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Module 9: Cancer Control Issues and Challenges

Module 9: Cancer Control Issues and Challenges . Welcome to Cancer Control Issues and Challenges. . This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module.

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Module 9: Cancer Control Issues and Challenges

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  1. Module 9: Cancer Control Issues and Challenges

  2. Welcome to Cancer Control Issues and Challenges. This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the module.

  3. Course Learnings By the time you complete this learning module you will be able to understand the impact of: Data and Awareness Gaps Lack of Physician / Poor Coordination of Care Transportation / Distance Issues Cancer Control Issues and Challenges

  4. Course Learnings By the time you complete this learning module you will be able to understand the impact of: You will also learn considerations for care planning and treatment for on-reserve FNIM. Modifiable Risk Factors Fear/Trust on Health Decisions Cancer Control Issues and Challenges

  5. In order to realize the benefits of an advanced system of health care, Canadian individuals must have physical, political and social access to those services; this is often not the case for FNIM people. Current health care services remain focused on communicable disease, while mortality and morbidity among FNIM people are increasingly resulting from chronic illness. Move forward to begin Chapter 1 Social access to health care is similarly limited or denied to FNIM people through health systems that account for neither culture nor language, or the social and economic determinants of FNIM peoples’ health.

  6. Chapter 1: Understanding/Awareness and Data Gaps “The first step in solving any problem is acknowledging there is a problem”

  7. Understanding and Awareness GapsFirst Nations, Inuit and Métis (FNIM) Understanding of the Health SystemIn general there appears to be a lack of awareness about cancer and cancer risk factors within FNIM communities.

  8. We know better cancer control begins with the modification of associated behavioural risk factors like: • Smoking • Alcohol use • Healthy dietary choices • Regular physical activity One of the keys to prevention and improving mortality rates in FNIM people, is to improve understanding of risk factors, controls and the importance of early detection.

  9. Cultural conceptions of cancer and other diseases may help explain lower rates of participation in: Prevention, early diagnosis, and treatment programs. It also can help overcome beliefs about cancer that may contribute to later-stage diagnoses. Health care information resources generally do not address the uniqueness of FNIM cultures. AwarenessGaps They also may experience difficulty accessing relevant resources to inform themselves. Education is needed not only to inform people about the facts of cancer, but also to help overcome: Therefore FNIM people may be unaware of the existence or benefits of these programs

  10. Provision of Health Services

  11. To improve mortality rates, FNIM peoples’ knowledge and awareness of diseases with a focus on prevention and screening needs to be significantly enhanced. This includes ensuring FNIM people understand the importance of timely access to accurate diagnosis and safe, high-quality care.

  12. Trusting relationships and culturally safe environments can work to encourage FNIM people to participate in: • screening, • and other prevention programs, • and contribute to more positive experiences. For example, frontline health staff specifically designated to support the unique needs of FNIM people, such as: Aboriginal Patient Navigators or translators that are on call 24/7, can help to increase awareness of the importance of certain measures and programs such as screening, while being sensitive to fears and beliefs.

  13. Health Care Provider Understanding of FNIM Cultural Needs in Health CareThe First Nations, Inuit and Métis (FNIM) population has noted they have experienced culturally insensitive health care, and at times, they also meet with subtle and overt racism. This has impacted decisions to seek health care support outside of the community. Source: Anishnawbe Health Toronto, http://www.aht.ca/aboriginal-culture-safety

  14. The experience of many FNIM people with the mainstream health care system has been negative, often due to cultural differences. Frequently, the differences and the inability of health providers to appropriately address them have contributed to high rates of: • noncompliance, • reluctance to visit mainstream health facilities even when service is needed, and • feelings of fear, disrespect and alienation.

  15. The First Step to Improving Understanding:

  16. Develop the general skills, attitude and awareness that culturally competent patient care requires. The understanding or adoption of the values or beliefs of that culture. Can clarify uncertainties. Background knowledge of a culture is important, but observing and asking questions Being born to or residing within a particular culture does not automatically generate : Second Steps to Understanding It is imperative that generalizations and assumptions about patients be avoided. Individual personality, experiences and outside influences can dictate what each patient: Desires and respects just as much, if not more, than the culture to which they belong.

  17. Overwhelming as it may seem for physicians to understand the background of the many diverse cultures in Canada: Taking small steps toward that understanding through communication and education will start to bridge the cultural gap.

  18. Data Gaps

  19. “You can’t manage what you don’t measure” is as true for disease prevention as for anything else. Data sources must be comprehensive, connected, complete, valid and accessible to both local and provincial health planners. Such as the cancer journey of Ontario’s FNIM people. The cancer system requires accurate FNIM baseline measures and regular updates to evaluate progress. There is very limited recent data on disease controls and outcomes. Research and Surveillance There is very limited to no data for on-reserve FNIM people, or the broader group of FNIM people: One of the most pressing needs to help develop population-specific programs is improved data. Not captured in the Canadian Community Health Survey (CCHS).

  20. Many factors play a role in the lack of cancer control data specific to FNIM populations: • Lack of cultural identifiers in existing databases • No surveillance systems that identify FNIM • Currently there is no central database for existing information, research and surveillance studies that have been done. • FNIM-specific data not available or extremely limited (incidence, mortality, morbidity, etc.) • Need for research on occupational and environmental risk factors • There is an historical reluctance of communities to participate in research studies based on previous trust issues and broken promises. • Lack of capacity at community level for interpretation and translation of research findings into practice. Good strides are being made in this direction.

