title: Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review.
abstract: OBJECTIVE
  We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples.
  
  
  METHODS
  Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies.
  
  
  RESULTS
  Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures.
  
  
  CONCLUSIONS
  Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples.
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Rona
authors.initials: R
authors.lastname: Tranberg
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Alexander
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hatcher
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mackey
authors.affiliation: Western Australian Centre for Rural Health (WACRH), University of Western Australia, Perth, Australia.|School of Nursing, Midwifery and Para Medicine, Curtin University, Perth, Australia.
authors.forename: Shaouli
authors.initials: S
authors.lastname: Shahid
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Lynda
authors.initials: L
authors.lastname: Holden
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Cannas
authors.initials: C
authors.lastname: Kwok
mesh_terms: D001294:Attitude to Health / Q000208:ethnology*; D003657:Decision Making; D003695:Delivery of Health Care; D006303:Health Services, Indigenous / Q000458:organization & administration; D006801:Humans; D009369:Neoplasms / Q000208:ethnology* / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D044382:Population Groups / Q000706:statistics & numerical data*; D036301:Qualitative Research