The Canadian Partnership Against Cancer (the Partnership) is working together with First Nations, Inuit and Métis peoples and partners, and cancer service providers to improve the cancer experience of First Nations, Inuit and Métis throughout the continuum of care, from prevention to end of physical life or survivorship. To accomplish this goal, there are currently (as of 2015) six strategic Partnership initiatives with multiple projects, working with First Nations, Inuit and Métis cancer patients, communities and organizations.
First Nations, Inuit and Métis Cancer Control Initiative
The First Nations, Inuit and Métis Cancer Control Initiative (also referred to as the Continuity of Care Initiative) aims to advance improvements in continuity of care in a culturally responsive and safe way, with First Nations, Inuit and Métis cancer patients residing in rural, remote and isolated communities by March 2017. The focus of the Initiative is on improving supports provided at the time of diagnosis, and at several points throughout care including patients’ return from treatment centres to their home community.
The 10 multi-jurisdiction/multi-year initiatives
Launched in March 2014, the Partnership has invested in 8 multi-jurisdiction/multi-year initiatives, spanning across the Yukon, Northwest Territories, British Columbia, Alberta, Saskatchewan, Manitoba, Quebec and Newfoundland and Labrador. For some of these jurisdictions, the Initiative represents foundational work to build cancer control strategies specific to First Nations, Inuit and Métis and for other jurisdictions, they are working to enhance existing efforts.
This initiative takes a multi-faceted approach to improving the First Nations cancer journey in the Yukon, specifically in relation to diagnosis delivery and discharge planning. The work is carried out in collaboration and partnership with the Yukon government and First Nations across the territory to advance the following outcomes:
- education and training for more informed First Nations patients
- education and training for health-care providers within the Yukon to support better continuity of care from diagnosis to discharge
- consistency in practices around diagnosis, delivery and discharge planning
- implementation of a culturally meaningful way of supporting patients through diagnosis to discharge
This initiative brings the Department of Health and Social Services together with Northwest Territories communities, regional health and social services authorities, Indigenous governments, the Stanton Elders’ Council, Alberta Health Services, the Northern Health Services Network, the NWT Breast Health/Breast Cancer Action Group and other important stakeholders in the Northwest Territories.
Recognizing that communities are a critical part of the health-care system, this project will strengthen the cancer care system in the Northwest Territories and assist communities to support cancer patients. This involves relationship building, developing language and tools to speak productively about cancer, and integrating greater support for patients and caregivers along the continuum of care. The project aims to:
- strengthen the Northwest Territories health system to serve and support First Nations, Inuit and Métis cancer patients and their families in a culturally safe and supportive way
- increase knowledge among First Nations, Inuit and Métis cancer patients and their families about the cancer journey
- identify ways to increase the use of telehealth and other remote communication technologies by cancer patients and care providers in the Northwest Territories
The First Nations Health Authority, BC Cancer Agency, Provincial Health Services Authority, Métis Nation British Columbia and British Columbia Association of Aboriginal Friendship Centres have joined forces to create a better understanding of the needs and opportunities for improving the cancer journey for First Nations, Inuit and Métis in British Columbia.
Preliminary engagement with First Nations, Inuit and Métis cancer patients and care providers in British Columbia suggests there are gaps in culturally appropriate resources and organizational protocols/processes for ensuring cultural safety and access to traditional health support. Through this project, the partners will work together to address these gaps and improve existing services and supports through the continuum of cancer care from diagnosis to discharge.
Efforts will focus on developing additional tools and resources, enhancing health literacy of patients and cultural competency of practitioners, and enhancing multi-jurisdictional cooperation and partnerships.
