaupapa podcasts The Ministry has developed a video and podcast series to build collective understanding of the impacts of racism on health, while also exploring key levers in the health system that could be used for change Land of the Long White Cloud This podcast series from NZ Herald is about how Pakeha New Zealanders could learn to acknowledge the injustice of colonisation and do something practical about it. Videos The Journey of Health and WellbeingYou Tube resource developed by the Western Australia Department of Health, which explains some of the history of Aboriginal and Torres Strait Islander people and the effects of colonisation and oppression on health and wellbeing. Health Navigator - Maori health videosThis video series includes stories about engaging with healthcare services from a Maori perspective. Understanding Conscious BiasPresentation by Professor David Tipene Leach on why understanding bias contributes to anti-racism and promotes equity. The presentation was sponsored by Choosing Wisely and Eastern Institute of Technology Te Whare Takiura o Kahungunu, Hawke’s Bay. Online Modules The following online modules are available for completion. Some modules requirement payment of a fee. RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resourceThe Royal Australasian College of Physicians (RACP) have granted permission for RANZCR trainees to complete the RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource. This resource includes in-depth content, video scenarios, reflection and discussion activities and recommended further resources. This module is a Phase 2 requirement for Clinical Radiology trainees. Understanding bias in health careThree learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias MaurioraMauriora provides two courses:Cultural Competency (Maori) - developed specifically for the registered New Zealand workforce and provides a basic understanding of cultural competency in the New Zealand Health context. 3 modules.Te Tiritu o Waitangi and Maori Health – Four modules, takes 1-3 hours to complete. University of Sydney – Kinship ModuleOnline learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives. Guidelines and Frameworks Communicating Effectively with Aboriginal and Torres Strait Islander peopleGeneral guide developed by Queensland Health. Aboriginal and Torres Strait Islander Patient Care GuidelineReference tool to support healthcare staff in delivering safe, clinically and culturally responsive inpatient care to Aboriginal and Torres Strait Islander patients, developed by Queensland Health. Includes information on:Factors influencing access to healthcareProviding culturally capable patient careAspects of clinical care, such as medical examinations, pain management and end-of-life care Sad News, Sorry BusinessGuidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. This document aims to provide some insight into appropriate cultural practices and identify tools that will assist in providing culturally and clinically responsive care for Aboriginal and Torres Strait Islander patients and their families. Aboriginal and Torres Strait Islander – Cultural Safety Framework and Continuum of Cultural Safety Reflective ToolThe framework provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations, developed by the Victorian Department of Health. Guidelines for Research Health Research Council of New Zealand - Māori Health ResearchIf your study involves Māori participants or research on issues relevant to Māori health, you should undertake appropriate and relevant consultation with Māori communities that will be involved in the design, development and implementation of the research. This webpage provides links to guidelines for researchers. National Health and Medical Research CouncilGuidelines on ethical conduct of research with Aboriginal and Torres Strait Islander peoples and communities. Articles Sharing the true stories: improving communication between Aboriginal patients and healthcare workersCass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia. 2002 May;176(10):466-70. Transforming institutional racism at an Australian hospitalBourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Australian Health Review. 2018 Nov 21;43(6):611-8.The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communicationJennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health. 2018 May 8;24(2):109-15.By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definitionCurtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health. 2019 Dec;18(1):1-7.A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia.Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health. 2021 Jan;18(6):3014.This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Six themes were identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiencesJones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International journal for equity in health. 2020 Dec;19(1):1-1.It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. To search for articles specific to medical specialties … Lowitja InstituteSearch tool which provides easy access to Aboriginal and Torres Strait Islander health literature on the PubMed database. Books and e-Books Overview of Aboriginal and Torres Strait Islander Health Status 2021Australian Indigenous HealthInfoNet (2022). Overview of Aboriginal and Torres Strait Islander health status 2021. Perth: Australian Indigenous HealthInfoNet.The Overview aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Telethon Kids Institute, Kulunga Aboriginal Research Development Unit, Department of the Prime Minister and Cabinet (Australia); 2014 May 1. Culture, Diversity and Health in Australia: Towards Culturally Safe Health CareDune T, McLeod K, Williams R, editors. Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care. Routledge; 2021 May 30. Indigenous Australian health and cultures: an introduction for health professionals.Scott K. Indigenous Australian health and cultures: an introduction for health professionals. Pearson; 2010. Cultural awareness and cultural safety training Individuals can complete the following courses. Check the websites for registration and fee information.University of OtagoMIHI 501 Health Professionals Course: Application of the Hui Process / Meihana Model to Clinical PracticeThis course comprises on-line learning modules, one on-site training seminar and an assessment module. The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, with a special focus on the application of the Hui Process and Meihana Model. Understanding bias in health care (a certificate of completion can be issued)Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias RACGP - Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practiceIt aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing the cultural awareness of GPs, general practice staff, primary healthcare staff and other healthcare providers. This 6 hour activity aims to help participants to:extend their knowledge about Aboriginal and Torres Strait Islander history and cultureexplore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical settingdiscuss key issues facing the practice team and Aboriginal and Torres Strait Islander peopleconsider ways to address these issues. RACS - Aboriginal and Torres Strait Islander Health and Cultural Safety eLearning programTwo courses, which take around 10 hours each, designed to be completed over 12 months.Small individual modules of 30 minutes each Introduction to providing Culturally Safe Care for Aboriginal and Torres Strait Islander PeoplesVictoria University – Future Learn4 weeks, 3 hours per week, available at selected times. Not specifically health related SBS Cultural Competence ProgramNot specific to health care – designed more for relationships in the workplace University of Sydney – National Centre for Cultural CompetenceCultural Competence Online Modules4 hours, with a maximum of 90 days to complete. Reports Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives. Final Report. Allen + Clarke 2020, Baseline Data Capture: Medical Council of New Zealand and Te Ohu Rata o Aotearoa, Wellington. ISBN 978-0-473-54688-5 (Epub) Medical Council of New Zealand – Statement on Cultural SafetyOctober 2019.This statement outlines what cultural safety means, why it is important and how doctors need to reflect on their own biases and attitudes to understand how these can impact on how patients receive their care. Medical Council of New Zealand - He Ara Hauora Māori: A Pathway to Māori Health EquityOctober 2019This document outlines the Medical Council of New Zealand’s position on how doctors can support the achievement of best health outcomes for Māori. It also provides guidance for healthcare organisations to support achieving cultural safety and Māori health equity1. It has been developed in partnership with Te Ohu Rata O Aotearoa, the Māori Medical Practitioners Association (Te ORA). Partnership for Justice in Health: Scoping paper on Race, Racism and the Australian Health SystemWatego, C., Singh, D. & Macoun, A. 2021, Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, DOI: 10.48455/sdrt-sb97 Indigenous Health and Engagement The College is committed to supporting the professions of Clinical Radiology and Radiation Oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and is reflected in the College’s Strategic Plan.This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.To view the RANZCR Statement of Intent in its entirety, click here. Radiation Oncology Specific ResourcesThe following resources are specific to Radiation Oncology. National Indigenous Cancer Network (NiCAN) National Indigenous Cancer Network (NiCAN) is a partnership between the Menzies School of Health Research, the Australian Indigenous HealthInfoNet, the Lowitja Institute and Cancer Council Australia.NICaN was established in 2013 and aims to improve health services for Indigenous people with cancer. NICaN brings together Indigenous audiences, consumers, service providers, researchers and health professionals from a broad range of disciplines, as well as private sector and government organisations.The NiCaN online portal is now accessed via the HealthInfoNet site, it was originally on the Menzies School of Health Research website.Key documents:Review of cancer among Aboriginal and Torres Strait Islander people (2020)The purpose of this review is to provide a comprehensive synthesis of key information on cancer among Aboriginal and Torres Strait Islander people in Australia to: (1) inform those involved or interested in Aboriginal and Torres Strait Islander health; and (2) provide the evidence for those involved in policy, strategy and program development and delivery.The review provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people. It provides detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation. This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people. It concludes by discussing possible future directions for combatting cancer in Australia. Guide to Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander People With CancerEach Optimal Care Pathway is underpinned by principles such as multidisciplinary care and care coordination. The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) incorporates additional concepts to support the delivery of culturally appropriate and responsive cancer care. It is the responsibility of the healthcare system and all people within its employment to address the needs of Aboriginal and Torres Strait Islander people in a culturally appropriate and responsive way. Patient Information Cancer Information for PatientsCancer Information for Aboriginal and Torres Strait Islander Peoples Websites/Webpages Australian Indigenous Doctors’ AssociationAustralian Indigenous Doctors’ Association (AIDA) offer an online Cultural Awareness course and face to face Cultural Safety training.Cancer Australia – For Aboriginal and Torres Strait Islander peopleThe site includes Aboriginal and Torres Strait Islander cancer statistics, Breast Cancer Awareness, Resources for Health Professionals and Resources for people with cancer.Culturally safe communication skills for non-Indigenous health professionalsThe resource comprises a series of short videos and a key messages tip sheet providing practical advice for cancer care specialists to optimise culturally safe and responsive communication with Aboriginal and Torres Strait Islander patients, their families and carers.The videos feature medical oncologists, cancer care co-ordinators, Aboriginal and Torres Strait Islander Liaison Officers and Health Workers, as well as Aboriginal and Torres Strait Islander people with cancer. The videos include delivering a diagnosis, staging and treatment, care after treatment and recover, and managing recurrent, residual and metastatic.There is also a summary Tip Sheet.Our Mob and Cancer This website provides culturally safe support and information for patients, their families, communities and health professionals. Information for health professionals is available here. Articles Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Services Research. 2013 Dec;13(1):1-3.A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal Cancer Service Providers (CSPs) from across WA and CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. The support has been brilliant: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services.Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. “The support has been brilliant”: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC health services research. 2021 Dec;21(1):1-5.Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience.This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples.Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Current opinion in supportive and palliative care. 2021 Sep 1;15(3):162-8.Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.
The following general resources have been collated to support clinical radiologists and radiation oncologists to enhance cultural competency and promote cultural safety.
The first step, acknowledgement of difference. Recognising that your culture and behaviour are different.
Being aware of cultural differences and understanding the need to respect cultural difference.
Cultural competence has been defined as a clinician who 'has the attitudes, skills and knowledge needed to function effectively and respectively when working with and treating people of different cultural backgrounds'.
Cultural safety requires clinicians to examine themselves and the potential impact of their own culture on clinical interactions and service delivery. This required individuals and health care organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.
In doing so, cultural safety encompasses a critical consciousness where health care workers and health care organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care.
Te Tahū Hauora. 2023. Health literacy, equity, cultural safety and competence. URL: Health literacy, equity, cultural safety and competence | Health Quality & Safety Commission (hqsc.govt.nz)
Council of Medical Colleges New Zealand and Te ORA. 2023. Cultural Safety Training Plan for Vocational Medicine in Aotearoa. URL: cultural-safety-training-plan-for-vocational-medicine-in-aotearoa.pdf (cmc.org.nz)
The following are links to websites for news, information and resources about Aboriginal and Torres Strait Islander people and Maori people in relation to health.
The Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions like the forced removal of children from their families.
Specific pages:
These short fact sheets provide useful overview of demographics and social determinants.
Short articles (400-500 words) and accompanying YouTube videos on specific topics such as ‘What is country and the stolen generation.
Some articles might help clinicians understand the perspectives of First Nations people. For example, Death and Sorry Business and protocols of bereavement.
An Aboriginal and Torres Strait Islander organisation working for the health and wellbeing of Australia’s First Peoples through high impact quality research, knowledge translation, and by supporting Aboriginal and Torres Strait Islander health researchers.
The portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive healthcare that is free from racism. Links are provided here to Aboriginal and Torres Strait Islander health and cultural safety resources with links for specific medical disciplines.
Leaders in Indigenous Medical Education resources hub was developed to enhance information sharing and develop deliver initiatives in Indigenous medical and health education and encourage the development of Indigenous health as a discipline. Ao Mai te Rā | The Anti-Racism KaupapaManatū Hauora published this website as part of Ao Mai te Rā | the Anti-Racism Kaupapa initiative to support the health system to better understand, react and respond to racism in health.Other sites Stop Institutional RacismSTIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.The site contains links to current news and includes a page of resources.
Manatū Hauora published this website as part of Ao Mai te Rā | the Anti-Racism Kaupapa initiative to support the health system to better understand, react and respond to racism in health.
STIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.
The site contains links to current news and includes a page of resources.
A trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori. The episodes include hearing from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of “unequal outcomes”- in the real world, “unequal outcomes” means sickness and death.
