Aims: The were two research questions in this PhD. In what ways do Aboriginal service users, Aboriginal staff and non-Aboriginal staff experience intercultural communication at Alice Springs Hospital (ASH)? Do initiatives, policies and practices foster intercultural communication between these groups? Setting: The ASH catchment area covers 872,861 square kilometres and includes six local government areas (LGAs) with a total population of 45,161. There are 10 remote communities in SA, 10 in WA and 34 communities in the NT serviced by ASH. In the top responses of languages other than English, there were 13 Aboriginal languages and seven non-English languages in these LGAs. There are 25 known language groups surrounding Alice Springs within three main Aboriginal language families: Western Desert, Ngaarkic and Arandic. These language family groups have multiple dialects, often with commonalities between vocabulary and grammar. Results: Referral data were collected from the Aboriginal Engagement and Strategy Unit (AESU) within ASH and the Aboriginal Interpreter Service ( AIS), an external Territory Government department. Categories included types of requests and who utilised the services between July 2018 and June 2019. The top three reasons for referral data to the AESU (n=4,462) were interpreting (41.4%), transport (29.7%) and cultural brokerage (16.8%). The AIS (n=270) primarily managed mental health related referrals (27%), medical reviews (17%) and general discussions (16%). Overarching themes emerged from the participant interviews. An effort was made not to deliver the same story about deficits in healthcare communication in the Northern Territory, as this is well documented. Instead, the focus shifted towards the impact on human feelings which will be demonstrated through dramaturgical analysis. In general, three themes focus on procedural mechanisms and processes. Hard or challenging situations; education, knowledge, learning, and understanding; workflow, resources, protocols, and approaches. Themes about interpersonal aspects of communication include personalities, emotions, and expressed feelings; trust and relationships; cultural influences, differences, and explanations. This research found that support service structures often do not align with staff expectations and needs. The PhD acknowledged certain shortcomings then provided recommendations and propositions as a means to address these issues.

Background: Historically, collaboration between the Allied Health teams at a Northern Territory cancer care centre and palliative care service was minimal. This initiative aimed to improve collaboration and use the arts to support quality of life and death, focusing on reducing stigma around cancer and palliative care. Methods: Adapted from the UK-based Art Bag Project, the Allied Health teams facilitated a six-month soap carving initiative between June and November, 2024. The project offered an accessible, low-barrier creative activity for patients, families, and staff, promoting self-reflection and connection. Participant demographics and qualitative feedback were collected across two surveys and from an exhibition showcasing the participants' carved creations. Data analysis comprised descriptive statistics and thematic analysis. Results: Survey results revealed 100% of participants expressed interest in more art activities. With 92% reporting enjoyment in the soap carving sessions, highlighting its therapeutic benefits. 100% of exhibition attendees reported enjoyment, with 85% understanding the project’s aims. 100% of participants felt the exhibition successfully destigmatised hospice care. Eight themes from the exhibition feedback survey were identified including: creativity and variety, bringing people together, collaboration between services and the positive atmosphere of the event. Participants shared positive reflections, noting personal growth, such as “testing my patience,” and the communal aspect of the project, “the laughter of fellow carvers.” One participant highlighted the importance of the initiative in fostering “open minds and hearts,” reinforcing its role in building community. Conclusion: The project suggests that creative initiatives can improve quality of life and death, enhance team collaboration, and reduce stigma around palliative and cancer care. By engaging patients and staff in soap carving, the project fostered emotional healing and connection. This initiative has the potential to spark a broader cultural shift in healthcare, encouraging the integration of creativity into patient care, fostering collaboration, and enhancing the patient and family experience across healthcare settings.

Introduction : A study reviewing gastrointestinal cancers in the Northern Territory looked at data from 1990 – 2017 showed a significant decrease in incidence of gastrointestinal adenocarcinomas in individuals aged > 50 years, whilst the younger cohort (18-50 year) remained unchanged with a noticeable trend towards an increase. In both cohorts there is a significant improvement noted, but Aboriginal and Torres Strait Islander people living in the Territory still have worse survival outcomes. Case Report: The following demonstrates the case of a 43-year-old indigenous woman diagnosed with advanced Stage III gastric adenocarcinoma. The patient has two young children, who together with her family are living in the remote area of the Anangu Pitjantjatjara Yankunytjatjara (APY) lands. These remote parts in the far northwest of South Australia are covered by the only Cancer Services in Central Australia located in Alice Springs. The patient initially presented with abdominal pain and malnutrition. The patient was transferred to Adelaide for examinations, where gastric adenocarcinoma with linitis plastica was confirmed. The MDM recommendations included to have 4 cycles of pre-operative chemotherapy (FLOT: fluorouracil, leucovorin, oxaliplatin and docetaxel), followed by surgery (gastrectomy) and then a further 4 cycles of post-operative chemotherapy. The impacts on the patient were not only physical (several hospital admissions, jejunostomy tube insertion, peripheral neuropathy impacting on her painting ability) but also emotional/psychological (increased isolation, frustration, not being able to go home and see her children related to factors like traveling distance, lack of safe follow up care in remoter areas, not completing all cycles of chemotherapy due to side effects and long-term prognosis) Discussion: This case highlights the impact of gastric cancer diagnosis for a patient from a remote indigenous community.

Coronary heart disease (CHD) is the primary cause of mortality in Australia and the largest contributor to the 'gap' in cardiovascular disease deaths between Aboriginal and Torres Strait Islander (First Nations) people and non-indigenous Australians.To assess secondary prevention of CHD in First Nations people in primary care in Australia.Retrospective cohort study of patients with CHD under active primary care management using electronic medical records from 406 general practices across Australia. Ultimately, 50 088 people with CHD were included in the study, and 3.5% of those were First Nations people. After 5.9 years (standard deviation 5.0) in primary care adjusting for gender, age, remoteness, comorbidities, smoking status and continuity of care, First Nations peoples received equal statin (adjusted odds ratio (aOR): 0.9; 95% CI:0.8-1.1, P = 0.28), angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (aOR:1.0; 95% CI:0.9-1.2, P = 0.85) and beta blockers (aOR:0.9;95% CI:0.8-1.1, P = 0.41) prescriptions. First Nations peoples were more likely to achieve BP <1.8 in similar proportions (35.2% vs 36.9%, P = 0.16) but less likely to have HDL-C >1.0 mmol/L (57.5% vs 73.7%, P < 0.001), triglycerides<2.0 mmol/L (61.7% vs 76.0%, P < 0.001) and HbA1C ≤ 53 mmol/mol (7.0%) (67.7% vs 82.1%, P < 0.001). A higher proportion of First Nations people had HbA1c measured (75.7% vs 66.6%, P < 0.001).First Nations peoples with CHD under active primary care management received similar secondary prevention medications and achieved BP and LDL-C targets as frequently as non-indigenous Australians. A focus on easier access to facilitate attending primary care is needed to close the gap as well as addressing social determinants of health and structural inequities.

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