The Narratives of Māori Referred for Colonoscopy

Abstract

Background: Colorectal cancer (CRC) is one of the most common causes of mortality and morbidity among the New Zealand population (1), with New Zealand having one of the highest rates of CRC in the world (2). There is disparity in CRC diagnosis between Māori and non-Māori (1,3-6), with diagnosis, using colonoscopy, one section of the CRC pathway which has seen inequity (7-9). Barriers to colonoscopy attendance exists (10-13), and Māori are reported as representing a disproportionate number of non-attendances (7). Aim: To explore the perspectives of Māori who non-attend to colonoscopy at Waikato Hospital. Interviews of participants’ explored their perspectives and expectations of the healthcare system and of endoscopy. Method: Māori who were booked for colonoscopy at Waikato Hospital with at least one prior nonattendance were offered interviews. Interviews were conducted by a Māori gastroenterology trainee, using a Kaupapa Māori lens. Participants explored perspectives of the healthcare system, CRC, and effective or ineffective processes to participation. All interviews were audio recorded and transcribed. Thematic analysis was used to develop themes and significant statements. Findings: The major themes were: 1. The importance of whānau: Tūpuna, whānau and friends influenced perceived risks and benefits of endoscopy. Whānau were relied on for transport, costs and advocacy. Mokopuna and positive role modelling were strong motivators. 2. Communication: Explanation of endoscopy by written pamphlet, and doctors using ambiguous terminology, (“polyp”), along with improved bowel symptoms, deterred and de-prioritised endoscopy. 3. Mana and dignity: embarrassment, unfamiliarity, and cultural misunderstandings, lead to unequal power relationships between doctors and patients. 4. Trust: bad hospital experiences, including experiences of racism, poor service and death of whānau, lead to endoscopy hesitancy. Single but memorable positive interactions with hospital staff and motivating Māori GP’s, improved trust. Conclusion: Colonoscopy non-attendance for Māori reflects barriers seen in other health services but as an invasive test it creates exponential challenges. The findings of this research indicate that solutions are multidimensional and should integrate the major themes, alongside de-colonising the health system in Aotearoa, and identifying and eliminating racism and equity hotspots throughout the CRC pathway.