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New tool could ‘change the trajectory’ of Indigenous heart consults


Chelsea Heaney


8/05/2024 3:31:01 PM

Heart disease is the leading cause of preventable death for First Nations people, but there is hope a new GP resource could help address that.

Bundjalung man David Follent
Bundjalung man David Follent is excited about the new approach. (Image: Supplied)

A shared decision-making tool for Aboriginal and Torres Strait Islander heart health has been launched by the Australian National University (ANU), aiming to improve intercultural communication between GPs and their Indigenous patients.
 
The Heart Health Yarning tool was co-designed by community members, research led by Associate Professor Carissa Bonner, from the University of Sydney Health Literacy Lab, and academic GP Dr Rosemary Wyber, from the National Centre for Aboriginal and Torres Strait Islander Wellbeing Research at ANU.
 
The platform was informed by consultations about heart health with Indigenous people led by Aboriginal and Torres Strait Islander Health Worker Judith Parnham.
 
The concept was based on the establishment of similar approaches during the COVID-19 pandemic.
 
The latest data from the Aboriginal and Torres Strait Islander Health Performance Framework shows that, over a five-year period, 60% of all deaths of Indigenous people were potentially avoidable – with the leading cause listed as coronary heart disease.
 
Dr Wyber said this statistic reflects the ongoing effects of colonisation, which the new ANU tool could help to address as the vast majority of general practice consults Aboriginal Torres Strait Islander people have are with non-Indigenous GPs.
 
‘This tool provides a framework for clinicians to have culturally safe conversations and talks about, for example, the importance of family, social and cultural determinants of health, that might be impacting on somebody’s capacity to engage in a conversation about detailed medication side-effects today,’ she said.
 
‘It makes sure that the conversation is not a reductionist approach about this tablet or that tablet but that there is a much broader acknowledgment of the things going on in people’s lives.’
 
Bundjalung man David Follent, who helped develop those COVID-19 responses, is excited that this approach is now being applied to other health issues.
 
‘We know that holistic, culturally safe care is critical to reducing cardiovascular risk,’ he said.
 
‘This tool supports clinicians to do that really well.’
 
A 2021 study of perspectives during the pandemic showed Indigenous people were cautious and confirmed recommendations that communication, or yarning, needs to be prioritised in key groups, including Aboriginal and Torres Strait Islander people, so that concerns can be addressed and questions asked.
 
Dr Wyber said this was the genesis of introducing shared decision-making with Indigenous people in clinical settings.
 
‘What we’ve been able to do is take that model that was developed specific to COVID-19 decision-making for vaccination and adapt it to cardiovascular health,’ she said.
 
‘It really matters because we know that too often conversations about how to lower cardiovascular risk are reduced to things like “it’s time to start your heart tablets for your blood pressure or cholesterol”.
 
‘But what this tool does is provide a framework for clinicians and patients to sit together and yarn about what all the options are, which ones are right for the person today, what information they need to make that decision.’
 
Dr Wyber said they have established that when Indigenous people go through a shared decision-making process, they are much more likely to engage in follow up.
 
‘Either in lifestyle changes or starting new medications, and in turn reduce their cardiovascular risks,’ she said.
 
‘So this changes the conversation from being didactic and clinician-focused to being much more a shared journey.’
 
The Heart Health Yarning Tool can be used after a person’s risk has been established through the Australian CVD Risk Calculator and involves a series of prompts which the patient can be shown.
 
‘So, a patient can say “I want to talk about more information, or about the options or actually, I want to take a bit of a break, this has already been a pretty overwhelming conversation”,’ Dr Wyber said.
 
‘It’s designed to be a pretty iterative, organic process where people can meet people where they are at and facilitate a conversation where needs are met for both the clinician and the consumer.
 
‘We think that this is going to change the trajectory of a lot of these conversations, and we’re really excited about what that means in the real world.’
 
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Aboriginal and Torres Strait Islander Australian National University cardiovascular disease cultural safety First Nations heart disease Heart Health Yarning Tool Indigenous health


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