Browsing by Author "Cunningham J."
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Item Aboriginal and Torres Strait Islander people's domains of wellbeing: a comprehensive literature review.(2019-06-15) Butler T.L.; Anderson K.; Garvey G.; Cunningham J.; Ratcliffe J.; Tong A.; Whop L.J.; Cass A.; Dickson M.; Howard K.There are significant health and social disparities between the world's Indigenous and non-Indigenous people on factors likely to influence quality of life (QOL) and wellbeing. However, these disparities in wellbeing are not captured in conventional QOL instruments, as they often do not include dimensions that are likely to be relevant to Indigenous people. The objective of this comprehensive literature review was to identify these wellbeing domains for Aboriginal and Torres Strait Islander people in Australia (hereafter, respectfully referred to collectively as Indigenous Australians). We searched PsycINFO, MEDLINE, Econlit, CINAHL, and Embase (from inception to June 2017, and updated in March 2019), and grey literature sources using keywords relating to adult Indigenous Australians' QOL and wellbeing. From 278 full-text articles assessed for eligibility, 95 were included in a thematic analysis. This synthesis revealed nine broad interconnected wellbeing dimensions: autonomy, empowerment and recognition; family and community; culture, spirituality and identity; Country; basic needs; work, roles and responsibilities; education; physical health; and mental health. The findings suggest domains of wellbeing relevant to and valued by Indigenous Australians that may not be included in existing QOL and wellbeing instruments, domains that may be shared with Indigenous populations globally. This indicates the need for a tailored wellbeing instrument that includes factors relevant to Indigenous Australians. Developing such an instrument will ensure meaningful, culturally-relevant measurement of Indigenous Australians' wellbeing.Copyright © 2019 Elsevier LtdItem Australian cancer services: a survey of providers' efforts to meet the needs of Indigenous patients.(2018-11-01) Taylor E.V.; Haigh M.M.; Shahid S.; Garvey G.; Cunningham J.; Holloway M.; Thompson S.C.Objective: To examine where Indigenous Australians undergo cancer treatment and learn about specific service initiatives that have been implemented to meet their needs. Method(s): Public cancer treatment centres across Australia were invited to participate in an online survey about various characteristics of their centre, including the type of service provided, Indigenous patient numbers and policy, and implementation of Indigenous-specific initiatives. Result(s): Surveys were completed for 58 of 125 public cancer treatment centres. Almost half (47%) of the services saw more than 10 Indigenous patients per year, although Indigenous patients generally represented a small minority of patients. The most commonly reported initiatives were "having links with Indigenous health organisations in the community" (74% of services), "making a dedicated effort to address the needs of Indigenous patients" (69%) and proactively "creating partnerships with Indigenous communities and health organisations" (69%). Conclusion(s): The majority of respondents indicated that they were working to meet the needs of Indigenous patients and were interested in learning strategies from others to improve their services. More work is needed to describe and evaluate the specific initiatives that have been implemented. Implications for public health: Information from this study can assist cancer service providers to identify gaps in current services, plan new service delivery initiatives and ultimately improve Indigenous cancer outcomes. Copyright © 2018 The AuthorsItem Cancer outcomes for Aboriginal and Torres Strait Islander Australians in rural and remote areas.(2017-04-05) Diaz A.; Whop L.J.; Valery P.C.; Moore S.P.; Cunningham J.; Garvey G.; Condon J.R.Objective: To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Design: Systematic review and matched retrospective cohort study. SETTING: Australia. PARTICIPANTS: Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). MAIN OUTCOME MEASURES: Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Results: Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. Conclusion: More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians.Copyright © 2015 National Rural Health Alliance Inc.Item Cancer services and their initiatives to improve the care of Indigenous Australians.