title: Sharing the true stories: improving communication between Aboriginal patients and healthcare workers.
abstract: OBJECTIVE
  To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication.
  
  
  METHODS
  Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication.
  
  
  METHODS
  A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001.
  
  
  METHODS
  Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers.
  
  
  METHODS
  Factors influencing the quality of communication.
  
  
  RESULTS
  A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.
  
  
  CONCLUSIONS
  Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.
authors.affiliation: Cooperative Research Centre for Aboriginal and Tropical Health, Menzies School of Health Research, PO Box 41096, Casuarina, NT 081. alancass@menzies.edu.au
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Anne
authors.initials: A
authors.lastname: Lowell
authors.forename: Michael
authors.initials: M
authors.lastname: Christie
authors.forename: Paul L
authors.initials: PL
authors.lastname: Snelling
authors.forename: Melinda
authors.initials: M
authors.lastname: Flack
authors.forename: Betty
authors.initials: B
authors.lastname: Marrnganyin
authors.forename: Isaac
authors.initials: I
authors.lastname: Brown
mesh_terms: D003142:Communication; D003144:Communication Barriers; D006282:Health Personnel; D015876:Northern Territory; D000095283:Australian Aboriginal and Torres Strait Islander Peoples