Learning from a codesign exercise aimed at developing a navigation intervention in the general practice setting.

To examine whether routine assessment of distress, recommended as part of comprehensive cancer care, is utilised equally with culturally and linguistically diverse (CALD) vs non-CALD people living with cancer. A medical records review of all patients attending cancer-specific treatment units at a single tertiary hospital in Melbourne, Australia between 2015-2018. Recording of administration of the Distress Thermometer and Problem Checklist (DT and PC) was extracted for all patients. Details regarding how the DT and PC (used together) was administered were extracted for a random sub-sample of 294 CALD patients and 294 matched non-CALD patients. A total of 6977 patients were identified (12.0% CALD). Just over half of the CALD (54.7%) and non-CALD (58.2%) patients had a recorded DT and PC (P > 0.05). For the sub-sample analysis, CALD patients were less likely to complete the form themselves (14.8% vs 75.9% non-CALD) and were more likely to have a family member complete the form (55.1% vs 15.1% non-CALD). CALD patients reported a similar level of distress to non-CALD patients. Distress scores for CALD and non-CALD patients were higher when family members completed the form. Provision of discussion, written information, referral offers and rates of referral acceptance were similar between CALD and non-CALD patients. Assessment of distress and associated problems, and the process following assessment, were similar for CALD and non-CALD patients. However, differences in how the form was completed highlight the need for further improvements to ensure that CALD patients are actively involved in their care.

MA22.06 Longer Lung Cancer Time Intervals Amongst Culturally and Linguistically Diverse Patient Than Anglo-Australian Patients

To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non-CALD chest pain (CP) patients presenting to the ED. A cohort study of 258 patients was enrolled on presentation to Liverpool Hospital ED with a complaint of CP over a 2-week period. Main outcomes included frequency and timeliness of diagnostic and radiological investigations, medication administered and ED length of stay. Administrative and clinical data were extracted and linked from Cerner EMR FirstNet®, PowerChart® and paper records. There were 155 (60%) CALD and 103 (40%) non-CALD patients. CALD patients were older by 10 years (95% CI 4, 15; P < 0.0001). There were no significant differences in the number of pathology and imaging investigations carried out in each group, and similarly there were no significant differences in the number of patients administered analgesia or cardiac-specific medications. Neither group differed in their ED length of stay (median 280 vs 259.5 min; P = 0.79) or hospital admission rate (median 56% vs 55%, P = 0.8). Both CALD and non-CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. A larger cohort, matched for age, would provide further insights into potentially important differences.

<h3>Aim</h3> To examine perceptions of the appropriateness of Advance Care Planning (ACP) among Culturally and Linguistically Diverse (CALD) populations in oncology and explore preferences for who, needs to do what, where, when and to whom across the phase of ACP. <h3>Background</h3> ACP is a critical process that enables individuals to define, discuss, and document their future healthcare preferences, improving patient-centred care and reducing unwanted interventions. Despite its benefits, ACP uptake remains low particularly among CALD populations- who experience significant disparities in access, awareness, and implementation. Healthcare professionals often report challenges in initiating ACP conversations with CALD patients, contributing to missed opportunities for early and meaningful discussions. Given that individuals from CALD backgrounds comprise approximately 30% of Australia’s population, it is imperative to determine if ACP practices are culturally appropriate concepts and to better understand how to ensure equitable access and culturally appropriate engagement. <h3>Main Narrative</h3> Applying implementation science methods, we explored attitudes towards and preferences for ACP uptake among CALD patients in oncology settings. Recruiting people of Indian and Chinese ethnicity, we used the Action, Actor, Context, Target, Time (AACTT) framework to map ACP processes, identifying misalignments in preferences, expectations, and practice between healthcare providers and CALD patients at key touchpoints across the phases of ACP. Acceptability of current practice at touchpoints spanning ACP phases (preparing for the conversation, having the conversation, creating the document, and enacting the document) varied amongst CALD consumer groups identifying where culturally appropriate interventions are needed to improve opportunity for ACP uptake. <h3>Unique Contribution</h3> This is the first study to systematically map preferences across ACP pathways for CALD populations from the perspectives of both healthcare professionals and CALD consumers. By embedding consumer insights into intervention design, this work has the potential to inform ACP strategies that are inclusive, scalable, and culturally safe. <h3>Implications for Policy and Practice</h3> Findings will inform policy and practice reforms by embedding culturally safe and sensitive approaches to introducing/discussing ACP into routine oncology care. Addressing these barriers is critical to reducing inequities and enhancing opportunities for ACP engagement.

