There is limited research about the meaning and psychosocial impact of cancer from the perspective of Indigenous peoples in Australia.
A qualitative study explored the meaning of cancer from the perspective of Aboriginal women in two rural communities in Queensland.18, 28 Its key findings can help SCNs understand Indigenous women's attitudes toward cancer and their reluctance to undergo screening or follow-up treatment when a diagnosis of cancer is confirmed.
Video 17: Cindy (1.50 min)
Cindy talks about how Aboriginal & Torres Strait Islander people view cancer, self-care & health priorities.
Video 18: Peta (0.46 min)
Peta talks about the need to explain processes & procedures in different ways to enhance understanding, & how this may need to be done visually or through an interpreter.
Attitudes towards cancer
The dominant attitude toward cancer is one of fear and fatalism. There is a general reluctance to talk about cancer as it's linked to a fear that just mentioning the 'C' word could prompt fate. Many Indigenous women assume that cancer is just one disease and fatal regardless of the site or stage of growth. Some believe cancer is contagious.
Avoiding the diagnosis by choosing not to follow-up abnormal test results
Aboriginal and Torres Strait Islander women who receive a cancer diagnosis chose one or two of several options:
- forgo treatment because they believe it to be futile
- negotiate to undergo treatment until the side effects become unacceptable
- prioritise family responsibilities over their own health needs
- deny the whole thing and 'get on with life'
- accept the diagnosis as just another problem in a difficult life
- seek traditional medicine and healing as the first line of treatment.
Cancer related treatments
Other reasons Aboriginal people may appear ambivalent about cancer treatment include:
- fear of being in a hospital linked to experience of racism and colonial mentality of staff
- the first point of decision making about treatment is the family
- fear of hospitals because of lingering spirits of people who have died
- lack of belief in the efficacy of treatment
- fear of being away from the community
- threat to cultural integrity imposed by hospital systems unsupportive of the individual's cultural needs
- fear of being 'cut up' by surgery which is viewed a violation of the 'sacred body'
- fear of surgery as it is thought to cause the spread of cancer
- no evidence of cancer survivorship in Indigenous communities.
Video 19: Catherine (0.35 min)
Catherine talks about building knowledge & understanding in Aboriginal & Torres Strait Islander people affected by cancer.
Video 20: Peta (1.14 min)
Peta talks about being culturally sensitive to an Aboriginal & Torres Strait Islander person's needs, & how changes may need to be made to the hospital environment to enhance their stay.
Many Indigenous people hold a belief in the authority of traditional medicine and healing practice. There is also a belief in the influence of 'bad spirits' that inflict serious diseases like cancer as a 'payback' for some cultural or relational misdemeanor.
Aboriginal people apportion blame for the disease of cancer on the whiteman's invasion of their land which colonised traditional lifestyles including diet, bush medicines and healing practices.
Video 21: Catherine (1.10 min)
Catherine talks about a cancer diagnosis being viewed by Aboriginal & Torres Strait Islander people as a 'death sentence'. She discusses how being sick is more than just physical, but also part of the spirit is damaged & needs to be healed.
Barriers to cancer screening for women include concerns about confidentiality where life in contained rural communities is like living in a 'fishbowl'. When required to undergo screening services or treatments at health services in larger regional centres or cities, Aboriginal people may have to incur costs, travel considerable distances, and live away from their communities.
Cultural factors determine that family and friends need to be involved in the care of the sick person. Large numbers of people visiting can overstretch the facilities of the hospital ward or clinic. Aboriginal people from rural communities also like to have access to the outside environment, which may be prohibited by hospital infrastructure and geography.
Video 22: Peta (0.33 min)
Peta talks about liaising with the community the person is from & identifying it on a map to enhance cultural understanding & understand the remoteness of the location.
Cultural mores about the privacy of women's and men's business mean topics relating to women's personal health are not discussed with men and vice versa. Family decision-making about treatment can sometimes manifest by women forgoing medical advice.
Gender and sexual implications
Women may feel 'shame' when expected to touch their bodies in ways recommended for self-examination. This sense of 'shame' also accounts for women's reluctance to undergo physical examinations and screening tests (such as Pap smear tests) in the presence of male health care providers. Faith and spiritual beliefs about the sacred body can sometimes prohibit violation by surgery.
Older women do not always consider themselves at risk of certain types of cancer, such as cervical cancer, if they are not sexually active. Many regard gynaecological cancers as 'dirty diseases' and assign the same social stigma as sexually transmitted diseases such as syphilis and gonorrhoea.
Video 23: Peta (0.25 min)
Peta talks about body language & awareness of cultural protocols with regards to hygiene & care differences for males and females.
Video 24: Roslyn (1.02 min)
Ros recommends SCNs talk to the local Aboriginal & Torres Strait Islander community. She advises using an Indigenous health worker as a resource/support person, who could be educated & upskilled to inform the patient/family in a culturally appropriate way.
Video 25: Peta (0.39 min)
Peta talks about advance planning, also called 'yarning', & how it is an individual's choice of place to pass away.