(2018-04-18) Taylor E.V.; Haigh M.M.; Shahid S.; Garvey G.; Cunningham J.; Thompson S.C.Indigenous Australians continue to experience significantly poorer outcomes from cancer than non-Indigenous Australians. Despite the importance of culturally appropriate cancer services in improving outcomes, there is a lack of awareness of current programs and initiatives that are aimed at meeting the needs of Indigenous patients. Telephone interviews were used to identify and describe the Indigenous-specific programs and initiatives that are implemented in a subset of the services that participated in a larger national online survey of cancer treatment services. Fourteen services located across Australia participated in the interviews. Participants identified a number of factors that were seen as critical to delivering culturally appropriate treatment and support, including having a trained workforce with effective cross-cultural communication skills, providing best practice care, and improving the knowledge, attitudes, and understanding of cancer by Indigenous people. However, over a third of participants were not sure how their service compared with others, indicating that they were not aware of how other services are doing in this field. There are currently many Indigenous-specific programs and initiatives that are aimed at providing culturally appropriate treatment and supporting Indigenous people affected by cancer across Australia. However, details of these initiatives are not widely known and barriers to information sharing exist. Further research in this area is needed to evaluate programs and initiatives and showcase the effective approaches to Indigenous cancer care.Copyright © 2018 by the authors. Licensee MDPI, Basel, Switzerland.Item Cervical abnormalities are more common among Indigenous than other Australian women: a retrospective record-linkage study, 2000-2011.(2016-04-22) Whop L.J.; Baade P.; Garvey G.; Cunningham J.; Brotherton J.M.L.; Lokuge K.; Valery P.C.; O'Connell D.L.; Canfell K.; Diaz A.; Roder D.; Gertig D.M.; Moore S.P.; Condon J.R.Indigenous Australian women have much higher incidence of cervical cancer compared to non-Indigenous women. Despite an organised cervical screening program introduced 25 years ago, a paucity of Indigenous-identified data in Pap Smear Registers remains. Prevalence of cervical abnormalities detected among the screened Indigenous population has not previously been reported. We conducted a retrospective cohort study of populationbased linked health records for 1,334,795 female Queensland residents aged 20-69 years who had one or more Pap smears during 2000-2011; from linked hospital records 23,483 were identified as Indigenous. Prevalence was calculated separately for Indigenous and non-Indigenous women, for cytology-detected low-grade (cLGA) and highgrade abnormalities (cHGA), and histologically confirmed high-grade abnormalities (hHGA). Odds ratios (OR) were estimated from logistic regression analysis. In 2010-2011 the prevalence of hHGA among Indigenous women (16.6 per 1000 women screened, 95% confidence interval [CI] 14.6-18.9) was twice that of non-Indigenous women (7.5 per 1000 women screened, CI 7.3-7.7). Adjusted for age, area-level disadvantage and place of residence, Indigenous women had higher prevalence of cLGA (OR 1.4, CI 1.3-1.4), cHGA (OR 2.2, CI 2.1-2.3) and hHGA (OR 2.0, CI 1.9-2.1). Our findings show that Indigenous women recorded on the Pap Smear Register have much higher prevalence for cLGA, cHGA and hHGA compared to non-Indigenous women. The renewed cervical screening program, to be implemented in 2017, offers opportunities to reduce the burden of abnormalities and invasive cancer among Indigenous women and address long-standing data deficiencies.Copyright © 2016 Whop et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Item Development of a national Aboriginal and Torres Strait Islander cancer framework: a shared process to guide effective policy and practice.(2018-05-19) Brands J.; Garvey G.; Anderson K.; Cunningham J.; Chynoweth J.; Wallington I.; Morris B.; Knott V.; Webster S.; Kinsella L.; Condon J.; Zorbas H.Indigenous Australians experience a substantially higher cancer mortality rate than non-Indigenous Australians. While cancer outcomes are improving for non-Indigenous Australians, they are worsening for Indigenous Australians. Reducing this disparity requires evidence-based and culturally-appropriate guidance. The purpose of this paper is to describe an initiative by Cancer Australia and Menzies School of Health Research (Menzies) to develop Australia's first National Aboriginal and Torres Strait Islander Cancer Framework using a process of co-design with relevant stakeholders. The initiative was guided by three core principles: achieving policy-relevant evidence-based outcomes; engaging and maintaining trust with Indigenous Australians at every phase; and employing best-practice and appropriate research methods. Four components of research comprised the Framework development: evidence review; multifaceted stakeholder consultation and input; triangulation of findings; and direct stakeholder input in drafting and refining the Framework. The evidence review confirmed the increasing burden of cancer on Indigenous Australians, while stakeholder consultations facilitated comprehensive input from those with lived experience. The consultations revealed issues not identified in existing literature, and gave different emphases of