This is a collaborative project with Alberta First Nations and CancerControl Alberta (part of Alberta Health Services). Other partners include the Alberta First Nations Information Governance Centre, First Nations Inuit Health Branch, Indigenous Nurses Association of Canada and Indigenous Physicians Association of Canada. The goals of the project are to:
- increase First Nations and Métis knowledge and understanding of cancer and cancer care services
- educate health-care workers about First Nations and Métis people in Alberta
- better coordinate care and services for First Nations and Métis people with cancer
- increase access to culturally responsive cancer care services
- develop educational resources and tools to support First Nations and Métis cancer pathways
Cancer is a growing health concern among First Nations and Métis populations and sustainable, meaningful improvements in health outcomes are imperative. However, without reliable health data specific to First Nations and Métis in Saskatchewan, it is difficult to design culturally relevant programs and services that can effectively address the gaps in cancer control.
In Saskatchewan, the cancer journey of First Nations and Métis people often crosses health-care systems, providers, geographic locations and cultures. This prompted the Federation of Sovereign Indigenous Nations (FSIN) and the Saskatchewan Cancer Agency to come together in an unprecedented partnership to review current cancer surveillance systems and practices.
Ultimately, improved data related to the cancer experience of First Nations and Métis will serve as the foundational component necessary to advance cancer care services across the continuum of care and reduce the burden of cancer among First Nations and Métis people in Saskatchewan.
In consideration of the unique needs of First Nations and Inuit cancer patients in Manitoba, an initiative was developed in partnership with First Nations and Inuit cancer stakeholders to improve the continuity of their cancer care in the province.
The initiative’s first objective is to enhance transitions between cancer care and primary care by improving communication between the two. This objective will be met through the adaption of the existing cancer transition toolkits (which include a patient-specific follow-up care plan and resources) to ensure they will meet the needs of First Nations and Inuit patients and family, and the health-care providers who serve them. The toolkit is provided to a patient during a transition appointment (a new appointment type where a health-care provider reviews the next steps in a patient’s care). Audio recording of the transition appointment will also be introduced to remove the barriers of literacy and language. Patients can take the information home, review it and share it.
The second objective is to improve existing practices used to deliver a cancer diagnosis to patients and their families, to ensure that culturally and emotionally safe methods are used. Diagnosis delivery guidelines and a patient story video will be developed, forming the basis of diagnosis delivery training for health-care providers. In addition, a patient support tool for use during a diagnosis delivery appointment will be developed. The diagnosis delivery guidelines, patient video and patient support tool will be made publicly available.
This initiative was developed and is guided by a Project Network. The Project Network includes those who provided formal letters of support for the project in the beginning and those who are engaged in the work as it progresses.
This initiative aims to increase the quality and cultural relevance of health care and health services for First Nations, Inuit and Métis patients with cancer. It was developed by the Nunavik Regional Board of Health and Social Services (area 17) and the Cree Board of Health and Social Services of James Bay (area 18).
This initiative will make it possible to:
- Provide culturally relevant services to improve the efficacy of the health-care system for patients. Patients’ compliance with treatment, as well as their motivation to self-manage their condition, depends on their level of acceptance of the health-care approach they receive. This compliance also depends on their understanding of their treatment options. Taking into account the cultural dimension of health services also makes it possible to fulfill the need for a comprehensive approach to cancer care and to reduce disparities related to cultural differences.
- Improve the coordination of health-care services for Inuit and Cree patients. There is a lack of coordination in the health-care system with respect to managing chronic diseases – especially in remote areas.
- Improve access to health-care and cancer care services in Nunavik and Eeyou Istchee through the development of local health-care provision.
- Position areas 17 and 18 within the national cancer control network.
A three-year initiative of the Cancer Care Program of Eastern Health is aimed at enhancing cancer care services for Labrador Inuit, Innu and members of the NunatuKavut Community Council Inc. Titled Journey in the Big Land, the initiative recognizes the unique challenges faced by many First Nations, Inuit and Métis when confronted with a cancer diagnosis, including language barriers, cultural differences and geographical isolation from primary care and secondary and tertiary health centres.
