Aims
Fear of cancer recurrence (FCR) is one of the most common unmet needs of people with cancer. To support the timely identification and management of FCR, a clinical pathway has been developed. Given that FCR affects up to 67% of people from culturally and linguistically diverse backgrounds, there is a need to adapt this pathway to ensure equitable access to care. In partnership with CanRevive (Australia’s largest Chinese cancer support organisation), this research aimed to identify cultural barriers and enablers to equitable implementation of the clinical pathway among Chinese-speaking people affected by cancer, and guide culturally appropriate adaptations and implementation strategies.
Methods
Qualitative interviews and focus groups informed by the Health Equity Implementation Framework (HEIF) were conducted by a bilingual researcher to identify factors affecting equitable implementation of the pathway (i.e., how the pathway is applied in clinical practice). HEIF domains include Innovation Characteristics; Clinical Encounter; Patient/Provider Factors; Inner/Outer Context; and Societal Influence. Multiple perspectives were sought from Chinese-speaking survivors (n=10), caregivers (n=5), healthcare professionals (n=10), and community stakeholders (n=5). Directed content analysis was performed on transcripts, with quotes coded independently by two researchers within the HEIF domains.
Results
Factors that influenced pathway implementation included sociocultural norms surrounding FCR discussions (Cultural Factors of Recipients); availability of interpreters (Clinical Encounter); and availability of local multicultural support referrals (Societal Context). Barriers included absence of training for health professionals in culturally appropriate communication strategies, and patient concerns about the cost of accessing psychological support. A key facilitator included multicultural cancer support organisations (e.g., CanRevive) providing culturally responsive information and social support.
Conclusions
These findings can inform culturally responsive and equitable implementation of a clinical pathway to identify and manage FCR among Chinese-speaking people affected by cancer, and contribute to equitable access to FCR identification and management within health services and community settings.