Perspectives of Nunavut patients and families on their cancer and end of life care experiences.

The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.

Doing the right thing! A model for building a successful hospital-based ethics committee in Nunavut.

BACKGROUND: There exists a need throughout the North to increase capacity to address issues of health ethics and for community members to better understand and share their perspectives on this topic. Ethics comes down to weighing rights and wrongs, evaluating differing needs and understandings, acknowledging the many shades of grey and doing our best to come up with the just, fair and moral approach to the question at hand. Northern regions must collaborate to share capacity, successes and experiences in order to meet the unique needs of northern health care institutions and move forward on this issue. While guidelines for ethical research with indigenous populations exist, little has been published about an Inuit approach to health ethics more broadly. DESIGN: To fill a critical need and to meet accreditation standards, the Qikiqtani General Hospital (QGH) in Iqaluit, Nunavut, Canada, is in the process of building an Ethics Committee. Capitalizing on partnerships with other bodies both in northern and southern Canada has proved an efficient and effective way to develop local solutions to challenges that have been experienced both at QGH and other jurisdictions. METHODS: The Ottawa Hospital Ethics Office and the active ethics committee at Stanton General Hospital in Yellowknife, NT, contributed expertise and experience, and helped provide some direction for the QGH ethics committee. At the local level, based on our shared commitment to health care ethics, the Qaujigiartiit Health Research Centre is an invaluable partner whose parallel efforts to develop a northern Health Research Ethics Board (REB) gives great synergy to the QGH Ethics Committee. RESULTS: Passion and commitment, as well as administrative support and endorsement from health care leaders, are the aspects of successful initiatives that we have identified to date. Using the information from both the experiences of other partners, as well as information gathered at a retreat held in Iqaluit in September 2011, we are working to develop a model for the QGH ethics committee that incorporates multi-level perspectives, from that of community to that of front-line worker. CONCLUSION: Ideally, the scope of the QGH Ethics Committee will grow over time to include ethics education, facilitation of clinical ethical consults, ethical review of policy, advice on governance issues and involvement and support of an external northern Health REB.

Youth sexual health in Nunavut: a needs-based survey of knowledge, attitudes and behaviour.

OBJECTIVES: This study attempts to address the need for culturally specific data on beliefs and behaviours in order to design and implement appropriate public health interventions. The goal of the health promotion booklet that followed the study is to give youth a tool that will promote healthy choices and give non-judgmental information about sexuality. STUDY DESIGN AND METHODS: Knowledge gaps and beliefs about birth control, healthy sexuality and sexual health education were assessed through a written survey of young adults in three schools on Baffin Island. The sexual health survey was four pages long and written in simple language. The survey was voluntary, consensual and confidential, and it was administered by teachers. RESULTS: Some of the findings from the Iqaluit high school student survey (n=71) are reported with references to results from a smaller Iqaluit college student group (n=31). CONCLUSIONS: In Nunavut, teen pregnancy and sexually transmitted infection rates exceed national averages and continue to have devastating health and social consequences--particularly for Inuit girls and women. Using the data and a participatory approach, a culturally appropriate, bilingual booklet about sexual health is being developed for Nunavut youth.