Blending Western and Australian Aboriginal Approaches: A Study Protocol for Codesign of Bicultural Teleoncology Models of Care in Remote Australian Communities

Cancer treatments have failed to reach people who live in rural and remote Australia. Geographic constraints on service delivery are exacerbated for Aboriginal and Torres Strait Islander peoples who continue to be marginalised by a colonial legacy that drives disparities in access to healthcare. This is particularly evident in the remote communities of Bourke and Brewarrina which are home to significant Aboriginal populations. They are located 100 km apart and 400 km from the nearest cancer centre. We aim to codesign bicultural models of care to deliver a bespoke cancer service, enabling administration of low and medium risk chemotherapies via teleoncology in two remote Australian communities. Aboriginal philosophy and pedagogy will be used with Community-Led participatory research methods. Maximum variation and snowball sampling will ensure diversity of participants in the codesign. Up to 100 participants will contribute, with multiple data collection events held in each monthly data collection cycle. Data will be collected in individual or small group yarning style sessions and recorded on a visual template. Framework analysis will be used to map each round of data collection to consolidate visual models of cancer care for each town. This incremental data collection involves participants in cycles of analysis and interpretation. Both communities have study-specific Research Governance Groups with representation from Aboriginal and non-Aboriginal community members to guide investigators. This study approaches codesign by following Aboriginal cultural protocols. Ethical (axiology) and relational (ontological) processes precede intellectual (epistemology) and operational (methodology) processes. A direct outcome of this research will be provision of teleoncology aligned with the models in each community supported by the nearest regional cancer centre (Western Cancer Centre Dubbo). Another novel aspect is use of the Australian Bicultural Model of care which was first described in an alcohol treatment context and is tested here for transferability to other settings.