Background
Māori are twice as likely to die after a diagnosis of cancer compared to non-Māori in Aotearoa, New Zealand. Cancer care coordination is not universally available and there is lack of regional or national infrastructure and integration. Māori cancer experts sought a service delivery approach for supporting Māori through a cancer journey that was health enhancing, equity positive and implementable nationally. The resulting Whiri model has been developed and tested and shown to be feasible and effective at improving cancer care for Māori.
Aims
This study sought to co-design, implement and evaluate a holistic cancer service that is patient and family centred using Whiri, an established Māori model of care. This comprehensive, racism-free, wellbeing enhancing and responsive approach was redesigned for the care cancer pathway.
Design and Method
Whiri includes an integrated team structured around navigators, a well-being screening tool, and a nurse led clinical team, with strong Indigenous clinical governance. The team used Kaupapa Māori methodology, incorporating the Meihana Model of health and the ‘He Pikinga Waiora’ Māori implementation framework to guide the research process. The process involved working in partnership with patients, whānau/family, cancer clinicians, and key stakeholders in the cancer space. Cancer Whiri was piloted with 34 Māori patients referred for suspicion of cancer to Waikato hospital and is being tested further in the follow-on project at another major cancer centre.
Results
Cancer Whiri included the following components: Patient and whānau centred care; relationships; maximised hauora/wellbeing and equity gain, including access to rongoā (Māori medicine); systems; and tino rangatiratanga/Māori autonomy. Within the pilot these components allowed healthcare professionals to create culturally safe environments to enhance the delivery of care, while incorporating modern and traditional medical practices such as rongoā Māori. The model has potential to expand with reach from primary care through to palliative care.