He pito ora : exploring the role of Māori cancer navigators : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Philosophy in Public Health (Māori Health)

Listed in 2019 Dean's List of Exceptional ThesesAppendices 24, 26, 27, 28, 29 & 32 have been removed.In Aotearoa, New Zealand, cancer is now the leading cause of death. The cancer burden is disproportionately high for Māori, the indigenous people, compared with non-Māori across all stages of the cancer continuum. Additionally, Māori experience access barriers to timely and quality cancer care. Māori cancer navigator positions were created to assist patients in negotiating the complex cancer system. To date, no research has examined the Māori cancer navigator’s contribution to cancer service provision, including the ways in which they undertake their key role of providing supportive care to patients with cancer. The overall aim of this study was to examine the implementation of Māori cancer navigator/coordinator roles, and their contribution to and impact on the experience of Māori health consumers, patients, and whānau during their cancer care journey. The objectives of the study were to: 1) describe the ways in which Māori cancer navigator positions have been developed across the cancer continuum; 2) examine the contextual factors impacting on Māori cancer navigator roles; and 3) identify key success factors relating to the ways in which Māori cancer navigator positions make a difference to the patient/whānau cancer experience. The study is underpinned by kaupapa Māori methodology. Participants were recruited from Māori health consumers, patients, whānau, Māori cancer navigators, and clinical and non-clinical health professionals involved in cancer care. Data was collected via semi-structured interviews, observation and hui (n=24), and an online survey (n=52). The data were analysed using thematic, whakapapa and experiential analysis and the emergent themes applied to a continuity of care framework. The major themes/principles identified from this work were: whanaungatanga, which relates to trust and multiple relationships; whakamōhio, which encompasses communication and the sharing of information and; manaakitanga, where consistency in care and system influences are the key factors. These principles were developed into a model He Pito Ora for this thesis. Māori cancer navigator/coordinator positions help facilitate patient/whānau continuity of care. Greater integration of Māori cancer navigators/coordinators within cancer services will help address fragmentation in care and improve communication between health professionals and with patients and whānau. These are key areas which can improve the quality of care and potentially make a difference to patient/whānau cancer outcomes