J KELLY1, K SCHWARTZKOPFF1, K O’DONNELL1, P DENT2, K OWEN3
1University Of Adelaide, Adelaide , Australia, 2Lowitja Institute, Melbourne, Australia, 3National Indigenous Kidney Transplantation Taskforce, Adelaide, Australia
Aim: To synthesise existing evidence on health services initiatives that target cultural bias to improve models of care for Indigenous Australians with kidney disease.
Background: In 2019, the TSANZ report, “Improving Access to and Outcomes of Kidney Transplantation for Aboriginal and Torres Strait Islander People in Australia” identified systemic biases in relation to kidney transplantation for Indigenous Australians. Following this, the TSANZ established a National Indigenous Kidney Transplantation Taskforce (NIKTT), who commissioned a scoping review to summarise initiatives that support and inform culturally safe access and outcomes to kidney transplantation for Indigenous people.
Methods: A systematic review of peer reviewed and “grey” literature was undertaken to identify cultural bias initiatives in renal health and other relevant areas. We analysed the efficacy of these from patient, health professional and clinical outcomes perspectives, and identified key enablers for establishing and evaluating cultural bias initiatives. A panel of NIKTT members assisted with the detection and interpretation of key themes.
Results and Conclusions: We identified 20 Australian health care initiatives that reported evaluation of cultural bias initiatives: renal (2), maternity (10), cancer (5), diabetes (1), emergency department (1) and general hospital (1). Enablers of successful initiatives across all studies were arranged under four main themes: inclusion of patients/families/community in care and decision making; Indigenous workforce and overall staff skills; service delivery, approach and models of care; and structures and policies. Initiatives that improved cultural safety, communication, coordination, collaboration, resources, policies, and organisational commitment were identified. A further 7 NIKTT initiatives are currently underway to address inequities in transplant access and outcomes. These projects will add significantly to the evidence.
Dr Janet Kelly is South Australian researcher who works collaboratively with Aboriginal and Torres Strait Islander community members, health professionals, health services, peak organisations and policy makers to improve renal care experiences and outcomes. She co-designs patient journey mapping tools to identify barriers and enablers to care, and co-creates new models of care to better meet patient and health service needs.