priority, thus reinforcing the value of including stakeholder perspectives. This paper focuses primarily on documenting the methods used; findings are presented only in order to illustrate the results of the process. The published Framework is available at www.canceraustralia.gov.au; further description and analyses of findings from the consultations will be published elsewhere. The logistics inherent in large-scale consultation are considerable. However, the quality of data and the foundation for sustained partnership with stakeholders and knowledge translation vastly outweighed the challenges. The process of wide-ranging stakeholder consultation described in this paper offers a model for other areas of national and international Indigenous priority setting and policy and practice development that meets the needs of those most affected. The Framework, through the establishment of an agreed, shared and evidence-based agenda, provides guidance for jurisdictional cancer plans, optimal care pathways, and program and service planning for the multiple players across all levels of the health system.Copyright © 2018 by the authors. Licensee MDPI, Basel, Switzerland.Item Development of the What Matters 2 Adults (WM2A) wellbeing measure for Aboriginal and Torres Strait Islander adults.Howard K.; Garvey G.; Anderson K.; Dickson M.; Viney R.; Ratcliffe J.; Howell M.; Gall A.; Cunningham J.; Whop L.J.; Cass A.; Jaure A.; Mulhern B.Purpose: As wellbeing is culturally bound, wellbeing measures for Aboriginal and Torres Strait Islander peoples must be culturally relevant and grounded in Aboriginal and Torres Strait Islander values and preferences. We describe the development of a nationally-relevant and culturally grounded wellbeing measure for Aboriginal and Torres Strait Islander adults: the What Matters to Adults (WM2A) measure. Methods: We used a mixed methods approach to measure development, combining Indigenist methodologies and psychometric methods. Candidate items were derived through a large national qualitative study. Think-aloud interviews (n = 17) were conducted to assess comprehension, acceptability, and wording of candidate items. Two national surveys collected data on the item pool (n = 312, n = 354). Items were analysed using exploratory factor analysis (EFA), and item response theory (IRT) to test dimensionality, local dependence and item fit. A Collaborative Yarning approach ensured Aboriginal and Torres Strait Islander voices were privileged throughout. Results: Fifty candidate items were developed, refined, and tested. Using EFA, an eight factor model was developed. All items met pre-specified thresholds for maximum endorsement frequencies, and floor and ceiling effects; no item redundancy was identified. Ten items did not meet thresholds for aggregate adjacent endorsement frequencies. During Collaborative Yarning, six items were removed based on low factor loadings (<0.4) and twelve due to conceptual overlap, high correlations with other items, endorsement frequencies, and/or low IRT item level information. Several items were retained for content validity. The final measure includes 32 items across 10 domains (Balance & control; Hope & resilience; Caring for others; Culture & Country; Spirit & identity; Feeling valued; Connection with others; Access; Racism & worries; Pride & strength). Conclusions: The unique combination of Indigenist and psychometric methodologies to develop WM2A ensures a culturally and psychometrically robust measure, relevant across a range of settings and applications. (PsycInfo Database Record (c) 2024 APA, all rights reserved)Item How well is the national cervical screening program performing for Indigenous Australian women? Why we don't really know, and what we can and should do about it.(2015-11-12) Whop L.J.; Cunningham J.; Condon J.R.Since its inception in 1991, Australia's organised approach to cervical screening, the National Cervical Screening Program (NCSP), has seen a 50% reduction in both incidence and mortality from cervical cancer in Australia. However, Indigenous Australian women continue to experience a disproportionately higher burden of cervical cancer. No national data on screening participation of Indigenous women currently exist, in large part because pathology forms, the primary source of data for Pap Test Registers (PTR), do not record Indigenous status. While including Indigenous status on pathology forms is the obvious solution for producing essential information about cervical screening of Indigenous women, this will require an appropriate consultative process and it will be many years before reliable data are available. One interim option being explored is the feasibility of linking the PTR to another data source which includes Indigenous status, such as hospital data. However, despite its promise, there remain major impediments to obtaining useful linked data in Australia, and it continues to be unclear whether such an approach is viable for routine reporting. If we are to understand and improve cervical screening participation and outcomes for Indigenous women in the foreseeable future, Australia needs to act now to include Indigenous status in pathology forms and (subsequently) PTRs. Copyright © 2014 John Wiley & Sons Ltd.Item Identifying research priorities to improve cancer control for Indigenous Australians.