Healing Conversations: developing a practical framework for clinical communication between Aboriginal patients, their families and healthcare practitioners

Abstract

Introduction: This Healing Conversations project aims to contribute to building culturally capable healthcare practitioners skilled in effective communication with Aboriginal peoples and their families. To achieve this, the research has developed a communication framework for use in healthcare curricula. The conceptual notion of two-eyed seeing, or Etuaptmumk, put forth by Mi'kmaw elders Albert and Murdena Marshall has guided implementation of the research. This approach values Indigenous and non- Indigenous perspectives and recognises the importance of Indigenous governance in the research process. Ontological and methodological approach: A qualitative approach was implemented to gain in depth understandings of key stakeholders. An initial framework, developed from the literature to form the basis of data collection, was refined in response to findings from the research data. Data collection consisted of: (1) semi-structured interviews with Aboriginal community members and registered healthcare practitioners in South Australia (SA) and Western Australia (WA); (2) a workshop with a health education academic and an Aboriginal community member from SA, and two medical students (from SA and WA). Ethics approval for this research was obtained from the Adelaide University human research ethics committee, the South Australian Aboriginal health ethics committee, the Western Australian Aboriginal Health Ethics Committee, and the University of Notre Dame Australia human research ethics committee and Community organisational support has been provided by Pika Wiya Health service, Nunkuwarrin Yunti Aboriginal health service and Kimberley Aboriginal Health Planning Forum. Key findings: Four key themes emerged from the interviews: building the therapeutic relationship; communication in the clinical encounter; institutional and organisational factors impacting communication; and educating healthcare practitioners in communication. These results acknowledged that communication approaches need to be patient-centred, considerate of Indigenous worldviews and guided by geographical and community contexts. The workshop validated the interview findings, recognising the Framework encompassed a broad range of cultural capabilities and required a scaffolded approach to curriculum development and implementation. The workshop highlighted the importance of quality, well-resourced teaching and assessment of Indigenous health in healthcare curricula. Discussion: The targeted communication Framework was developed in stages in response to different avenues of feedback from Aboriginal community members, healthcare practitioners and medical students. Implementing the Framework in healthcare curricula will require close consideration to effective approaches to knowledge translation in Aboriginal health. This can include learning on Country experiences as well as supported clinical exposure, the inclusion of diverse perspectives in curricula and ensuring effective and meaningful assessment opportunities for students to demonstrate learning and identify knowledge deficiencies. This has important implications for the resourcing and governance of Indigenous health curricula. Conclusion and future directions: Healing Conversations presents a Framework for use in healthcare professional education to better prepare students to communicate effectively with Aboriginal patients and their families (figure 1). Applying this Framework into tertiary health professional education can assist with decolonising health education academies and Indigenising health professional education. The use of the Framework in medical education and post-graduate training will provide a platform for further nuanced research into the educational impact on cultural capability outcomes for healthcare practitioners.