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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Managing Matajoosh: determinants of first Nations’ cancer care decisions

Authors: Josée G. Lavoie, Joseph Kaufert, Annette J. Browne, John D. O’Neil

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes.

Methods

The analysis presented in this paper focuses on the experience of First Nation peoples’ access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15).

Results

Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients’ clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system’s limitations.

Conclusions

We argue that a whole system’s approach is required in order to address these limitations.
Footnotes
1
The prescription drug formulary for the NIHB program is defined nationally, and implemented for all First Nations no matter where they live. In contrast, all Canadian provinces define their own prescription drug formulary for coverage. Important discrepancies between provinces have been noted especially for cancer drug coverage [45]. For example, Manitoba Health currently provides free access to cancer drugs for all Manitoba residents, unless they are First Nations. First Nations are expected to get their cancer drug coverage from the federal–funded NIHB program. The NIHB formulary however includes only a few cancer drug options, leaving Manitoba First Nations with few free treatment options when compared to other Manitobans.
 
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Metadata
Title
Managing Matajoosh: determinants of first Nations’ cancer care decisions
Authors
Josée G. Lavoie
Joseph Kaufert
Annette J. Browne
John D. O’Neil
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1665-2

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