Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: A qualitative study

Background/objectives: Delayed presentation of symptomatic cancer is associated with poorer survival. Aboriginal patients with cancer have higher rates of istant 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. Methods: In-depth, open-ended interviews were conducted in two stages (20062007 and 2011). Inductive thematic analysis was assisted by use of NVivo looking around delays in presentation, diagnosis and referral for cancer. Participants: Aboriginal patients with cancer/family members (n=30) and health service providers (n=62) were recruited from metropolitan Pert and six rural/ remote regions of Western Australia. Results: 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 decisionmaking,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 womens domain emerged as a reason why Aboriginal men were reluctant to receive health checks. Conclusions: 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