Advertisement

Healing Conversations: Developing a Practical Framework for Clinical Communication Between Aboriginal Communities and Healthcare Practitioners

  • Andrea McKivett
  • David Paul
  • Nicky Hudson
Review Paper
  • 981 Downloads

Abstract

In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner’s own cultural identity and will be guided by collective Aboriginal worldviews in select Australian settings. Using a two-eyed seeing approach the framework will be developed and tested in health professional education. The aim of this research journey is to enable health practitioners to have more effective healthcare conversations with Aboriginal peoples, working toward more socially just and equitable healthcare interactions and outcomes

Keywords

Aboriginal health Indigenous health Clinical communication Health disparities 

References

  1. 1.
    Moreton-Robinson A. I still call Australia home: Indigenous belonging and place in a white postcolonising society. In uprootings/regroundings: questions of home and migration. New York: Berg; 2003.Google Scholar
  2. 2.
    Purdie N, Dudgeon P, Walker R, et al., editors. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Canberra: Department of Health and Ageing; 2010.Google Scholar
  3. 3.
    Durey A, et al. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq. 2012;19(2):144–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374(9683):65–75.CrossRefPubMedGoogle Scholar
  5. 5.
    Brown A, et al. South Australian Aboriginal cardiovascular health profile for the South Australian Aboriginal Heart and stroke plan 2017–2021. Adelaide: SAHMRI; 2016.Google Scholar
  6. 6.
    Australian Bureau of Statistics. Life tables for Aboriginal and Torres Strait Islander Australians 2010–2012. Canberra: Commonwealth of Australia; 2013.Google Scholar
  7. 7.
    Askew D, et al. Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary health care service. Aust J Prim Health. 2017;23(5):446–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Hambleton S. Achieving best practice in primary health care for Aboriginal and Torres Strait Islanders. Barton: Australian Medical Association; 2011.Google Scholar
  9. 9.
    Smedley B, Stith A, Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. Washington National Academies Press: Washington, DC; 2009.Google Scholar
  10. 10.
    Australian Medical Council. Standards for Assessment and Accreditation of Primary Medical Programs by the Australian Medical Council: Kingston ACT; 2012.Google Scholar
  11. 11.
    Van Schaik K, Thompson S. Indigenous beliefs about biomedical and bush medicine treatment efficacy for indigenous cancer patients: a review of the literature. Int Med J. 2012;42(2):184–91.CrossRefGoogle Scholar
  12. 12.
    Lie DA, et al. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med. 2011;26(3):317–25.CrossRefPubMedGoogle Scholar
  13. 13.
    Grant J, Parry Y, Guerin P. An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition. Aust N Z J Public Health. 2013;37(3):250–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Paul D, Hill S, Ewen S. Revealing the (in) competency of “cultural competency” in medical education. AlterNative. 2012;8(3):318–28.CrossRefGoogle Scholar
  15. 15.
    Jongen C, et al. Cultural competence in health: a review of the evidence. SpringerBriefs in Public Health. 2017.Google Scholar
  16. 16.
    Ewen S, Paul D, Bloom G. Do indigenous health curricula in health science education reduce disparities in health care outcomes? Med J Aust. 2012;197(1):50–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Peiris D, Brown A, Cass A. Addressing inequities in access to quality health care for indigenous people. Can Med Assoc J. 2008;179(10):985–6.CrossRefGoogle Scholar
  18. 18.
    Taylor JE, et al. Effective Aboriginal community involvement in health planning: a case study. ACT: National Rural Health Alliance; 2007.Google Scholar
  19. 19.
    Lock M. Aboriginal holistic health: a critical review. Casuarina: Cooperative Research Centre for Aboriginal Health; 2007.Google Scholar
  20. 20.
    National Aboriginal Health Strategy Working Group. A national aboriginal health strategy. Canberra. 1989.Google Scholar
  21. 21.
    Alford V, et al. Communication in Indigenous healthcare: extending the discourse into the physiotherapy domain. J Physiother. 2014;60(2):63–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Forbes D, Wongthongtham P. Ontology based intercultural patient practitioner assistive communications from qualitative gap analysis. Inf Technol People. 2016;29(2):280–317.CrossRefGoogle Scholar
  23. 23.
    Neuliep JW. Intercultural communication: a contextual approach. Los Angeles: Sage; 2017.Google Scholar
  24. 24.
