Kaitiaki Nursing ServiceKaitiaki Nursing ServiceKaitiaki Nursing ServiceKaitiaki Nursing ServiceKaitiaki Nursing ServiceKaitiaki Nursing ServiceKaitiaki Nursing ServiceKaitiaki Nursing Service

Kaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraKaimahi Ngaiotanga Hauora

Whanau: Cancer Support NursesWhanau: Cancer Support NursesWhanau: Cancer Support NursesWhanau: Cancer Support Nurses

Based in Tauranga Based in Tauranga

Western Bay of PlentyWestern Bay of Plenty

BecauseBecause statistics tell us that:statistics tell us that:

•• Maori have cancer mortality rates up to Maori have cancer mortality rates up to 78%78% higher higher than nonthan non--MaoriMaori

•• 51%51% higher for Maori males and higher for Maori males and •• 51%51% higher for Maori males and higher for Maori males and

•• 78%78% higher for Maori females than for nonhigher for Maori females than for non--MaoriMaori

•• Maori are more likely to be diagnosed with cancers with Maori are more likely to be diagnosed with cancers with poorer survival ratespoorer survival rates, such as lung, liver, stomach, , such as lung, liver, stomach, cervix and testicular cancers. cervix and testicular cancers.

2006 t2006 the Western Bay of Plenty PHO he Western Bay of Plenty PHO

(WBOP PHO)(WBOP PHO)

mademade the decision to fund a Maori Nursing service the decision to fund a Maori Nursing service

to provide services to Maori and their whanau to provide services to Maori and their whanau

affected by canceraffected by cancer

•• NZ Health StrategyNZ Health Strategy

•• He Korowai Oranga He Korowai Oranga -- Maori Heath StrategyMaori Heath Strategy

•• Cancer Control strategyCancer Control strategy

WBOP PHO WBOP PHO

•• Has a Maori population of 14,000 and Has a Maori population of 14,000 and growinggrowing

•• Children <16 are exclusion to our serviceChildren <16 are exclusion to our service

Boundary / region we serviceBoundary / region we service

2006 began 8 week scoping exercise 2006 began 8 week scoping exercise -- a needs analysis a needs analysis

to identify whanau needs and gaps to determine service to identify whanau needs and gaps to determine service

delivery delivery

We Consulted with key stakeholders:We Consulted with key stakeholders:

•• Iwi/hapuIwi/hapu

•• HauoraHauora

•• Maori providersMaori providers

•• Chemotherapy unitChemotherapy unit

•• OncologistsOncologists

•• SpecialistsSpecialists•• Maori providersMaori providers

•• Maori people with cancer Maori people with cancer

and their whanauand their whanau

•• GP’sGP’s

•• Cancer societyCancer society

•• Waipuna HospiceWaipuna Hospice

•• SpecialistsSpecialists

•• Other relevant secondary Other relevant secondary

providers (hospital providers (hospital

services)services)

•• Community providersCommunity providers

•• Allied health servicesAllied health services

Needs/gaps identifiedNeeds/gaps identified

FindingsFindings

•• No culturally appropriate services for No culturally appropriate services for Maori requiring cancer care.Maori requiring cancer care.

•• Many Maori are slipping through the Many Maori are slipping through the gaps.gaps.

•• Maori have a lack of knowledge and Maori have a lack of knowledge and understanding of the diagnosis, the understanding of the diagnosis, the disease process, treatment and disease process, treatment and medication.medication.

Service ConstraintsService Constraints

Current services cannot cope withCurrent services cannot cope withproviding a culturally appropriate careproviding a culturally appropriate carepartly due to:partly due to:

•• lack of Maori nursing stafflack of Maori nursing staff

•• A lack of knowledge of Maori cultureA lack of knowledge of Maori culture

•• the inability to relate to and the inability to relate to and communicate with Maori peoplecommunicate with Maori people

medication.medication.

•• Apprehension & denial (afraid, see Apprehension & denial (afraid, see this as a death sentence) opt to this as a death sentence) opt to delay or not to have treatment. delay or not to have treatment. Some ‘head for the hills’ only to Some ‘head for the hills’ only to return for help, when the disease has return for help, when the disease has progressed to a stage where it is progressed to a stage where it is unfortunately unable to be treated unfortunately unable to be treated successfully.successfully.

•• UserUser--friendly information does not friendly information does not exist,exist, re risk factors, early signs and re risk factors, early signs and symptoms and availability of symptoms and availability of services.services.

