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 Peoples throughout the continuum of care from prevention to end of physical life or survivorship. To accomplish this goal, there are currently (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 aims to advance improvements in continuity of care, in a culturally responsive and safe way, with and for 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 eight 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 project represents a multi-faceted approach of implementing several priorities pertaining to the First Nations and Métis cancer journey within Yukon, specifically in relation to diagnosis delivery and discharge planning. The work will be carried out in collaboration and partnership with the Yukon cancer system and advance the following outcomes:
- Education and training for more informed First Nations, and Métis patients,
- Education and training for health care providers within 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 and development of a patient identification strategy.
Believe in our Healing Journey: Supporting Continuity of Care of First Nations, Inuit and Métis (FN/I/M) Cancer Patients in the Northwest Territories brings the Department of Health and Social Services together with Northwest Territories (NWT) communities, regional health and social services authorities, Aboriginal 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 NWT.
Recognizing that communities are a critical part of the health care system, this project will strengthen the cancer care system in the NWT 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 NWT health system to serve and support Aboriginal cancer patients and their families in a culturally safe and supportive way; increase knowledge among Aboriginal cancer patients and their families about the cancer journey; and identify ways to increase the use of telehealth or other remote communication technologies by cancer patients and care providers in the NWT.
The First Nations Health Authority, British Columbia Cancer Agency, Provincial Health Services Authority, Métis Nation British Columbia and British Columbia Association of Aboriginal Friendship Centres joined forces in a collaborative effort to create a better understanding of the needs and opportunities for improving the cancer journey for Aboriginal peoples in BC. Preliminary engagement with Aboriginal cancer patients and care providers in BC suggests there are gaps in culturally appropriate resources for Aboriginal cancer patients 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, advancing patient identification, enhancing health literacy of patients and cultural competency of practitioners, and enhancing multi-jurisdictional cooperation and partnerships.
Increased Access to Culturally Safe Cancer Care Pathways by Alberta First Nations Communities (First Nations Cancer Pathways Project) is a collaborative project with Alberta First Nations and Alberta Health Services-CancerControl Alberta. Other partners include the Alberta First Nations Information Governance Centre, First Nations Inuit Health Branch, Aboriginal Nurses Association of Canada, Indigenous Physicians Association of Canada, Dr. Cora Voyageur and more. The goals of the project are to increase First Nations knowledge and understanding of cancer and cancer care services, educate health care workers about First Nations people in Alberta, better coordinate care and services for First Nations people with cancer, increase access to culturally responsive cancer care services, and develop educational resources and tools to support First Nations cancer pathways.
With cancer as a growing health concern among First Nations and Métis populations, it is imperative that a sustainable and meaningful improvement towards the health outcomes of these communities begin to take shape. However, without reliable health data specific to these peoples 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 systems, multiple providers, geographic locations and cultures. This prompted the Federation of Saskatchewan Indian Nations (FSIN) and the Saskatchewan Cancer Agency to come together in an unprecedented partnership to review current cancer surveillance systems and practices on a local and international stage. Outreach to northern Metis communities to include in this initiative is ongoing.
This groundbreaking initiative will give the partners the ability to determine a method of identification of Status First Nations and Métis peoples within the health care system, leading to a framework that will be piloted in a select group of communities in Saskatchewan.
Ultimately, a First Nations and Métis surveillance system will serve as the foundational component necessary to effectively advance cancer care services across the continuum of care and reduce the burden of cancer in First Nations and Métis people in Saskatchewan.
Impact of work
- To review cancer surveillance systems and practices on a local and international stage. This surveillance system will serve as the foundational component necessary to effectively advance cancer care services across the continuum of care and reduce the burden of cancer in First Nations and Métis people in Saskatchewan.
In consideration of the unique needs of First Nations and Inuit cancer patients in Manitoba, a project was developed in partnership with First Nations and Inuit cancer stakeholders to improve the continuity of First Nations and Inuit cancer care in Manitoba.
The first objective of the project 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, allowing patients to take the information home, review and share it.
The second objective is to improve existing practices used to deliver a cancer diagnosis to a patient and their family, 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.
The final objective is to engage stakeholders and support the development of a strategic plan for patient self-identification in Manitoba. To ensure the sustainability of the plan, stakeholders will be invited to sign agreements to ensure the work will move forward.
This project 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.
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 project aims to increase the quality and cultural relevance of health care and health services for First Nations, Inuit and Métis patients with cancer.
This project 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 the different treatment options that are presented to them. 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.
Labrador (Newfoundland and Labrador)
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 Aboriginal peoples 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. They are to:
- Enhance transitions in care between hospital and community setting,
- Expand Tele-Oncology for enhanced consultation between oncology specialists, family physicians, nurses in community clinics and patients themselves, and
- Increase cultural sensitivity through employee training programs, information packages in the languages of the Labrador Aboriginal 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 voice and perspective in all of its work. Efforts are taken to facilitate and encourage engagement of First Nations, Inuit and Métis communities and organizations in the initiatives undertaken by the organization.
The following are Partnership initiatives that are pan-Canadian, are not specific to any one population and are working with First Nations and/or Inuit and/or Métis people, communities and organizations.
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 currently has 3 strategic initiatives that engage First Nations communities. They are:
- 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), Propel Centre for Population Health Impact) are now 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).
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, and have chosen to make person-centred care a foundational element in efforts to improve cancer control.
From 2014 to 2017, the Partnership has invested in strategic initiatives that will guide more person-centred approaches to cancer control. Of the fourteen Person-centred Perspective initiatives, five reach out to First Peoples. They are:
- Canadian Virtual Hospice Knowledge Tools: Addressing National Gaps. Canadian Virtual Hospice, across multiple provinces and territories.
- Integrating Emergency Health Services and Palliative and End-Of-Life Care to Enhance the End of Life Experience for Nova Scotia and PEI Cancer Patients and their Families. 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 throughout 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.
Canadian Alliance for Healthy Hearts and Minds