Institutional Factors Associated with Equitable Cancer Care Provision for Culturally and Linguistically Diverse Populations in Queensland, Australia: A Critical Race Theory Analysis

Abstract

Background: Cancer inequities for Culturally and Linguistically Diverse (CALD) populations have been demonstrated in Australia. Historically, research has focused on individual factors, but addressing structural and institutional determinants is crucial for equitable care provision. This study utilised Critical Race Theory to examine institutional factors impacting equitable care provision.

Methods: We undertook a qualitative exploration of a large tertiary hospital in metropolitan Queensland. Institutional barriers, facilitators, and staff experiences regarding equitable care were explored through semi-structured interviews (n = 21). Participants included oncology registered nurses (n = 6), oncology doctors (n = 5), specialist nurses (n = 7), and executive-level staff (n = 3). Data were analysed using The Framework Method.

Results: Findings revealed an inflexible health system with strong deficit framing of CALD patients. A reliance on assumptions and informal mechanisms to address the needs of CALD patients resulted in suboptimal practises such as simplified information sharing, use of unqualified interpreters, limited treatment access, and avoidance of psycho-social discussions. Staff reported experiencing moral conflict when providing care discordant with their professional values.

Conclusions: This study demonstrates the need for cultural and structural reform within Australian health services. Adapting services to promote equity will have demonstrable benefits for patient outcomes, quality of care, and staff wellbeing.

Keywords: Cancer care; Critical Race Theory; Health equity; Health services; Institutional racism; Medical oncology; Racialisation; Service delivery; Universal health coverage.