    Stewart M. Towards a global definition of patient centred care. BMJ. 2001;322(7284):444–5.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sakamoto I, Pitner RO. Use of critical consciousness in anti-oppressive social work practice: disentangling power dynamics at personal and structural levels. Br J Soc Work. 2005;35(4):435–52.CrossRefGoogle Scholar
  26. 26.
    Mcdermott D. Can we educate out of racism. Med J Aust. 2012;197(1):15.CrossRefPubMedGoogle Scholar
  27. 27.
    Buluş M, Atan A, Sarıkaya HE. Effective communication skills: a new conceptual framework and scale development study. Int Online J Educ Sci. 2017;9(2):1–16.Google Scholar
  28. 28.
    Gudykunst WB, Mody B. Handbook of international and intercultural communication. Los Angeles: Sage; 2002.Google Scholar
  29. 29.
    Paternotte E, et al. Factors influencing intercultural doctor–patient communication: a realist review. Patient Educ Couns. 2015;98(4):420–45.CrossRefPubMedGoogle Scholar
  30. 30.
    Alden DL, et al. Who decides: me or we? Family involvement in medical decision making in Eastern and Western countries. Med Decis Mak. 2017;38(1):14–25.CrossRefGoogle Scholar
  31. 31.
    Haynes E, et al. Examining the potential contribution of social theory to developing and supporting Australian Indigenous-mainstream health service partnerships. Int J Equity Health. 2014;13(1):75.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Miller K. Balancing individualism and collectivism in an Australian Aboriginal context. In: McIntyre-Mills J, Romm N, Corcoran-Nantes Y, editors. Balancing individualism and collectivism: social and environmental justice; Cham: Springer; 2018.Google Scholar
  33. 33.
    Donkin A, Allen GP, Nathanson J, Marmot V. M,. Global action on the social determinants of health. BMJ Glob Health. 2017;2(e000603):1–7.Google Scholar
  34. 34.
    Lin I, et al. ‘I can sit and talk to her’: Aboriginal people, chronic low back pain and heathcare practitioner communication. Aust Fam Physician. 2014;43(5):320–4.PubMedGoogle Scholar
  35. 35.
    Hayman N, White N, Spurling G. Improving Indigenous patients’ access to mainstream health services: the Inala experience. Med J Aust. 2009;190(10):604–6.PubMedGoogle Scholar
  36. 36.
    Franks C, Curr B Keeping company: An inter-cultural conversation. Centre for Indigenous Development Education and Research, University of Wollongong. 1996.Google Scholar
  37. 37.
    Street RL. How clinician–patient communication contributes to health improvement: modeling pathways from talk to outcome. Patient Educ Couns. 2013;92(3):286–91.CrossRefPubMedGoogle Scholar
  38. 38.
    Schirmer JM, et al. Assessing communication competence: a review of current tools. Fam Med. 2005;37(3):184–92.PubMedGoogle Scholar
  39. 39.
    Haq C, et al. Integrating the art and science of medical practice: innovations in teaching medical communication skills. Fam Med. 2004;36(sup1):43–50.Google Scholar
  40. 40.
    Simmenroth-Nayda A, et al. Do communication training programs improve students’ communication skills?-a follow-up study. BMC Res Notes. 2012;5(1):486.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Elwyn G, et al. Shared decision making: a model for clinical practice. J Gen Int Med. 2012;27(10):1361–7.CrossRefGoogle Scholar
  42. 42.
    Kurtz S, et al. Marrying content and process in clinical method teaching: enhancing the Calgary–Cambridge guides. Acad Med. 2003;78(8):802–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Mccormack LA, et al. Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach. Soc Sci Med. 2011;72(7):1085–95.CrossRefPubMedGoogle Scholar
  44. 44.
    Alyami H, et al. Teaching medical students history taking content: a systematic review. Am J Educ Res. 2016;4(3):227–33.Google Scholar
  45. 45.
    Hausberg MC, et al. Enhancing medical students’ communication skills: development and evaluation of an undergraduate training program. BMC Med Educ. 2012;12(1):16.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Pitama S, Huria T, Lacey C. Improving Maori health through clinical assessment: Waikare o te Waka o Meihana. N Z Med J. 2014;127(1393):107–19.PubMedGoogle Scholar
  47. 47.
    Pitama S, et al. Meihana model: a clinical assessment framework. N Z J Psychol. 2007;36(3):118–25.Google Scholar
  48. 48.
    Al-Busaidi I, et al. Māori Indigenous Health Framework in action: addressing ethnic disparities in healthcare. N Z Med J. 2018;131(1470):89–93.PubMedGoogle Scholar
  49. 49.
    Foucault M. Beyond structuralism and hermeneutics. Sussex: Harvester Press; 1982.Google Scholar
  50. 50.
    Cass A, et al. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Med J Aust. 2002;176(10):466–71.PubMedGoogle Scholar
  51. 51.