Within the quality use of medicines (QUM)-which entails timely access to, and the rational use of, medicines-medicine safety is a global health priority. In multicultural countries, such as Australia, national medicines policies are focused on achieving QUM, although this is more challenging among their Culturally and Linguistically Diverse (CALD) patients (i.e., those from ethnic minority groups). This review aimed to identify and explore the specific challenges to achieving QUM, as experienced by CALD patients living in Australia. A systematic literature search was conducted using Web of Science, Scopus, Academic search complete, CINHAL, PubMed and Medline. Qualitative studies describing any aspects of QUM among CALD patients in Australia were included. Major challenges in facilitating QUM among CALD patients in Australia were identified, particularly in relation to the following medicines management pathway steps: difficulties around participation in treatment decision-making alongside deficiencies in information provision about medicines. Furthermore, medication non-adherence was commonly observed and reported. When mapped against the bio-psycho-socio-systems model, the main contributors to the medicine management challenges identified related to "social" and "system" factors, reflecting the current health-system's lack of capacity and resourcing to respond to patients' low health literacy levels, communication and language barriers, and cultural and religious perceptions about medicines. QUM challenges were different among different ethnic groups. This review suggests a need to engage with CALD patients in co-designing culturally appropriate resources and/or interventions to enable the health-system to address the identified barriers to QUM.

Although many diabetes self-management apps exist, these are not tailored for people from culturally and linguistically diverse (CALD) backgrounds. This study aimed to explore GP perceptions of how diabetes app features could help GPs better support their patients from CALD backgrounds. Twenty-five semi-structured interviews with GPs in Western Sydney explored attitudes towards a proposed app's suitability for CALD patients. Interviews were audio-recorded, transcribed and coded using Framework Analysis. Theme 1 explored the implications of perceptions that patients' health literacy is dependent on the language used. Theme 2 explored the influence of messaging from sources that share the patient's language and culture (including misinformation from community sources). Theme 3 described the suitability of the app platform for CALD patients, and its potential challenges in this group. GPs perceived that a diabetes app could be useful for providing support to patients from CALD backgrounds. Findings suggest app features should be optimised to address existing challenges that GPs face and carefully consider strategies for recruiting CALD patients. It is important that GPs feel comfortable promoting an app to their CALD patients to help increase participation rates by people in the CALD community.

1587 Background: Culturally and linguistically diverse (CALD) populations and First Nations People are at-risk communities who face unique challenges in cancer diagnosis and management resulting in inequities. Optimal Care Pathways (OCP) established by Cancer Council Australia aim to address these disparities. The Breast cancer OCP outlines an integrated model of care with optimal timeframes such as time from general practitioner (GP) referral to specialist surgical review, time from decision to treat to surgery or neoadjuvant chemotherapy (NAC), and time from completion of NAC to surgery. Methods: Retrospective data was collected for all CALD (migrant from non-English speaking country and/or primary language identified as not English) and First Nations patients diagnosed with breast cancer treated at a regional centre in Australia (Townsville University Hospital) from 2018 – 2022. A comparison cohort (control) of consecutive non-CALD, non-First Nations patients was included. Data collected included patient demographics, tumour characteristics, stage, and identified timeframes which were compared with OCP. Results: 133 patients were included with 43 CALD (32%), 41 First Nations (31%) and 50 control (37%). CALD and First Nations cohorts had higher rates of stage IV disease at diagnosis (12 v 15%) compared to control cohort (0%). They were also more likely to be diagnosed via emergency department admission (CALD 16 v First Nations 7%) compared to control cohort (0%) suggesting later presentation. Of those referred through OCP defined GP pathway, a similar percentage were reviewed by specialist surgeon within optimal 2-week timeframe in all groups (CALD 47%; First Nations 39%; control 44%). Median time from decision to treat to surgery were longer in CALD versus control groups (19 v 13 days; p = 0.03), and in First Nations versus control groups (22 v 13 days; p = 0.02). Less CALD (89%, n = 24) and First Nations (82%, n = 18) patients underwent surgery within optimal 5-week timeframe compared to control (98%, n = 40). Similarly, median time from decision to treat to NAC were longer in CALD versus control groups (19 v 14 days; p = 0.05), and First Nations versus control groups (20 v 14 days; p = 0.03). Most patients (91%, n = 29) commenced NAC within optimal 4-week timeframe; 2 CALD and 1 First Nations patients did not. Median time from completion of NAC to surgery was longer in CALD versus control groups (29 v 24 days; p = 0.15), and in First Nations versus control groups (35 v 24 days; p = 0.04). Of those who recieved NAC, 100% CALD (n = 9), 69% First Nations (n = 9), and 89% control (n = 8) patients underwent surgery within optimal 4-week timeframe. Conclusions: Achievement of key OCP timeframes was lower in both CALD populations and First Nations People. Strategies need to be further developed to address the delays and health outcome disparities in these vulnerable cohorts.

