Better cardiac care - the patient experience - a qualitative study

Warren Jennings; Sonya Egert; Celestine Fisher; Sonia Renouf; Vivian Bryce; Sean Grugan; William Wang; Deborah Askew

doi:10.1186/s12939-023-01931-5

Better cardiac care - the patient experience - a qualitative study

Int J Equity Health. 2023 Jun 28;22(1):122. doi: 10.1186/s12939-023-01931-5.

Authors

Warren Jennings^{1

2}, Sonya Egert³, Celestine Fisher⁴, Sonia Renouf⁴, Vivian Bryce⁴, Sean Grugan⁴, William Wang^{4

5}, Deborah Askew⁶

Affiliations

¹ Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, Inala, Qld, 4077, Australia. w.jennings@uq.edu.au.
² General Practice Clinical Unit, The University of Queensland, Women's Hospital, Level 8, Health Sciences Building, Royal Brisbane, Brisbane, Qld, 4029, Australia. w.jennings@uq.edu.au.
³ Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, Inala, Qld, 4077, Australia.
⁴ Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia.
⁵ Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia.
⁶ General Practice Clinical Unit, The University of Queensland, Women's Hospital, Level 8, Health Sciences Building, Royal Brisbane, Brisbane, Qld, 4029, Australia.

Abstract

Background: In 2015, a Brisbane tertiary hospital's cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients' voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members.

Methods: This descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones' hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants' stories to be heard and understood from their perspectives.

Results: Relationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys.

Conclusions: Empowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient's needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality.

Keywords: Aboriginal and Torres Strait Islander people; Cardiac care.; Cultural competence; Equity; Health access; Health worker; Indigenous; Qualitative; Racism; Relationality; Yarning.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Family*
Health Facilities*
Health Personnel
Humans
Patient Outcome Assessment
Prospective Studies