The initiative will focus on three priority areas:
- enhance transitions in care between hospitals and the community setting
- expand tele-oncology for enhanced consultation between oncology specialists, family physicians, nurses in community clinics and patients themselves
- increase cultural sensitivity through employee training programs, information packages in the languages of the Labrador First Nations, Inuit and Métis groups and the placement of Labrador imagery at the Dr. H. Bliss Murphy Cancer Centre
More work with and for First Nations, Inuit and Métis people at the Partnership
The Partnership strives to embed First Nations, Inuit and Métis patient voices and perspectives in all of its work. Efforts are taken to facilitate and encourage engagement of First Nations, Inuit and Métis communities and organizations in the Partnership’s initiatives.
Coalitions Linking Action and Science for Prevention, or CLASP, is a Partnership initiative that aims to improve the health of communities and of Canadians. CLASP does this by bringing together organizations from two or more provinces and territories, with research, practice and policy experts forming coalitions to integrate cancer prevention with strategies to prevent other chronic diseases. CLASP responds to the fact that many aspects of healthy living and a healthy environment can reduce the risk not only of cancers, but also of chronic diseases such as diabetes, lung disease and heart disease.
Through CLASP, the Partnership has three strategic initiatives that engage First Nations communities:
- Working on Wellness in Strategic Populations (WoW)
- Nourishing School Communities
CAREX Canada is a national surveillance project that estimates the number of Canadians exposed to substances associated with cancer in workplace and community environments. These estimates provide significant support for targeting exposure reduction strategies and cancer prevention programs. CAREX Canada and partners (University of Victoria, First Nations Environmental Health Innovation Network (FNEHIN) and Propel Centre for Population Health Impact) are working with representatives from five First Nations organizations to develop pilot training projects on the CAREX tools (e.g., Emissions Mapping Project, eRISK and eWORK).
Research shows tobacco use by cancer patients reduces the effectiveness of their treatment and their likelihood of survival. There is an opportunity for the tobacco control and cancer control communities to work together to help prevent Canadians from starting to smoke, help those who wish to quit smoking, and specifically support Canadian cancer patients who wish to quit smoking. In 2014, the Partnership established a new initiative to support better integration of tobacco control and cancer control resources across the country.
Leading Practices in First Nations, Inuit and Métis Smoking Cessation is a scan which provides information on current practices in smoking cessation programs developed by, with and for First Nations, Inuit and Métis across Canada by jurisdiction. The scan is updated annually.
Cancer care must be responsive and centred on the needs of the individuals living with cancer. Embedding a person-centred perspective requires an approach to cancer care that is respectful of and responsive to each patient’s preferences, needs and values. These attributes are critical to providing the right care for the right person at the right time.
The Partnership and our provincial, territorial and cancer organization partners have long understood this fact. We have chosen to make person-centred care a foundational element in efforts to improve cancer control.
From 2014 to 2017, the Partnership invested in strategic initiatives that will guide more person-centred approaches to cancer control. Of the 14 Person-centred Perspective initiatives, five reach out to First First Nations, Inuit and Métis. They are:
- Canadian Virtual Hospice Knowledge Tools: addressing national gaps (Canadian Virtual Hospice, across multiple provinces and territories)
- Enhancing End of Life Care for Cancer Patients and Their Families: integrating emergency health services and palliative and end-of-life care to enhance the end-of-life experience in Nova Scotia and PEI (Cancer Care Nova Scotia, Emergency Health Services Nova Scotia, Health PEI)
- The Integrate Project: an Initiative to Integrate Palliative Care (Cancer Care Ontario, CHU Laval in Quebec)
- Dialogue and Story Work in support of First Nations, Inuit and Métis Cancer patients throu ghout oncology and primary care transition experience (Government of Northwest Territories, Alberta Health Services)
- Improving Patient Experience and Health Outcomes Collaborative (iPEHOC) (Cancer Care Ontario, Rossy Cancer Network, Montreal, Quebec)