As Australia's aging population increases and diversifies, there will be a growing need to address the burden of dementia among culturally and linguistically diverse (CALD) communities. Due to a lack of CALD-appropriate services and bilingual health professionals, older people from CALD backgrounds often receive a delayed diagnosis of dementia. The use of telemedicine (TM) to deliver video-interpreting services may overcome the barriers of interpreter availability when diagnosing and assessing dementia in older people from CALD backgrounds. This paper aims to present a review of the literature on the use of TM to deliver video-interpreting during dementia assessments. Factors affecting the reliability and agreement, feasibility, and satisfaction and acceptability when using TM or video-interpreting have been described. The review found evidence that dementia assessments conducted via TM are as reliable as face-to-face (FTF) assessments and that participants are satisfied and find TM acceptable. There was less evidence about the feasibility of TM from the health care perspective, particularly regarding the acceptability and potential financial cost-savings. Only five studies investigated the use of video-interpreting during clinical assessments with CALD patients. Although video-interpreting was found to be satisfactory among CALD patients and clinicians, a common finding was the preference for FTF interpreting. More research is needed to examine the financial feasibility and the health care perspective on the implementation and adoption of TM for dementia assessments. The use of TM to deliver video-interpreting for dementia assessments has never been investigated and represents a significant gap in the literature.

PC-FACS

Communicating with culturally and linguistically diverse patients in an acute care setting: nurses’ experiences

Pharmacists' experience of asthma management in culturally and linguistically diverse (CALD) patients.

BackgroundThe end of life represents a therapeutic context that acutely raises cultural and linguistic specificities, yet there is very little evidence illustrating the importance of such dynamics in shaping choices, trajectories and care practices. Culture and language interplay to offer considerable potential challenges to both patient and provider, with further work needed to explore patient and caregiver perspectives across cultures and linguistic groups, and provider perspectives. The objective of this study was to develop a critical, evidence-based understanding of the experiences of people from Culturally and Linguistically Diverse (CALD) backgrounds, and their caregivers, in a palliative care setting.MethodsA qualitative study, using semi-structured interviews to explore key experiences and perspectives of CALD patients and caregivers currently undergoing treatment under oncology or palliative care specialists in two Australian hospitals. Interviews were digitally audio recorded and transcribed in full. A thematic analysis was conducted utilising the framework approach.ResultsSixteen patients and fourteen caregivers from a range of CALD backgrounds participated in semi-structured interviews. The research identified four prevalent themes among participants: (1) Terminology in the transition to palliative care; (2) Communication, culture and pain management; (3) (Not) Talking about death and dying; and, (4) Religious faith as a coping strategy: challenging the terminal diagnosis.ConclusionsCALD patients and caregivers’ experiences are multifaceted, particularly in negotiating linguistic difficulties, beliefs about treatment, and issues related to death and dying. Greater attention is needed to develop effective communication skills, recognise CALD patients’ particular cultural, linguistic and spiritual values and needs, and acknowledge the unique nature of each doctor-patient interaction.

This review aims to identify healthcare providers' (HCPs) experiences with issues related to the quality use of medicines among culturally and linguistically diverse (CALD) patients, the underlying factors, and the enablers of and barriers to providing culturally safe care to promote quality use of medicines. The searched databases were Scopus, Web of Science, Academic search complete, CINHAL-Plus, Google Scholar and PubMed/Medline. The initial search returned 643 articles, of which 14 papers were included. HCPs reported that CALD patients were more likely to face challenges in accessing treatment and sufficient information about treatment. According to the theoretical domains framework, determinants such as social influences due to cultural and religious factors, lack of appropriate resources about health information and cultural needs, lack of physical and psychological capabilities such as lack of knowledge and skills, and lack of motivation could impede HCPs' abilities to provide culturally safe care. Future interventions should deploy multilevel interventions, such as education, training, and organisation structural reforms.

