Lung cancer
Overall lung cancer survival in NZ is poor especially for Mori. This is because lung cancer is typically diagnosed at a late stage once a patient has presented with symptoms. The reasons for late diagnosis can be due to both patient and health system factors. Both need to be addressed in order to improve survival.
H Ora Improving early diagnosis of lung cancer for Mori and rural communities
Final Report
This study was conducted over three years in the Midland Cancer Region which comprises Waikato, Lakes, Bay of Plenty and Tairawhiti DHBs and our research into the late diagnosis of lung cancer among Mori communities identified several barriers preventing Mori from accessing primary care.
Findings of the project highlight:
- Barriers in primary care, including symptom ambiguity, accumulating costs, barriers and enablers relating to GP patient relationships.
- Barriers in secondary care, including a lack of access to diagnostic tests, long waiting times, barriers and enablers relating to communication between HCPs and patients
- The importance of whnau as carers and advocates for Mori patients on their lung cancer journey.
Our hypothesis is that a multi-pronged, community designed intervention will improve early detection and diagnosis for Mori with symptoms of lung cancer. Our aim was to understand the barriers to early diagnosis of Mori at risk of lung cancer.
Through a series of community-based co-design processes with four localities (ptiki, Gisborne, Rotorua and Te Kuiti), we designed and implemented interventions to improve early presentation and diagnosis of at risk Mori.
The interventions co-designed were:
, to improve awareness of lung-related ailments and provide information on local community support services.
A Pou Pupuru Oranga/Cancer navigator, to provide support and advocate for whnau diagnosed with lung cancer, and to help them navigate the cancer care pathway.
A kaiawhina training programme, involving upskilling kaiawhina and clinical staff through a series of workshops discussing lung cancer symptoms, diagnostic and treatment pathways.
A series of lung cancer awareness videos, featuring a community-composed waiata encouraging whnau to go and see a doctor if they have a persistent cough
Project partners
This research was funded by the Health Research Council, and conducted in partnership with AUT, Centre for Health, Lakes DHB, and Waikato DHB. Special mention goes to our Mori health care partners: Te Puna Oranga, Waikato DHB, Whakathea Mori Trust Board in Optiki, Turanga Health in Gisborne, Ngti Maniapoto Marae Pact Trust and Maniapoto Whnau Ora Centre in Te Kuiti and Aroha Mai Cancer Support Services, Te Arawa Whnau Ora in Rotorua.
Recent publications
- Kidd, J., Cassim, S., Rolleston, A., Keenan, R., Lawrenson, R., Sheridan, N., Warbrick, I., Ngaheu, J. & Hokowhitu, B. (2021). H Ora: Reflecting on a Kaupapa Mori community engaged co-design approach to lung cancer research, International Journal of Indigenous Health, 16(2). doi:
- Cassim, S., Lawrenson, R., Keenan, R., Middleton, K., Rolleston, A.,匠idd, J. (2021). Indigenous perspectives on breaking bad news: Ethical considerations for healthcare providers, Journal of Medical Ethics. doi:
- Kidd, J., Cassim, S., Rolleston, A., Chepulis, L., Hokowhitu, B.,. Lawrenson, R. (2021). H Ora: Secondary care barriers and enablers to early diagnosis of lung cancer for Mori communities, BMC Cancer, 21. doi:
- Cassim, S., Kidd, J., Rolleston, A., Keenan, R., Aitken, D.,..Lawrenson, R. (2020). H Ora: Barriers and enablers to early diagnosis of lung cancer in primary healthcare for Mori communities, European Journal of Cancer Care. doi: 10.1111/ecc.13380
- Rolleston, A., Cassim, S., Kidd, J., Lawrenson, R., Keenan, R. & Hokowhitu, B. (2020). Seeing the unseen: Evidence of Kaupapa Mori health interventions, AlterNative. doi: 10.1177/1177180120919166
- Lawrenson, R., Lao, C., Brown, L. et al. (2020). Management of patients with early stage lung cancer why do some patients not receive treatment with curative intent?. BMC Cancer, 20, 109. doi:
- Kidd, J., Cassim, S., Rolleston, A. & Keenan, R. (2019). Co-opting or valuing the indigenous voice? A question of ethics, Ethnographic Edge 3(1). doi:
- Cassim, S., Chepulis, L., Keenan, R., Kidd, J., Firth, M. & Lawrenson, R. (2019). Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: A systematic review, BMC Cancer 19(1), 25. doi: 10.1186/s12885-018-5169-9.
- Chepulis, L, Ryan, B, Blackmore, T, Burrett, V, McCleery, J, Lawrenson, R. (2019) Characteristics of lung cancer patients receiving psychosocial support in urban New Zealand. Psycho-Oncology, 28, 1588-1590. doi:
- Lawrenson, R., Lao, C., Leonie, B., Wong, J., Middleton, K., Firth, M. & Aitken, D. (2018). Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry, NZMJ, 131(1479).