(2017-10-26) Morris B.A.; Anderson K.; Cunningham J.; Garvey G.Objectives: The cancer burden is high among Australia's Indigenous population. Following a period of increasing attention by researchers, policy makers and consumers, this study aimed to identify emerging research priorities in Indigenous cancer control. Method(s): A survey was administered to a network of individuals with an interest in cancer and Indigenous Australians. Respondents (N = 255) described what they thought was the most significant research priority for cancer control for Indigenous Australians and ranked prespecified research areas relating to components of the cancer continuum. Result(s): Identified research priorities included cancer prevention and early detection; health literacy; and culturally appropriate care for Indigenous patients, survivors and families. Community engagement, Indigenous ownership, and partnership and collaboration were highlighted as critical elements underpinning research. Conclusion(s): The identified research priorities, along with seminal documents such as the National Aboriginal and Torres Strait Islander Cancer Framework, provide a roadmap for developing, funding, implementing and translating research to reduce the burden of cancer for Indigenous Australians. Copyright © 2017 Morris et al.Item Improving outcomes for Aboriginal and Torres Strait Islander people with cancer requires a systematic approach to understanding patients' experiences of care.(2017-04-09) Green M.; Cunningham J.; O'Connell D.; Garvey G.Indigenous Australians experience a greater burden of cancer than other Australians, but there is little systematic information about their experiences of cancer care. Patient-centred care is increasingly recognised as one of the core domains of quality care, alongside clinical effectiveness and patient safety. Qualitative studies have identified significant issues relating to Indigenous patients' experiences of cancer care, but these data are often insufficient to inform and evaluate health service improvement. We need to establish appropriate methods that will lead to systematic, routinely collected, accurate, population-based data on the experiences of care of Indigenous people with cancer, and determine how best to translate these data into improvements in the delivery of care to this population. Genuine Indigenous leadership and involvement will be necessary, with the whole approach underpinned by the primary aim of improving health outcomes for this population. Copyright © 2017 AHHA.Item Investigating indicators for measuring the health and social impact of sport and recreation programs in Australian Indigenous communities.Cunningham J.; Beneforti M.A project was undertaken in 2002 on behalf of the Australian Sports Commission to identify potential indicators of health and social outcomes from sport and recreation programs in Indigenous communities in Australia. The project consisted of three stages: 1) a literature review to identify specific indicators of potential relevance in the Indigenous Australian context; 2) discussions with key members of three Indigenous communities in the Northern Territory to identify community expectations and experiences of sport and recreation programs; and 3) consultation with relevant stakeholders to determine the potential usefulness and appropriateness of the indicators identified in the first two stages. A number of indicators are proposed for immediate testing and refinement, while others are recommended for future development. (PsycInfo Database Record (c) 2022 APA, all rights reserved)Item Measuring health care experiences that matter to Indigenous people in Australia with cancer: identifying critical gaps in existing tools.(2021-04-22) Green M.; Cunningham J.; Anderson K.; Griffiths K.; Garvey G.Background: Measurement of patients' healthcare experiences is increasingly used as an indicator of quality of care, but there are concerns that existing measures omit information that is meaningful to patients and that results may not be used systematically to inform service improvement. Further, current approaches may be inadequate for some population groups, such as Indigenous people in Australia, whose healthcare experience is impacted by the context of colonisation and discordance between Indigenous understandings of health and the Western biomedical health system. This study aimed to assess the extent to which existing patient experience measures used in Australia collect information about critical aspects of cancer care, as previously identified by Indigenous people affected by cancer and their health care providers. Method(s): A