•• Maori unaware of available servicesMaori unaware of available services

•• the inability to relate to and the inability to relate to and communicate with Maori peoplecommunicate with Maori people

•• no understanding or knowledge of no understanding or knowledge of Rongoa (traditional Maori treatment/ Rongoa (traditional Maori treatment/ medicine) to be able to offer clients medicine) to be able to offer clients this optionthis option

•• existing information is inadequate for existing information is inadequate for MaoriMaori

•• too busy clinically to educate, too busy clinically to educate, advocate and supportadvocate and support

•• the service ‘too stretched’.the service ‘too stretched’.

FollowingFollowing the scoping exercisethe scoping exercise

Service delivery began in Service delivery began in

March 2006March 2006March 2006March 2006

Kaimahi Ngaiotanga HauoraKaimahi Ngaiotanga HauoraWhanau: Cancer Support NursesWhanau: Cancer Support Nurses

(NZRN Specialist Cancer Nurses)(NZRN Specialist Cancer Nurses)

We provideWe provide ‘supportive care’‘supportive care’ for Maori and their for Maori and their whanau affected by cancer whanau affected by cancer

Essential services:Essential services:

•• to meet physical, cultural and emotional needsto meet physical, cultural and emotional needs

•• nutritional and psychological needsnutritional and psychological needs

•• sexual, spiritual and practical needssexual, spiritual and practical needs

•••• to provide education/informationto provide education/information

•• to offer alternative treatment e.g. rongoa, tohunga, to offer alternative treatment e.g. rongoa, tohunga, karakia and mirimiri alongside western approach to karakia and mirimiri alongside western approach to medicine medicine

•• to navigate clients through health and social services for to navigate clients through health and social services for coco--ordinated care ordinated care

•• accompany client and whanau to specialist, GP, OPD accompany client and whanau to specialist, GP, OPD clinics and clinical proceduresclinics and clinical procedures

‘‘supportive caresupportive care’ that help the person and their ’ that help the person and their whanau to cope with cancer and treatmentwhanau to cope with cancer and treatment

•• –– from from prepre--diagnosis, through the process of diagnosis diagnosis, through the process of diagnosis and treatment, to cure, continuing illness, or death, and and treatment, to cure, continuing illness, or death, and into bereavement into bereavement -- with the whanau. with the whanau.

•• To help the person maximise the benefits of treatment To help the person maximise the benefits of treatment •• To help the person maximise the benefits of treatment To help the person maximise the benefits of treatment and to live as well as possible with the effects of the and to live as well as possible with the effects of the disease and todisease and to

•• manage the manage the impactimpact of cancer during their cancer of cancer during their cancer journey.journey.

We We

•• Assess their needs using Te Whare Tapa Wha Assess their needs using Te Whare Tapa Wha model.model.

��Taha hinengaroTaha hinengaro

��Taha wairuaTaha wairua

��Taha tinanaTaha tinana

��Taha whanauTaha whanau

•• Ensure client & whanau have a good Ensure client & whanau have a good understanding of their cancerunderstanding of their cancer

-- disease process and treatmentdisease process and treatment

-- ongoing careongoing care

•• Give ongoing support through regular visits & Give ongoing support through regular visits & phone callsphone calls

We are a mobile serviceWe are a mobile service

Services are delivered in settings most appropriate Services are delivered in settings most appropriate for the client/whanau: for the client/whanau:

•• clients’ home, clients’ home,

•• marae, hauora or marae, hauora or •• marae, hauora or marae, hauora or

•• other clinic facility, hospital, hospiceother clinic facility, hospital, hospice

•• workplace or any community setting as workplace or any community setting as appropriate.appropriate.

Our clients are referred fromOur clients are referred from

•• GP’sGP’s

•• hauora GP practiceshauora GP practices

•• whanauwhanau

•• clients themselvesclients themselves

•• friendsfriends

•• hospital serviceshospital services•• hospital serviceshospital services-- chemotherapy unitchemotherapy unit-- outpatients clinicsoutpatients clinics-- social workerssocial workers-- hospital ward staffhospital ward staff

•• district nursesdistrict nurses

•• Cancer SocietyCancer Society

•• Waipuna HospiceWaipuna Hospice

•• Cancer Support ServicesCancer Support Services

Number of referrals (2006Number of referrals (2006--July 2009)July 2009)

50

60

70

0

10

20

30

40

Mar 2006 - Feb 2007

Mar 2007 - Feb 2008

Mar 2008 - Feb 2009

Mar 2009 - July 2009

6561

67

21

Ethnicity (2006 Ethnicity (2006 –– July 2009)July 2009)