  21. A step towards improving cancer data in Ontario: As part of Cancer Care Ontario’s (CCOs) Aboriginal Cancer Strategy II, CCO is working with the Chiefs of Ontario to develop cancer surveillance data through a joint application to Aboriginal and Northern Affairs Canada for the Ontario Indian Registry of all Status Indians in Ontario. The personal identifier information in the Indian Registry would then be compared with the Ontario Cancer Registry to create cancer surveillance data on the registered Indians in Ontario.

  22. System Integration An overarching concern is the need for a system of cancer control that integrates all components of the health-care system and implements services responsive to the practical and cultural needs of FNIM populations. Research and surveillance are shared responsibilities between federal and provincial/ territorial levels of government.

  23. Move forward to begin the quiz for this chapter

  24. Insert Quiz slide: Quiz for Chapter 1 The quiz for this chapter has one question. Q:Many factors play a role in the lack of cancer control data specific to FNIM populations; select each option that is accurate in contributing to the lack of data as outlined in this chapter. A: • Lack of cultural identifiers in existing databases
 • No surveillance systems that identify First Nations, Inuit and Métis.
 • The central database for existing information, research and surveillance studies that have been done are missing some data. • Research on occupational and environmental risk factors has not been updated in 10 years. • There is an historical reluctance of communities to participate in research studies based on previous trust issues and broken promises. • Lack of capacity at community level for interpretation and translation of research findings into practice.

  25. Chapter 2: No Family Physician and Poor Coordination of Care

  26. Lack of a Family PhysicianThere are FNIM people with limited access to a family physician or without a regular family physician. This is due to many factors that act as barriers to access including:

  27. Contact with a Medical Doctor: Past 12 Months Source: The Canadian Community Health Survey, 2009-2010

  28. Has a Regular Medical Doctor Source: The Canadian Community Health Survey, 2009-2010

  29. Additionally, 19.6% of FNIM people have their health needs unmet in comparison to 13.6% of the general Canadian population.

  30. Placeholder: Interview • [Shelley Gonneville discussion lack of family physicians in the community – herself included.]

  31. Poor Coordination of CareThere are inter-governmental barriers as well as cross-jurisdictional barriers that affect the coordination and collaboration of health services. We have discussed some of them earlier in this chapter as part of other learning.

  32. Barriers to Coordination and Collaboration Taking on responsibility for community health care is complicated for many communities. It is not uncommon for a community to be located across two or more regional health authorities, each with its own way of doing business • It complicates trying to build better links and access to services for their people. • There are also First Nations communities that cross both regional health authority boundaries but also provincial boundaries. • Programs funded by the governments are valued but are underfunded and there is little coordination between them. • The result is large gaps in services, e.g. leaving many seniors without the very basic kind of health care and supports available to other Canadian seniors.

  33. At the Community Level

  34. All levels are working together to develop improved coordination processes. These are covered in Module 4: Current Array of Aboriginal Health Services. Move forward to begin the quiz for this chapter

  35. Insert Quiz slide: Quiz for Chapter 2 This chapter has one true or false question. Q: Almost 20% of FNIM people have their health needs unmet in comparison to almost 14% of the general Canadian population. A:  True  False

  36. Chapter 3: Transportation/Distance, Expense and Jurisdictional Issues

  37. Canada Health Act based on Equity and Accessibility The Canada Health Act has the primary objective "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers". This tells us that a core Canadian value and a primary objective of provincial health systems continue to be addressing inequalities in health services access and health status among all residents. Yet we continue to see discrepancies in this and other reports. High rates of cancer risk factors among FNIM people are likely linked with recent increases in traditionally low cancer incidence rates among FNIM life expectancy.

  38. Impact of Jurisdictional Issues on Cancer ControlJurisdictional ChallengesWhile FNIM people are all recognized as Aboriginal under the Canadian Constitution Act of 1982, policies are not applied consistently across the groups. Therefore, each group faces its own unique set of challenges in navigating the Canadian health care system.

  39. More information about jurisdictional issues can be found in Module 4: Current Array of Aboriginal Health Services Source: British Columbia Provincial Health Officer, 2009

  40. Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.

  41. Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.

  42. Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.

  43. Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.

  44. A look at federally and provincially funded programs in Ontario It is important to understand when a patient may fall outside of the funding provided to determine how to straddle between federal and provincial funding. Included at the end of the learning module is a resource that will provide you an overview of funding and the gaps and overlaps

  45. Transportation Issues In 2002, Roy Romanow’s report, “Building on Values: The Future of Health Care in Canada”, describes the health impacts of living in the far north:“... geography is a determinant of health. ... Access to health care also is a problem, not only because of distances, but because these communities struggle to attract and keep nurses, doctors and other health care providers.... let alone accessing diagnostic services and other more advanced treatments... facilities are limited and in serious need of upgrading. (People must)... travel in order to access the care they need. This often means days or weeks away from family and social support as well as the added cost of accommodation and meals.”

  46. One-third of FNIM communities are located in rural, remote or isolated areas Defined by Health Canada

  47. This is due to a number of factors including: 78% of Inuit live in remote, isolated regions with a similar number of inhabitants. More than 60% of First Nations communities are remote or are fly-in with no road access. 60 %of First Nations communities have less than 500 people. 7 % have more than 2,000 people. This means that physical and human resources are often scarce due to geographical dispersion. Accessing health services is a challenge due to the burden of travel and associated costs . Distances from facilities dissuade many FNIM people from accessing these services, regardless of the type of community in which they live. Source: The Assembly of First Nations

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