    Lowell A, et al. “Hiding the story”: Indigenous consumer concerns about communication related to chronic disease in one remote region of Australia. Int J Speech-Lang Pathol. 2012;14(3):200–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Shahid S, et al. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Serv Res. 2013;13(1):460.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Towle A, Godolphin W, Alexander T. Doctor–patient communications in the Aboriginal community: towards the development of educational programs. Patient Educ Couns. 2006;62(3):340–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Amery R. Recognising the communication gap in indigenous health care. Med J Aust. 2017;207(1):13–5.CrossRefPubMedGoogle Scholar
  55. 55.
    Lowell A. Communication and cultural knowledge in aboriginal health care, in Cooperative Research Centre for Aboriginal and Tropical Health. Casuarina NT: 2001.Google Scholar
  56. 56.
    Zuckermann G, Walsh M. Language reclamation and mental health: Revivalistics in the service of the wellbeing of Indigenous people. In Day D, Rewi P, Higgins R editors, The journeys of besieged languages. Cambridge: Cambridge Scholars Publishing. 2016: 94–122.Google Scholar
  57. 57.
    Anderson K, et al. “All they said was my kidneys were dead”: Indigenous Australian patients’ understanding of their chronic kidney disease. Med J Aust. 2008;189(9):499–503.PubMedGoogle Scholar
  58. 58.
    Christie M, Verran H. The touch pad body: a generative transcultural digital device interrupting received ideas and practices in Aboriginal health. Societies. 2014;4(2):256–64.CrossRefGoogle Scholar
  59. 59.
    Janca A, Bullen C. The Aboriginal concept of time and its mental health implications. Aust Psychiatry. 2003;11(sup1):40–4.CrossRefGoogle Scholar
  60. 60.
    Bartlett C, et al. Integrative science and two-eyed seeing: Enriching the discussion framework for healthy communities. In: Hallstrom L, Guehlstorf N, Parkes M, editors. Beyond Intractability: convergence and opportunity at the interface of environmental, health and social issues. Vancouver: UBC Press; 2012.Google Scholar
  61. 61.
    Pitner RO, Sakamoto I. The role of critical consciousness in multicultural practice: examining how its strength becomes its limitation. Am J Orthopsychiatry. 2005;75(4):684–94.CrossRefPubMedGoogle Scholar
  62. 62.
    Mckenna V, Anderson K. Kimberley Dreaming: old law, new ways—finding new meaning. In Presentation to World Congress for Psychotherapy, Sydney. 2011.Google Scholar
  63. 63.
    Uncle Bob Randall. Kanyini. 2018; http://kanyini.org/kanyini-principles/. Accessed 19 Jan 2018.
  64. 64.
    Yap M, Yu E. Operationalising the capability approach: developing culturally relevant indicators of indigenous wellbeing—an Australian example. Oxf Dev Stud. 2016;44(3):315–31.CrossRefGoogle Scholar
  65. 65.
    Brown N. Exploring Cultural determinants of health and wellbeing. Carlton South: Lowitja Institute Roundtable; 2014.Google Scholar
  66. 66.
    Lin I, Green C, Bessarab D. ‘Yarn with me’: applying clinical yarning to improve clinician–patient communication in Aboriginal health care. Aust J Prim Health. 2016;22(5):377–82.CrossRefPubMedGoogle Scholar
  67. 67.
    Carter C, et al. Urban first nations men: narratives of positive identity and implications for culturally safe care. J Transcult Nurs. 2016;28(5):445–54.CrossRefGoogle Scholar
  68. 68.
  69. 69.
    Rider EA, Keefer CH. Communication skills competencies: definitions and a teaching toolbox. Med Educ. 2006;40(7):624–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Hill S, et al. Can my mechanic fix blue cars? A discussion of health clinicians’ interactions with Aboriginal Australian clients. Aust J Rural Health. 2017;25(3):189–92.CrossRefPubMedGoogle Scholar
  71. 71.
    Panzironi F. Hand-in-hand. Report on Aboriginal Traditional Medicine. 2013.Google Scholar
  72. 72.
    Marsh TN, et al. The application of two-eyed seeing decolonizing methodology in qualitative and quantitative research for the treatment of intergenerational trauma and substance use disorders. Int J Qual Methods. 2015;14(5):317–25.CrossRefGoogle Scholar
  73. 73.
    Abbott P, et al. What do GPs need to work more effectively with Aboriginal patients?: views of Aboriginal cultural mentors and health workers. Aust Fam Physician. 2014;43(1/2):58–63.PubMedGoogle Scholar
  74. 74.
    The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute. National safety and quality health service standards user guide for Aboriginal and Torres Strait Islander health. Sydney: Australian Commission on Safety and Quality in Health Care; 2017.Google Scholar
  75. 75.
    Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Serv Res. 2014;14(99):1–17.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of MedicineThe University of AdelaideAdelaideAustralia
  2. 2.School of Medicine FremantleThe University of Notre Dame AustraliaFremantleAustralia
  3. 3.University of AdelaideAdelaideAustralia
  4. 4.University of NewcastleNewcastleAustralia
  5. 5.University of WollongongWollongongAustralia

Personalised recommendations