Just five years ago this Northern Territory hospital was facing closure, its doctors were out of their depth and indigenous patients were leaving the wards in droves. This is the remarkable story of how Katherine Hospital turned its fortunes around. It now ranks among Australia's best for its relationship with its indigenous patients. How did the hospital do it and what lessons does this have for the rest of the nation?
Indigenous Health MedTalk covers topics related to women's and men's health, family health and wellness, mental health, sexual health and community innovations related to and affecting Aboriginal and Torres Strait Islander people.
Ask the Specialist is a podcast for health professionals who work with Aboriginal patients. Created in the Northern Territory of Australia, doctors from Royal Darwin Hospital ask Larrakia, Tiwi and Yolngu leaders (the ‘Specialists’) to answer their questions which span clinical to philosophical issues.
The Ministry has developed a video and podcast series to build collective understanding of the impacts of racism on health, while also exploring key levers in the health system that could be used for change
This podcast series from NZ Herald is about how Pakeha New Zealanders could learn to acknowledge the injustice of colonisation and do something practical about it.
You Tube resource developed by the Western Australia Department of Health, which explains some of the history of Aboriginal and Torres Strait Islander people and the effects of colonisation and oppression on health and wellbeing.
This video series includes stories about engaging with healthcare services from a Maori perspective.
Presentation by Professor David Tipene Leach on why understanding bias contributes to anti-racism and promotes equity. The presentation was sponsored by Choosing Wisely and Eastern Institute of Technology Te Whare Takiura o Kahungunu, Hawke’s Bay.
The following online modules are available for completion. Some modules requirement payment of a fee.
The Royal Australasian College of Physicians (RACP) have granted permission for RANZCR trainees to complete the RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource. This resource includes in-depth content, video scenarios, reflection and discussion activities and recommended further resources. This module is a Phase 2 requirement for Clinical Radiology trainees. Understanding bias in health careThree learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.Understanding and addressing implicit biasTe Tiritio Waitangi, colonisation and racismExperiences of bias MaurioraMauriora provides two courses:Cultural Competency (Maori) - developed specifically for the registered New Zealand workforce and provides a basic understanding of cultural competency in the New Zealand Health context. 3 modules.Te Tiritu o Waitangi and Maori Health – Four modules, takes 1-3 hours to complete. University of Sydney – Kinship ModuleOnline learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives.
Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.
Mauriora provides two courses:
Online learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.
See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives.
General guide developed by Queensland Health.
Reference tool to support healthcare staff in delivering safe, clinically and culturally responsive inpatient care to Aboriginal and Torres Strait Islander patients, developed by Queensland Health. Includes information on:
Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. This document aims to provide some insight into appropriate cultural practices and identify tools that will assist in providing culturally and clinically responsive care for Aboriginal and Torres Strait Islander patients and their families.
The framework provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations, developed by the Victorian Department of Health.
If your study involves Māori participants or research on issues relevant to Māori health, you should undertake appropriate and relevant consultation with Māori communities that will be involved in the design, development and implementation of the research. This webpage provides links to guidelines for researchers.
Guidelines on ethical conduct of research with Aboriginal and Torres Strait Islander peoples and communities.
Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia. 2002 May;176(10):466-70.
Bourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Australian Health Review. 2018 Nov 21;43(6):611-8.
The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation.
Jennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health. 2018 May 8;24(2):109-15.
By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system.
Curtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health. 2019 Dec;18(1):1-7.
A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.
Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health. 2021 Jan;18(6):3014.
This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Six themes were identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.
Jones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International journal for equity in health. 2020 Dec;19(1):1-1.
It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature.
To search for articles specific to medical specialties …
Search tool which provides easy access to Aboriginal and Torres Strait Islander health literature on the PubMed database.
Australian Indigenous HealthInfoNet (2022). Overview of Aboriginal and Torres Strait Islander health status 2021. Perth: Australian Indigenous HealthInfoNet.
The Overview aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people.
Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Telethon Kids Institute, Kulunga Aboriginal Research Development Unit, Department of the Prime Minister and Cabinet (Australia); 2014 May 1.
Dune T, McLeod K, Williams R, editors. Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care. Routledge; 2021 May 30.
Scott K. Indigenous Australian health and cultures: an introduction for health professionals. Pearson; 2010.
Individuals can complete the following courses. Check the websites for registration and fee information.