Background and Aims Australia is one of the world's most culturally and linguistically diverse (CALD) nations, yet there is limited research on the characteristics and outcomes of CALD individuals undergoing kidney replacement therapy (KRT). This study aims to examine demographic and clinical characteristics, access to transplantation, and health outcomes of CALD patients receiving KRT in Australia over the past two decades. Method Data were obtained from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) between 1 January 2002 and 31 December 2023. Non-Indigenous adults who initiated KRT in Australia during the study period were included. Patients were categorised into three groups: 1) individuals born in Australia/New Zealand (Aus/NZ), 2) CALD English (born in predominantly English-speaking countries), and 3) CALD non-English (born elsewhere). Statistical analysis included chi-squared tests, multivariate regression, and Kaplan-Meier survival curves to evaluate characteristics and outcomes, including mortality and access to transplantation. Results The cohort consisted of 52,045 patients, 64% of whom were male, with a median age of 62 years, and predominance of Aus/NZ-born individuals. CALD non-English patients had a higher prevalence of diabetic kidney disease, were more likely to commence KRT on peritoneal dialysis and had lower rates of pre-emptive kidney transplant. They were also more likely to live in postcodes with higher socioeconomic disadvantage and in major cities. In contrast, CALD English patients were older at KRT initiation, had higher number of comorbidities and were more likely to be former smokers. Late referrals were relatively consistent across the groups. While native fistulas were the most common vascular access across all groups, they were slightly less frequent in CALD groups. Baseline characteristics are summarised in Table 1. Mortality was highest in CALD-English patients and lowest in CALD-Non-English patients, consistent across all initial KRT modalities (Fig. 1). Cardiovascular disease and withdrawal from dialysis were the leading causes of death, with withdrawal being more frequent in CALD English and Aus/NZ groups, while infections were more common in CALD non-English patients (Fig. 2). Medical comorbidities, age, smoking status, body mass index, living in postcodes with higher socioeconomic disadvantage, and remoteness were all significant predictors of waitlisting and death. After adjustment for the above factors, CALD non-English had higher likelihood of waitlisting (subdistribution hazard ratios (SHR) 1.33, 95% CI: 1.28–1.4) and lower likelihood of death (SHR 0.76, 95% CI 0.74–0.78) (P &amp;lt; 0.001). Conclusion This study highlights significant differences in the characteristics and outcomes of CALD patients receiving KRT in Australia. CALD non-English patients demonstrated a healthier profile, with higher likelihood of waitlisting for kidney transplantation and lower mortality rates compared to Aus/NZ and CALD English groups. These findings suggest a “healthy immigrant effect” for CALD non-English patients and aligns with the data from the 2021 Australian census, which reported that individuals born in Australia had the highest prevalence of at least one long-term health condition, followed by those born in England, the USA, Scotland, and New Zealand. Further research is warranted to explore barriers to pre-emptive transplant and vascular access use among CALD groups and to evaluate the impact of these disparities on long-term outcomes. A deeper understanding of cultural and systemic factors influencing KRT care may inform policies to ensure equitable access and improve outcomes for all patients. This study may pave the way for similar research in other countries to assess outcomes and patterns of CALD patients on KRT, helping to identify universal and region-specific factors that influence access to care and patient outcomes across diverse populations.

BackgroundLow-participation of culturally and linguistically diverse (CALD) patients in medical research remains a problem in migrant and refugee destination countries such as Australia. The aims of this study were to explore i) CALD persons’ perceptions and experiences of the medical system and medical research, in this case, older Italian Australians; and ii) the views of research professionals on CALD patient participation in medical research.Design and MethodsA qualitative study was conducted in Melbourne, Australia, in 2015 utilising in-depth interviews and focus groups with four stakeholder groups: older Italian Australians (n=21); adult children of older Italian Australians (n=10); hospital Human Research Ethics Committee administrators (n=4); and clinical researchers (n=4). The data were analysed for content and thematic analysis.ResultsThemes for the CALD and family group were getting by in medical interactions; receptivity to medical research: testing the waters; and, receptivity to technology for support: passive versus active. Themes for the researcher and HREC groups about CALD patient participation in research were: exclusion; cultural factors; and e-consent.ConclusionsOur findings from four stakeholder perspectives and experiences confirm that there were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research. Furthermore, our findings showed that in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research. The findings informed the creation of a multimedia tool whose purpose is to address and improve representation of CALD groups in clinical research.Significance for public healthMany people from culturally and linguistically diverse (CALD) backgrounds remain excluded from medical research such as clinical trials due to a range of language and cultural factors that can be amplified when this population is ageing. This exclusion has implications for the ability of CALD populations to benefit from participating in medical research and for applying research findings to CALD populations. It is essential to develop and implement strategies to include CALD communities in medical research and to uphold the ethical obligation of obtaining informed consent to research. The findings of this study have guided the development of a tablet-based resource which can be used in clinical and community contexts to raise awareness about the purpose of medical research. The resource has been carefully designed to be appropriate for participants' cultural background as well as their preferred language and literacy level. Such a resource has potential to address some of the cultural and linguistic barriers to clinical trial participation of CALD populations.