Table 2 Generating themes from supporting quotes

Culture, family, and community

Culturally safe care services

“… the rooms are often too small for when family visits. They [Yamatji] have large families and prefer to sit outside in the garden during visiting hours. We only have two single rooms and having another person in the room doesn’t allow for much privacy, that’s why they also prefer the garden.” (Participant 1) [20].

Communication barrier

“Sometimes we have to use family members which isn’t ideal because, again, it’s all the understanding and relaying—you’ve no idea of what’s actually been said to the patients in terms of emphasis.” – CCP, 01 [23].

“Sometimes people would come down here and they would die in hospital and it would be very traumatic for everybody, and the staff are watching these people cry and be really upset and not be able to talk to them in the same language, so that’s very distressing for everybody.” (P14, female remote nurse) [46].

Aboriginal healthcare worker and liaison officer

“[The ILO] helps me to understand what the doctors are telling me. I need her to help because I don’t have escort with me.” [Patient interview] [56].

Involving family and community

“Yeah, well, that’s our culture. Like, when someone is close to passing away the whole extended family will come. That’s been like that for years and years. You can’t change that, you know” (Urban, female patient) [37].

Cancer outcomes

Late or advanced stage at diagnosis

“We know the mainstream doesn’t really work for our sick people. They are going to hospital because it’s a last resort …. They are sick. That’s why sometimes it’s too late for a lot of Aboriginal people because there is not culturally appropriate cancer clinics or surgeries.” (Urban Aboriginal HSP) [33].

Effects of comorbidity

“We have shown that increased comorbidity is associated with reduced five-year cause-specific and all-cause survival for Australian women diagnosed with cervical cancer.” [57].

Delay in treatment commencement or completion

“Indigenous Australians are modestly more likely than other patients to experience delay between being designated ready for care and commencing the episode of care.” [58].

Coping with cancer and poor QOL of cancer survivors

“And then it’s just funny how things turn out you know that after all, you know you get one (breast) taken off... I’ve accepted that I’ve had a mastectomy and like I walk around home with no shirt on you know, I’ve accepted it” (#2693) [34].

Culturally sensitive Allied health services

“They said they’d put dietitians and nutritionists to talk to me and psychiatrists and psychologists, but talking to me isn’t working, it isn’t doing anything. It’s frustrating me, and it makes me angry.” PT, 16 [23].

Psychological distress

Anxiety

“I think it’s probably just traumatic, … it’s traumatic for metro people to come to the hospitals and have treatment—but especially rural communities, the whole Perth [city] situation is traumatic” (rural Aboriginal family member) [33].

Fear

“There’s a lack of trust and a fearing of the hospital, so people present late, when they present late, they then die, and the cycle goes on and on.” (P18, female nurse) [46].

Shame

"…it was almost like you deserved it or there was definitely this sense of shame. It was whispered. If someone died of a heart attack you would say that, but… all this cancer stuff was a whispered sort of stuff." [32].

Financial stress

“[Indigenous] people are coming away from their communities – they have money issues, family issues, job issues, you name it. Let alone dealing with their cancer.” [Care provider, CP022] [56].

Access to healthcare

Geographic diversity

“If I had to go to Brisbane for lung treatment, I would not go. Neither would others, especially Indigenous. Getting down to Brisbane is very hard.” (Quote from a community member) [59].

Transport to health care center

“I’ve got a lady who comes down and every time she asks me to get her an earlier (appointment)… she comes from x [4 h away from Brisbane], so she leaves so early in the morning and she doesn’t get home until late at night”. Hospital ALO 7 [41].

Flexible cancer care and telehealth services

“ care providers in the current study recognized that flexibility in the duration, timing, location, and number of attendees of the consultations, was imperative to ensuring culturally relevant and appropriate care for Indigenous cancer patients.” [56].

Difficulty in access, continuation, and coordination of health care services

“I have a lot of women calling me because they don’t know what services they can claim. They don’t know that they can get a bed at home or have a nurse come and change their dressing. Most of the time I tell them who to ring up and help them with the paperwork.” (Participant 5) [20].

Cancer education and awareness

Misconception and myths

“[t]o my experience I – like I learn a lot of people, Aboriginal people, like believe in Aboriginal culture so … Yeah, like a curse, and I think beliefs come from old days. Cultural side … strong belief in spirits and I guess black magic or whatever you want to call it..” [24].

Aboriginal understanding of cancer

“I think still a small proportion that believes that cancer can be like a punishment of… the things that you have done in the past and that’s why you have to suffer past things in life. Like a karma type thing.” (R2) [21].

Limited cancer knowledge

“... with the remote Aboriginals in the community... they go home and take this medication and they haven’t got a clue what they are taking or what it is for or anything. If you don’t understand why you have to do something, sometimes you don’t do it.” — Rural female family member [32].

Lack of appropriate data

Lack of Aboriginal and Torres Strait Islander status recording

“It was proposed that perhaps Aboriginal patients are attending but that these attendances are not reflected in the statistics. This may be because patients are not identifying as Aboriginal or because their status is not being recorded due to inadequate processes.” [22].

Inadequate Aboriginal and Torres Strait Islander specific cancer data

“The NT Indigenous incidence rates reported here under-estimate actual cancer incidence by approximately 15–20%, because of a small degree of under-ascertainment of cases and misclassification of Indigenous status in the NTCR.” [60].