title: Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting.
abstract: OBJECTIVE
  To report Aboriginal patients' views about effective communication between Aboriginal people and health service providers in Western Australian hospital settings.
  
  
  METHODS
  Qualitative study involving indepth interviews between 1 March 2006 and 30 September 2007 with 30 Aboriginal people affected by cancer from across WA.
  
  
  METHODS
  Aboriginal patients' views about the quality of communication within the hospitals, factors impairing communication and suggestions for improvement.
  
  
  RESULTS
  Factors crucial to effective patient-provider communication such as language, shared understanding, knowledge and use of medical terminology require attention. Additionally, communication between Aboriginal people and health care professionals needs to be understood within a broader sociocultural and political context. Fear of the medical system and of being disempowered; mistrust; collective memories of the experience of colonisation and its aftermath; lack of understanding of Aboriginal customs, values, lifestyle and the importance of family and land; and experiences of racism were key issues impairing communication. Health service providers' inability to interpret non-verbal communication and the symbolism of hospital environments also posed problems.
  
  
  CONCLUSIONS
  Key areas for the attention of health service providers in communicating and caring for Aboriginal people in the hospital setting include culturally sensitive and empathetic personal contact, acknowledgement and respect for Aboriginal family structures, culture and life circumstances, an understanding of the significant role of non-verbal communication, and the importance of history, land and community. Employing more Aboriginal health workers in hospitals, and allowing Aboriginal people to participate at a decision-making level in hospitals is likely to improve Aboriginal people's access to cancer treatment, and would be important symbols of progress in this area.
authors.affiliation: Centre for International Health, Curtin University of Technology, Perth, WA, Australia. s.shahid@curtin.edu.au
authors.forename: Shaouli
authors.initials: S
authors.lastname: Shahid
authors.forename: Lizzie D
authors.initials: LD
authors.lastname: Finn
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003144:Communication Barriers; D005190:Family; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011287:Prejudice; D011369:Professional-Patient Relations; D012424:Rural Population; D014505:Urban Population; D014904:Western Australia