This course comprises on-line learning modules, one on-site training seminar and an assessment module. The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, with a special focus on the application of the Hui Process and Meihana Model.
It aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing the cultural awareness of GPs, general practice staff, primary healthcare staff and other healthcare providers. This 6 hour activity aims to help participants to:
Two courses, which take around 10 hours each, designed to be completed over 12 months.
Small individual modules of 30 minutes each
Victoria University – Future Learn
4 weeks, 3 hours per week, available at selected times.
Not specific to health care – designed more for relationships in the workplace
Cultural Competence Online Modules
4 hours, with a maximum of 90 days to complete.
Allen + Clarke 2020, Baseline Data Capture: Medical Council of New Zealand and Te Ohu Rata o Aotearoa, Wellington. ISBN 978-0-473-54688-5 (Epub)
October 2019.
This statement outlines what cultural safety means, why it is important and how doctors need to reflect on their own biases and attitudes to understand how these can impact on how patients receive their care.
October 2019
This document outlines the Medical Council of New Zealand’s position on how doctors can support the achievement of best health outcomes for Māori. It also provides guidance for healthcare organisations to support achieving cultural safety and Māori health equity1. It has been developed in partnership with Te Ohu Rata O Aotearoa, the Māori Medical Practitioners Association (Te ORA).
Watego, C., Singh, D. & Macoun, A. 2021, Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, DOI: 10.48455/sdrt-sb97
The College is committed to supporting the professions of Clinical Radiology and Radiation Oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and is reflected in the College’s Strategic Plan.This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.To view the RANZCR Statement of Intent in its entirety, click here.
This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.To view the RANZCR Statement of Intent in its entirety, click here.
To view the RANZCR Statement of Intent in its entirety, click here.
The following resources are specific to Radiation Oncology.
National Indigenous Cancer Network (NiCAN) is a partnership between the Menzies School of Health Research, the Australian Indigenous HealthInfoNet, the Lowitja Institute and Cancer Council Australia.
NICaN was established in 2013 and aims to improve health services for Indigenous people with cancer. NICaN brings together Indigenous audiences, consumers, service providers, researchers and health professionals from a broad range of disciplines, as well as private sector and government organisations.
The NiCaN online portal is now accessed via the HealthInfoNet site, it was originally on the Menzies School of Health Research website.
The purpose of this review is to provide a comprehensive synthesis of key information on cancer among Aboriginal and Torres Strait Islander people in Australia to: (1) inform those involved or interested in Aboriginal and Torres Strait Islander health; and (2) provide the evidence for those involved in policy, strategy and program development and delivery.
The review provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people. It provides detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation. This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people. It concludes by discussing possible future directions for combatting cancer in Australia.
Each Optimal Care Pathway is underpinned by principles such as multidisciplinary care and care coordination. The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) incorporates additional concepts to support the delivery of culturally appropriate and responsive cancer care. It is the responsibility of the healthcare system and all people within its employment to address the needs of Aboriginal and Torres Strait Islander people in a culturally appropriate and responsive way.
Australian Indigenous Doctors’ Association (AIDA) offer an online Cultural Awareness course and face to face Cultural Safety training.
The site includes Aboriginal and Torres Strait Islander cancer statistics, Breast Cancer Awareness, Resources for Health Professionals and Resources for people with cancer.
The resource comprises a series of short videos and a key messages tip sheet providing practical advice for cancer care specialists to optimise culturally safe and responsive communication with Aboriginal and Torres Strait Islander patients, their families and carers.
The videos feature medical oncologists, cancer care co-ordinators, Aboriginal and Torres Strait Islander Liaison Officers and Health Workers, as well as Aboriginal and Torres Strait Islander people with cancer. The videos include delivering a diagnosis, staging and treatment, care after treatment and recover, and managing recurrent, residual and metastatic.
There is also a summary Tip Sheet.
This website provides culturally safe support and information for patients, their families, communities and health professionals.
Information for health professionals is available here.
Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Services Research. 2013 Dec;13(1):1-3.
A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal Cancer Service Providers (CSPs) from across WA and CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer.
Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes.
Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. “The support has been brilliant”: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC health services research. 2021 Dec;21(1):1-5.
Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience.
This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service.
Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Current opinion in supportive and palliative care. 2021 Sep 1;15(3):162-8.
Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.