2%6%

1%

Maori

Pacific Island

91%

European

Indian

Diagnosis of referralsDiagnosis of referrals (2006 (2006 –– July 2009July 2009

15

20

25

30

35

4039

14

10 10

30

11 11

15

0

5

10

Acu

te L

ym

ph

ocytic L

eu

ka

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ia

Acu

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ye

loid

Le

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Ca

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Bre

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Co

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CA

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CA

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CA

Bre

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Ch

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Co

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Ho

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Me

lan

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Me

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an

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an

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all

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an

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Te

sticu

lar

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r

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rin

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an

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r

12

4

1 1 1

9

12

1 1

10

7

10

2 2 2

5

8

21

65

11

2

11

4

12

1

Diagnosis men (March 2008 Diagnosis men (March 2008 –– July 2009)July 2009)

3

4

5

6

2

4

2

3

2

6

2 2

3

0

1

2

1

2

1

2 2

1 1 1 1

2

1

2

1 1

Diagnosis women (March 2008 Diagnosis women (March 2008 –– July 2009)July 2009)

6

8

10

12

14 13

7

11

6

4

0

2

4

2

1 1 1

2

1 1 1

4

Mortality Diagnosis Total (2006 Mortality Diagnosis Total (2006 –– July 2009 )July 2009 )

8

10

12

14

16

18

20

10

7 7

20

8

0

2

4

6

21

3

1 12

4

1 1 12

1

32 2

1

4

2

Total = 86

Mortality of men & diagnosis (March 2008 Mortality of men & diagnosis (March 2008 –– July July

2009)2009)

Bladder Cancer5%

Colorectal Cancer10%

Gastric Cancer10%

Oesophageal Cancer10%

Pancreatic Cancer5%

Renal cell Cancer5%

Small Cell lung Cancer10%

Head and Neck Cancer15%

Hepatocellular/Liver Cancer

5%

Non small cell Lung Cancer

25%

Mortality of women & diagnosis ( March 2008 Mortality of women & diagnosis ( March 2008 ––

July 2009)July 2009)

Breast Cancer19%

Cervical Cancer9%

Oesophageal Cancer5%

Ovarian Cancer5%

Pancreatic Cancer5%

Small Cell lung Cancer5%

Colorectal Cancer5%

Head and Neck Cancer

5%

Melanoma5%Metatases of unknown

origin9%

Non small cell Lung Cancer

28%

Research & Audit day Waikato July 2009

Lung Cancer•60% Maori women still getting lung cancer•10% non-Maori women still getting lung cancer

Rotorua have comparably high rates of lung ca in NZ – high Maori popTauranga have comparably high rates of lung ca in NZ – smaller Maori pop

Cervical Cancer•rates have come down markedly in Maori women in the last 10 yrs •rates have come down markedly in Maori women in the last 10 yrs •(2001-2004) ↓ 25%

Breast Cancer

•generally, reduced mortality by 50% with better treatments

•In Midland Region -all women who received Herceptin treatment are still alive today -all women who didn’t receive Herceptin treatment are not.

Generally Maori women with breast cancer present later

• With higher grade tumours

• More aggressive tumours

• Take longer to get treatment • Take longer to get treatment

• but do receive appropriate treatment

Barriers to our serviceBarriers to our service

•• Lack of Maori NursesLack of Maori Nurses

•• Clients present later Clients present later

•• Barriers exist with some secondary services Barriers exist with some secondary services •• Barriers exist with some secondary services Barriers exist with some secondary services reluctance to referreluctance to refer

•• Aware clients are slipping through the gapsAware clients are slipping through the gaps

•• People not aware of our servicePeople not aware of our service

Future development of our serviceFuture development of our service

•• Prevention and promotionPrevention and promotion

•• A client/whanau survey to measure our service A client/whanau survey to measure our service deliverydelivery

•• Social worker to manage the many social issues Social worker to manage the many social issues

•• Research and analysis to measure our outcomesResearch and analysis to measure our outcomes

-- value added service?value added service?

A journey with one of my patientsA journey with one of my patients

•• Female 47 years, husband, 6 children and a mokopunaFemale 47 years, husband, 6 children and a mokopuna

•• Diagnosed 2004 cancer left breast , chose not to have surgery, Diagnosed 2004 cancer left breast , chose not to have surgery,

•• Referred 2008 Referred 2008 –– presenting status presenting status

•• Medication Medication

•• Rongoa initially then no to rongoaRongoa initially then no to rongoa

•••• Drinks Mona Vie Drinks Mona Vie

•• Agreed to mirimiri and still havingAgreed to mirimiri and still having

•• Current status, wellnessCurrent status, wellness

•• Kiri Kiri –– Kaimahi Ngaiotanga Hauora Kaimahi Ngaiotanga Hauora Whanau: Cancer Support NurseWhanau: Cancer Support Nurse