two-stage process was used to examine the adequacy of existing patient experience measures for Indigenous people in Australia: (1) relevant tools and measures were identified and assessed, and four measures selected as suitable comparators; (2) comparators were examined in detail and mapped against topics identified in earlier research as important to Indigenous people with cancer. Gaps in topic coverage in comparators were identified. Result(s): No comparators completely captured the critical aspects of cancer care identified by Indigenous people affected by cancer and their health care providers. The number of topics 'partially' captured by the four comparators ranged from 4 to 7 out of 9. While most topics were partially covered, the lack of questions around culture and cultural safety was notable. Conclusion(s): Existing tools are likely to miss key aspects of Indigenous peoples' experiences of cancer care in Australia. Failure to adequately assess care experiences related to cultural safety may compromise efforts to improve health outcomes. Addressing gaps requires development of experience measures that are strengths-based, reflect an Indigenous worldview and measure aspects of experience relevant to Indigenous people.Copyright © 2021, The Author(s).Item Placing Aboriginal and Torres Strait Islander mortality in an international context.(2002-03-06) Paradies Y.; Cunningham J.Objective: To assess whether the patterns of mortality observed among Indigenous Australians were seen in other countries or sub-populations. Previous reports have indicated that the life expectancy of Indigenous Australians compares unfavourably with that of Indigenous groups in other developed countries, and is similar to that in some developing countries. However, in contrast to many developing countries, low life expectancy of Indigenous Australians is the result of relatively high and early adult mortality, rather than high infant mortality. Method(s): Using routinely available administrative data on age-specific mortality and estimated life expectancy at birth, we compared data for Indigenous Australians (from the Northern Territory, Western Australia and South Australia combined) with corresponding data for 200 countries world-wide, as well as for several population groups of interest, including African Americans, Native Americans, Canadian Natives and New Zealand Maori. Result(s): Patterns of mortality among Indigenous Australians were markedly different to those of most other populations with available data, with the exception of the Russian Republic. The age-specific mortality rates for Russian males in 1990-95 were almost identical to those of Indigenous males in 1995-97. The similarities among females were less pronounced, but stronger than for any other country. Conclusion and implications: The dramatic fall in Russian life expectancy has been studied extensively and several important social and contextual factors have been identified. These factors are also relevant for the Indigenous population, and this may help to explain the similar mortality patterns of the two groups.Item Renal transplantation for Indigenous Australians: identifying the barriers to equitable access.(2003-10-08) Cass A.; Cunningham J.; Snelling P.; Wang Z.; Hoy W.Objective. To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation. Design. National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000. Results. Indigenous patients had a lower transplantation rate (adjusted Indigenous:non-Indigenous rate ratio 0.32, 95% CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95% CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95% CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease. Conclusions. Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.Item The development of an Indigenous cancer network - lessons learned.(2015-11-17) Morris B.; Reed B.; Gall A.; Arley B.; Cunningham J.; Garvey G.Cancer is the second leading cause of death among Indigenous Australians, and while non-Indigenous Australians have experienced improved outcomes in cancer diagnosis, treatment and survival, this is not mirrored among Indigenous Australians. A growing body of evidence indicates widespread failure of the health system to adequately prevent, diagnose and treat cancer among Indigenous Australians, and there is an increasing sense of urgency to escalate the effort to address these disparities. In response to this, the National Indigenous Cancer Network (NICaN) was launched in 2013. This presentation will discuss challenges and successes of developing NICaN, aimed at encouraging and supporting collaboration in Indigenous cancer research and the delivery of services to Indigenous people with cancer. NICaN is a partnership between Menzies School of Health Research, the Australian Indigenous HealthInfoNet (a national research institute specialising in translational research with a population health focus), the Lowitja Institute (Australia's national institute