Optimal Care Pathways: Proposed changes in the refresh of the Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer
Cancer Australia
Who funded the project
The purpose of this project was to present a summary of key themes and proposed changes for expert consideration for the refresh of the Optimal Care Pathway (OCP) for Aboriginal and Torres Strait Islander people with cancer, as informed by a rapid review of published evidence and stakeholder consultation activities.
The OCP for Aboriginal and Torres Strait Islander people with cancer, published in 2018, is undergoing an update:
to ensure that it is fit for purpose;
to ensure it reflects current evidence and available resources;
to refresh the narrative around Aboriginal and Torres Strait Islander health equity and cancer care; and
to incorporate implementation opportunities from the Guide to Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer and case studies/best practice examples of optimal cancer care.
Karabena Consulting completed a rapid review of literature and stakeholder consultation workshops to inform this update of the OCP. We delivered a report on the consultation findings for Cancer Australia to use in the rewrite of the OCP.
Summary
Optimal Care Pathways (OCPs) outline consistent, safe, high quality, and evidence-based care for people with cancer. They aim to improve patient outcomes by setting the benchmark for quality cancer care and ensuring that all people affected by cancer receive the best care, irrespective of who they are or where they live.
OCPs map nationally agreed best practice approaches for certain populations and tumour types across the cancer care continuum, placing patients at the centre of care. They are designed to be used in conjunction with clinical guidelines, ensuring a comprehensive approach to cancer care.
The pathway describes the optimal cancer care that should be provided at the seven key steps along the cancer continuum:
Prevention and early detection
Presentation, initial investigations and referral
Diagnosis, staging and treatment planning
Treatment
Care after initial treatment and recovery
Managing recurrent, residual or metastatic disease
End-of-life care.
While the steps are presented in a linear model, patient care may not follow a linear path. Additionally, a person may present at any stage along the cancer continuum.
There are seven key principles of optimal cancer care that underpin the guidance provided in the pathway and remain central to the delivery of quality care throughout the patient experience including: patient-centred care, safe and quality care, multidisciplinary care, supportive care, care coordination, communication, and research and clinical trials. For some populations, including Aboriginal and Torres Strait Islander people, there are additional and unique principles that need to be considered in planning care.
Project Aims
Our methodology integrated quantitative and qualitative approaches. Key elements included:
Review of existing resources: We thoroughly reviewed the evidence from 2018 – 2024 to ensure the refresh of the OCP included the latest published evidence.
Online and face-to-face consultations: We undertook consultations from December 2023 – February 2024. Stakeholder consultations included three national virtual workshops for service providers, two face-to-face workshops for service providers in Melbourne and Perth, and separate yarning circle-style consultations for Aboriginal and Torres Strait Islander people with lived experience of cancer. Approximately 70 stakeholders contributed feedback and input, representing a broad spread of services, professions, geography and demographics.
We relied on ongoing collaboration with stakeholders to highlight opportunities and aspirations. This ensured that the consultation report aligned with the perspectives of people invested in the OCP for Aboriginal and Torres Strait Islander People Living with Cancer.
Consultation workshops included participant discussion of policy-related issues associated with system and service enhancements, such as funding for staff and services. Common themes included:
The key role of Aboriginal and Torres Strait Islander health workforce with regard to the provision of optimal cancer care throughout the pathway for Aboriginal and Torres Strait Islander patients, their families and carers.
Acknowledgement that Aboriginal Community Controlled Organisations occupy a fundamental position in delivering culturally attuned care to Aboriginal and Torres Strait Islander communities, including the role of Aboriginal Community Controlled Health Organisations in optimal cancer care services.
Culture-led data collection: We utilised Indigenous research methodologies like Dadirri and yarning, as well as surveys. This allowed for respectful and inclusive data collection that prioritised community ownership and cultural safety.
Methodologies
The key output for this project was a Report on the consultation findings for Cancer Australia to use in the rewrite of the Optimal Care Pathway.
The report detailed our findings and recommendations across the key areas of context, principle, unique considerations and the steps involved in providing appropriate care to Aboriginal and Torres Strait Islander people with lived experiences of cancer care.
The findings of this project were again reviewed by Aboriginal and Torres Strait Islander people with lived experience of cancer, as well as professionals who have supported Aboriginal and Torres Strait Islander people on their cancer journey.
Cancer Australia then completed internal rounds to ensure the final OCP would reflect the evidence and the care needs of Aboriginal and Torres Strait Islander people across the country.
The updated OCP is due for release in the latter part of 2024.
Outputs
A ‘refreshed’ OCP for Aboriginal and Torres Strait Islander patients with a greater amount of buy in from the community, including the community controlled sector, to support and manage people’s cancer journey including:
Cultural Competency Training: Mandate comprehensive cultural competency training for all health care providers to ensure culturally sensitive care.
Community Engagement: Enhance community engagement strategies to include local Elders and community leaders in decision-making processes.
Holistic Care Approach: Incorporate traditional healing practices and a holistic approach to cancer care, addressing physical, emotional and spiritual needs.
Navigation Support: Introduce Indigenous Patient Navigators to guide patients through the health care system, ensuring continuity of care and support.
Telehealth Services: Expand telehealth services to improve access to care for remote and rural Aboriginal and Torres Strait Islander communities.
Screening Programs: Increase funding and resources for culturally tailored cancer screening programs to improve early detection rates.
Research and Data Collection: Prioritise research and data collection on cancer outcomes specifically for Aboriginal and Torres Strait Islander people to inform policy and practice
Partnerships and Collaboration: Strengthen partnerships between health care providers, Indigenous organisations, and government bodies to create a unified approach to cancer care.
Awareness and Education: Implement awareness and education campaigns focused on cancer prevention, treatment options and survivorship, tailored to Indigenous communities.
Support Services: Expand access to psychological and social support services for patients and their families, including grief and bereavement support.
Project Outcomes
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