Cultural Safety Training Framework for Oncology Care Providers

FormalPara Key Points

• The Indigenous-led Practice Change Implementation Model reframes cancer pathways for First Nations cancer patients and their families experiencing anti-Indigenous racism in health systems and experiencing a lack of cultural safety and acceptance of Indigenous health and healing approaches.

• The model provides an approach for standardizing culturally grounded, safe treatment in oncology care.

• Knowledge Holders/Practitioners have an essential role in Indigenous-led cancer research for practice change.

In Alberta, Canada, an Indigenous-led Practice Change Implementation Model was used to develop a culturally safe training program to increase oncologists’ understanding of the need for traditional support and medicines within oncology care.

The Indigenous-led Practice Change Implementation Model is cohesive, embedding an equitable and ethical transformative process to support oncology care providers and traditional knowledge holders. The model framed specific knowledge building around cancer pathways for First Nations cancer patients and their families who experience anti-Indigenous racism in health systems, required to build oncology cultural safety training and acceptance of Indigenous health and healing approaches. The model was developed in partnership by the Alberta First Nations Information Governance Centre (AFNIGC), Alberta Health Services (AHS), and a team of Indigenous researchers, Knowledge Holders/Practitioners, and cancer care oncology champions. Supported by the cultural leadership of the Knowledge Holders/Practitioners as Right Holders, the partnership transferred four foundational concepts for practice change into the model: (1) relationships, (2) family as medicine, (3) culture as prevention, and (4) Indigenous languages as fundamental. These concepts operationalized culturally grounded training for oncology care providers and offered a cultural-grooming approach that creates awareness among oncology healthcare providers of the distinct and diverse equitable and ethical pathways unique to Indigenous cancer patients. This main focus was to create culturally safe cancer care pathways and care for/with Indigenous cancer patients and families seeking to include traditional supports for improved cancer care outcomes.

Essential Practice Change Knowledge Components

The partnership strictly adhered to First Nations philosophies of knowledge transfer and exchange, including relational processes in which respect underpins all interactions. An Indigenous lens was utilized to embed cultural approaches and community solutions into the project to address emerging Peoples-specific priorities [1].

Key concepts emerged from cultural engagement through thematic project dialogues and narrative processes with Knowledge Holders/Practitioners. They identified pivotal sites of transformation and adaptation to lead health system improvements and improve understanding of traditional supports. Key objectives of the cultural safety education modules included:

• Incorporating First Nation worldviews, language, and ceremony to guide the healing pathways of First Nation people.

• Understanding ceremony and the need to include ceremony when requested by First Nation cancer patients.

• Acknowledging and applying protocols to position culturally collaborative processes within oncology care.

• Utilizing language and oral traditions in training through stories and narratives.

• Understanding traditional principles and values associated with traditional healing.

• Recognizing the significance of “family as medicine” within oncology care.

• Standardizing culturally grounded safe treatment in oncology care.

Relationship Building

Relationship building is the first key concept of culturally grounded, safe oncology training and knowledge transfer/sharing. This concept places emphasis on engaging with, listening to, sustaining, and maintaining the patient-as-expert—as a rights holder defining their own pathway, and with the cultural supports required as a family. Relationship building takes time and requires mutually respectful investment, including developing awareness of historical experiences and understanding the cultural biases that may impact the relationship.

In the partnership for this project, open communication helped to establish trust between all partners and contributed to healing on both sides. Knowledge Holders/Practitioners were consistent in their messaging—such as the importance of embracing the connection to and relationship between all things in existence as part of a larger whole. Knowledge Holders/Practitioners discussed ancestral ways of “coming to know” and “being in a collective and community” as including relational kinship with the natural world. This is evidence of a strong cultural community and supports the presence of healthy family systems to support the patient. The oncology health provider is seen and included as a valued, extended family member as they enter the family circle with a specific role and function.

Family as Medicine

The second and perhaps most central cultural concept is “family as medicine.” Family extends outward to include extended family, community, and kinship with the natural world. First Nation peoples have a strong sense of family and community. When one person is sick, the entire family, including extended family and community members, often gather to form a circle of support around the patient.

Developing a deeper understanding and appreciation of First Nation perspectives of the family helps oncology healthcare providers to understand the value of family as an extended resource rather than a hindrance to their cancer care role. Within the context of cancer care, family as medicine includes supportive relationships that are socially organized around health issues and challenges. Family, as the primary support structure, enhances care and fills gaps left by the healthcare system.

Culture as Prevention and Indigenous Language

Within the First Nation worldview, issues affecting the family or community are attended to, often through ceremony, through the prayerful engagement of mind, body, and spirit. The two final concepts, “culture as prevention” and “Indigenous languages,” are woven into the idea of family as medicine because knowledge resides within language, and culture supports an entire knowledge system that specifies and conveys a purposeful way of life. The concept of the whole health and wellbeing of both the family and community is central to a lived knowledge base, which informs the culturally grounded training.

Practice Change Implementation Model: First Nations Knowledge Holder Transformative Processes for Knowledge Transfer and Exchange

The sharing and exchange of Indigenous and cultural knowledge is a collective activity. Knowledge Holders/Practitioners add layer onto layer, using the bodies of knowledge contained within their oral histories to create a rich living knowledge base from which to implement and align practice change. These cultural transformative processes facilitated the establishment of the aims and aspirations that informed this project. Project co-lead and Knowledge Holder/Practitioner Lea Bill developed the graphic in Fig. 59.1 that shows the embodiment of a living system of knowledge transfer and exchange where multiple levels of life principles flow, intercede, and influence within the whole being, with change as a constant that moves with living knowledge (Fig. 59.1).

Fig. 59.1

Practice change implementation graphic developed by Lea Bill

Knowledge transfer and exchange are socially cohesive processes. Figure 59.1 demonstrates “group mindedness” in the decision-making processes that collaboratively organize around any issue in a dialogic, relational, and cultural way, which can be understood as embedded within collective, cultural, and collaborative processes.

First Nations Spiritual and Culturally Based Knowledge Transfer Framework

Knowledge transfer has been embedded within family systems and cultural transfer processes throughout history. However, traditional Indigenous methods and modes of transmission have been impacted by colonization. In Canada, the legacy of residential schools has interrupted knowledge transfer processes and continues to have an impact in all sectors of education. For practice change to occur, learning about Indigenous ways and implementing new understandings linked to Indigenous practices, values, and beliefs are critical and essential.

In response to this concept, the partnership discussed a First Nations spiritual and culturally based framework, based on the values and beliefs intrinsically linked to traditional spiritual and cultural knowledge transfer methods. The framework (Fig. 59.2) comes from the direct experience and practice of First Nation Knowledge Holder/Practitioner Lea Bill. It is a high-level framework that reflects the key principles associated with and facilitating knowledge transfer.

Fig. 59.2

First Nation spiritual and culturally based knowledge transfer framework

Conclusion

The interconnected nature of family, culture, language, and community, along with ethical space and natural knowledge transfer, is positioned within a model of Indigenous-led Practice Change Implementation. This model offers an authentic transformative space that supports culturally grounded and safe training and knowledge transfer to oncology care providers. Indigenous-led cultural processes are essential for the application of intact ancestral knowledge to work toward transforming current and future oncology healthcare systems. This holistic process requires great sensitivity, respect, and commitment to ensure ethical processes and spaces [2] are upheld within the partnership. The established circle, in which knowledge, healing, and process are managed according to the pace, volition, information, and connections with the spirit of the participants, informs culturally grounded training and education and ensures that steps toward practice change place begin to occur.