Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: a qualitative study.
Delayed presentation of symptomatic cancer is associated with poorer survival. Aboriginal patients with cancer have higher rates of distant metastases at diagnosis compared with non-Aboriginal Australians. This paper examined factors contributing to delayed diagnosis of cancer among Aboriginal Australians from patient and service providers' perspectives.



In-depth, open-ended interviews were conducted in two stages (2006-2007 and 2011). Inductive thematic analysis was assisted by use of NVivo looking around delays in presentation, diagnosis and referral for cancer.



Aboriginal patients with cancer/family members (n=30) and health service providers (n=62) were recruited from metropolitan Perth and six rural/remote regions of Western Australia.



Three broad themes of factors were identified: (1) Contextual factors such as intergenerational impact of colonisation and racism and socioeconomic deprivation have negatively impacted on Aboriginal Australians' trust of the healthcare professionals; (2) health service-related factors included low accessibility to health services, long waiting periods, inadequate numbers of Aboriginal professionals and high staff turnover; (3) patient appraisal of symptoms and decision-making, fear of cancer and denial of symptoms were key reasons patients procrastinated in seeking help. Elements of shame, embarrassment, shyness of seeing the doctor, psychological 'fear of the whole health system', attachment to the land and 'fear of leaving home' for cancer treatment in metropolitan cities were other deterrents for Aboriginal people. Manifestation of masculinity and the belief that 'health is women's domain' emerged as a reason why Aboriginal men were reluctant to receive health checks.



Solutions to improved Aboriginal cancer outcomes include focusing on the primary care sector encouraging general practitioners to be proactive to suspicion of symptoms with appropriate investigations to facilitate earlier diagnosis and the need to improve Aboriginal health literacy regarding cancer. Access to health services remains a critical problem affecting timely diagnosis.
Centre for Aboriginal Studies, Curtin University Western Australian Centre for Rural Health, University of Western Australia.
Shaouli
S
Shahid
Western Australian Centre for Rural Health, University of Western Australia.
Tiew-Hwa Katherine
TH
Teng
Centre for Aboriginal Medical and Dental Health, University of Western Australia.
Dawn
D
Bessarab
School of Nursing, Midwifery and Paramedicine, Curtin University.
Samar
S
Aoun
South West Radiation Oncology Service, Western Australia.
Siddhartha
S
Baxi
Western Australian Centre for Rural Health, University of Western Australia.
Sandra C
SC
Thompson
D000328:Adult; D057210:Delayed Diagnosis / Q000401:mortality / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006303:Health Services, Indigenous / Q000592:standards; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014904:Western Australia / Q000453:epidemiology / Q000208:ethnology
Aboriginal; Cancer; Indigenous health; diagnosis; health seeking behaviour; health service delivery