The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Session B-5: Improving communication between patients and care providers

Initiatives For Improving Communication Between Renal Patients And Care Providers: The Experience Of Indigenous Australians

This presentation summarizes the findings of a participatory action research study undertaken in the renal unit of the Royal Darwin Hospital, Northern Territory, Australia. This unit provides care to approximately 150 patients, the vast majority of whom are Aboriginal Australians from remote communities.

We aimed to identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication. We undertook a qualitative study, gathering data through (i) videotaped interactions between patients and staff, and (ii) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication. Research participants were Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers.

We found that a shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.

Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.

In this workshop, I will explore issues related to the research process we used, outline the key findings and also the strategies proposed for improving communication. The workshop provides an exciting opportunity to compare findings and experiences from research in diverse indigenous communities and to gain an insight into some of the critical issues facing indigenous people with chronic illness as they negotiate health care systems.

Alan Cass is a nephrologist and epidemiologist. He has worked in Darwin, Australia providing clinical care to Indigenous Australians with renal disease. Indigenous renal patients come from remote communities, speak a variety of Indigenous languages, and there is usually a vast cultural and language distance between them and their health carers.

His research interests include:

• Examination of the extent of miscommunication between Aboriginal patients with renal disease and their medical carers, and its effect on the quality of care.
• Development of strategies to improve communication.
• Examination of the interaction of biological, socioeconomic and cultural factors as they affect patterns of health and illness among Indigenous Australians.
• Examination of differences in access to, and utilization of health services, and outcomes with renal disease treatment for Indigenous Australians.

  Dr. Alan Cass, BA, MBBS, FRACP
  Harkness Fellow in Health Policy
  Department of Health Care Policy
  Harvard Medical School
  180 Longwood Avenue
  Boston, MA 02115
  Phone: 617-432 3447
  Fax: 617-432 0173
  E-mail: cass@hcp.med.harvard.edu

Elizabeth Wu is the Coordinator for the Regional Clinician-Patient Communication (CPC) Program for Kaiser Permanente, Southern California Region. She co-chairs the CPC Subcommittee on Cultural Diversity, and sits on the West Los Angeles Medical Center’s Culturally Responsive Care Education Committee. She has co-designed a number of Cultural Diversity training programs and was a principal founder for one of the organization’s multi-cultural employee associations, The Asian Pacific American Network. Elizabeth is also co-chair of the Kaiser Permanente Interregional Clinician-Patient Communication Leadership Group.

Elizabeth Wu, MA
Coordinator
Regional Clinician-Patient Communication Program
Kaiser Permanente, Southern California
393 East Walnut Street
Parson West, 1^st Floor
Pasadena, CA 91188
Phone: 626-685-5433
Phone: 626-685-0404
E-mail: Elizabeth.X.Wu@kp.org

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