Holding space: a participatory exploration of first nations health professionals’ experiences supporting cancer patients through hospital-based treatment

Abstract

BackgroundColonial mechanisms continue to inflict trauma on Aboriginal and Torres Strait Islander peoples, the First Nations peoples of Australia. Consequence of this trauma is a disproportionately high rate of cancer mortality experienced among First Nations peoples and inequities in access to cancer services that are culturally responsive. There is a critical need for cancer care that supports First Nations peoples' holistic health and wellbeing. Engagement with First Nations health staff is a known element of culturally safe healthcare, however the experiences of and challenges facing First Nations staff working in cancer care are unclear.MethodConducted as part of the What Matters to Adults Implementation (WM2A-Implementation) study, this paper presents the findings of a participatory approach to explore the experiences of four First Nations Health Professionals (FNHPs) providing holistic cancer care for First Nations peoples within cancer services located in public hospitals. Ten Yarning Circles were conducted by a First Nations researcher over a 12-month period. All were transcribed and a Knowledge Synthesis method employed a reflexive thematic analysis approach.Meaning making.FNHPs shared their experiences of working in a complex, highly pressured, and sometimes adverse space. FNHPs worked to support and advocate for their patients, create culturally safe spaces, and support and guide colleagues to the provision of culturally safe, patient-centred cancer care. Our knowledge synthesis revealed six intersecting themes that encapsulate their experiences: holding space; advocacy for patients; incorporating First Nations ways; serving your community; being everything to everyone; and the stigma of the role.MethodConducted as part of the What Matters to Adults Implementation (WM2A-Implementation) study, this paper presents the findings of a participatory approach to explore the experiences of four First Nations Health Professionals (FNHPs) providing holistic cancer care for First Nations peoples within cancer services located in public hospitals. Ten Yarning Circles were conducted by a First Nations researcher over a 12-month period. All were transcribed and a Knowledge Synthesis method employed a reflexive thematic analysis approach.Meaning making.FNHPs shared their experiences of working in a complex, highly pressured, and sometimes adverse space. FNHPs worked to support and advocate for their patients, create culturally safe spaces, and support and guide colleagues to the provision of culturally safe, patient-centred cancer care. Our knowledge synthesis revealed six intersecting themes that encapsulate their experiences: holding space; advocacy for patients; incorporating First Nations ways; serving your community; being everything to everyone; and the stigma of the role.MethodConducted as part of the What Matters to Adults Implementation (WM2A-Implementation) study, this paper presents the findings of a participatory approach to explore the experiences of four First Nations Health Professionals (FNHPs) providing holistic cancer care for First Nations peoples within cancer services located in public hospitals. Ten Yarning Circles were conducted by a First Nations researcher over a 12-month period. All were transcribed and a Knowledge Synthesis method employed a reflexive thematic analysis approach.Meaning making.FNHPs shared their experiences of working in a complex, highly pressured, and sometimes adverse space.FNHPs worked to support and advocate for their patients, create culturally safe spaces, and support and guide colleagues to the provision of culturally safe, patient-centred cancer care. Our knowledge synthesis revealed six intersecting themes that encapsulate their experiences: holding space; advocacy for patients; incorporating First Nations ways; serving your community; being everything to everyone; and the stigma of the role.DiscussionThese findings have implications for guiding cancer services to create an environment where First Nations staff are respected and given adequate resources, space, and support to deliver culturally grounded and supportive care to First Nations patients and their families. Specifically, services need to recognise the value of FNHPs in patient-centred care; balance this value with the burden on FNHPs; foster greater inclusion of First Nations culture and knowledges in mainstream healthcare; and actively focus on reducing racism and stigma facing FNHPs.