for Aboriginal and Torres Strait Islander health research), Cancer Council Australia (Australia's peak national non-government cancer control organisation). NICaN aims to ensure that what's known about cancer in Indigenous Australians is available for use by people with cancer, their families, practitioners, policy makers and researchers. Since its conception NICaN has grown in scope and membership and is a critical part of translating Indigenous cancer research into practice. There have been a number of lessons learned, challenges and successes, including: developing and maintaining collaborative partnerships with key players; role of cancer survivors as advocates and ambassadors; ensuring consumer buyin, input and ongoing engagement; and the use of social media strategies. NICaN has established itself as a credible, Indigenous-led, and independent (i.e., non-government, non-bureaucratic) organisation aimed at increasing access to information about cancer for Indigenous people, and facilitating community engagement and research translation to assist in improving cancer outcomes for Indigenous Australians.Item The patient co-payment and opportunity costs of accessing healthcare for Indigenous Australians with cancer: a whole of population data linkage study.(2019-08-02) Callander E.; Bates N.; Lindsay D.; Larkins S.; Preston R.; Topp S.M.; Cunningham J.; Garvey G.Aim: To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. Method(s): CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base population was a census of all persons diagnosed with cancer in Queensland, Australia between 1 July 2011 and 30 June 2012 (n = 25,553). Individual records were linked to corresponding Queensland Health Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between 1 July 2011 and 30 June 2015. Queensland data were weighted to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). Result(s): After adjusting for age, sex, rurality, area-based deprivation, and cancer group, Indigenous Australians accrued significantly less in postdiagnosis patient co-payments at 0-6 months (61% less) and 7-12 months (63% less). Indigenous Australians also had significantly fewer postdiagnosis hospitalizations at 0-6 months (21% fewer) and 7-12 months (27% fewer). Conclusion(s): There is growing concern regarding the financial burden of cancer to the patient. The time spent away from family and their community may also have an important time opportunity cost, which may affect a person's decision to undertake or continue treatment. This is the first study in Australia to identify the financial cost of co-payments for Indigenous people with cancer, as well as the number and length of hospitalizations as drivers of time opportunity costs.Copyright © 2019 John Wiley & Sons Australia, LtdItem Time to clinical investigation for Indigenous and non-Indigenous Queensland women after a high grade abnormal pap smear, 2000-2009.(2017-02-16) Whop L.J.; Baade P.D.; Brotherton J.M.L.; Canfell K.; Cunningham J.; Gertig D.; Lokuge K.; Garvey G.; Moore S.P.; Diaz A.; O'Connell D.L.; Valery P.; Roder D.M.; Condon J.R.Objectives: To investigate time to follow-up (clinical investigation) for Indigenous and non-Indigenous women in Queensland after a high grade abnormality (HGA) being detected by Pap smear. Design, setting, participants: Population-based retrospective cohort analysis of linked data from the Queensland Pap Smear Register (PSR), the Queensland Hospital Admitted Patient Data Collection, and the Queensland Cancer Registry. 34 980 women aged 20e68 years (including 1592 Indigenous women) with their first HGA Pap smear result recorded on the PSR (index smear) during 2000e2009 were included and followed to the end of 2010. Main Outcome Measure(s): Time from the index smear to clinical investigation (histology test or cancer diagnosis date), censored at 12 months. Result(s): The proportion of women who had a clinical investigation within 2 months of a HGA finding was lower for Indigenous (34.1%; 95% CI, 31.8e36.4%) than for non-Indigenous women (46.5%; 95% CI, 46.0e47.0%; unadjusted incidence rate ratio [IRR], 0.65; 95% CI, 0.60e0.71). This difference remained after adjusting for place of residence, area-level disadvantage, and age group (adjusted IRR, 0.74; 95% CI, 0.68e0.81). However, Indigenous women who had not been followed up within 2months were subsequently more likely to have a clinical investigation than non-Indigenous women (adjusted IRR for 2e4 month interval, 1.21; 95% CI, 1.08e1.36); by 6 months, a similar proportion of Indigenous (62.2%; 95% CI, 59.8e64.6%) and non-Indigenous women (62.8%; 95% CI, 62.2e63.3%) had been followed up. Conclusion(s): Prompt follow-up after a HGA Pap smear finding needs to improve for Indigenous women. Nevertheless, slow follow-up is a smaller contributor to their higher cervical cancer incidence and mortality than their lower participation in cervical screening.Copyright ©2017 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.