Patient healthcare experiences in the Northwest Territories, Canada: an analysis of news media articles

Figures & data

Table 1. Adapted framework for Indigenous peoples experiences in health care

Themes	Definition
Perpetuation of inequities & colonial legacy	A patient experience in which broad intersectional inequities and colonial legacy exist and play a role in the patient’s quality of care.
Structural barriers to care	A patient experience determined by the geographic location of the patient and/or discrepancies in policy and/or services.
Positive healthcare experience	Characterised by an experience that supports patients in their care plan through collaboration, support and respect for cultural beliefs and practices, and meeting patient expectations for providing appropriate health services.
Healthcare system communication	A patient experience characterised by ineffective communication in the healthcare system that leads to a perceived discrepancy in quality of care.

Figure 1. Article selection process

Figure 2. Distribution of news media articles about patients experiences in northern canada, 2008–2017 (n = 128)

Table 2. Patient characteristics from news media articles on patient healthcare experiences in the Northwest Territories, 2008–2017

	Frequency, N = 71	%
Territory
Northwest Territories	57	80.3
Nunavut	14	19.7
Community of residence
Yellowknife	37	52.1
Hay River	5	7
Iqaluit	4	5.6
Other territorial communities*	25	35.2
Gender
Female	36	50.7
Male	32	45.1
Non-Binary	1	1.4
Not Reported	2	2.8
Age Group
≤ 18 years	11	15.5
19–59	36	50.7
≥ 60 years	17	23.9
Not reported	7	9.9
Primary health condition or issue
Suicidality or mental health	12	16.9
Cancer	8	11.3
Circulatory	8	11.3
Digestive	6	8.5
Genitourinary	6	8.5
Injury	6	8.5
Respiratory	5	7
Obstetrics/Neo-natal	3	4.2
Geriatrics	2	2.8
Infectious	2	2.8
Nervous System	2	2.8
Other	8	11.3
Not reported	3	4.2
Outcome
Death	17	23.9
Deterioration	11	15.5
Improvement	16	22.5
Unchanged	5	7.0
No Outcome reported	22	31.0
Primary source in article
Patient	30	42.3
Family member	26	36.6
Health Official	11	15.5
Police	1	1.4
Advocate	2	2.8
MLA	1	1.4

* in NWT or Nunavut communities with a population of <3,500; NWT: Northwest Territories; MLA: Member of the Legislative Assembly.

Table 3. Summary of themes and patient quotes from news articles

THEME	Example from article
Perpetuation of inequities and Colonial Legacy
Colonial legacy of health care	“When people have painful experiences dealing with the government, whether it’s in a labour relations matter or whether it’s in respect to health-care delivery, wherever it is, it’s hard for people to trust that anybody looking into that will understand the nature of that mistrust and that pain”
	“[t]here is such a strong element of racism in the health system, and it’s more apparent in some regions than in others”
Denied appropriate care	“It wasn’t necessary. It should not have gone that way. Would he have died anyway? We all don’t know that and it’s a moot point because he was never seen.”
	“I told the doctor that was discharging me, she’s giving me a prescription for pills and I’m going to pick up those pills and take them all at one time … I told her I was going to hurt myself and she didn’t have me committed.”
Perceptions & experiences of poor quality care	“I didn’t receive the help right away I needed. It didn’t have to take so long, I don’t want other people to go through that.”
	“I believe that when my son entered the ambulance in the state that he was in, he became the responsibility of the [health system] … He should have been kept safe. They knew his mental condition but neglected to deal with it adequately.”
	“I have a problem and I attempted to fix it, and the health care system failed me when I demanded help.”
Lack of respect for cultural practices	“I know that the health professionals are always helping us with our needs, but when it comes to low-risk birthing, those of us birthing at home both in Iqaluit and in the communities, those of us are not given the opportunity to practise our Inuit ways of birthing”
Healthcare system communication
Breakdown in communication	“Too often, patients are denied a medical escort only to get to the hospital to be asked where their escort is”
	“There was no face-to-face. The doctor calls and says you have this kind of cancer. To hear that on the telephone was terrifying”
Lack of communication	“The perception is that we have a medical system where all parts of the system are talking to each other but they’re not. Partly because of the privacy act but also because of the way the services are divided”
	“I went inside at emergency and the nurse said, ‘What are you doing here?’ I said, ‘Did anybody call you from the Norman Wells health centre?’ … .They said nobody from the Norman Wells health centre notified them that I was coming.”
	“The health-care system has been really hard to navigate … A lot of the different areas that we’ve been dealing with, they don’t talk to each other and they don’t give us the resources to access a more full spectrum of care.”
Language barrier	“She likes to be able to speak to the doctors to tell them what her problems are but she can’t speak (English). She has a hard time … Sometimes when they don’t have a translator they just tell her to come back”
	“My wife doesn’t speak good English or read, and there is no one to help her with how to take her medication.”
Positive healthcare experience
Access to appropriate healthcare services	“For us, having to go with a three-month old baby all the way to Alberta for a five-minute consult, it just made a lot more sense to do it through telehealth.”
Desired outcome achieved	“They’re willing to let me stay here as long as the government here can have a plane ready when they call”
Healthcare provider-patient collaboration	“The staff all know each other [at the seniors home], we know the residents by first name, they’re not numbers. We really do care”
Structural barriers to care
Geographic isolation	“I haven’t been home since January … . What makes it harder is I have three other kids at home”
	“I wanted to be with my son too, to give him support, but we just can’t afford to fly over there … It’s pretty expensive when you’re a pensioner. All of us wanted to go to be by his side and give him support, we just can’t afford it.”
Health policy and funding	“[Patients are] busy fighting their disease, it’s not fair to make them fight the bureaucracy at the same time. Delaying their coverage and leaving them in the dark over whether they will be covered is just an added burden.”
	“She was killed by the system”
Healthcare services shortage	“There are challenges to recruiting talent to the North … trying to find people who want to come up here and commit long term is never easy in any of the medical specialities or fields.”
	“There’s a long, long waiting list. I don’t want to be the whiner and complainer, but I said, ‘We’re going to try and keep my mom in her house another year’ and they said, ‘Oh boy, you’ve got to get going on this paperwork application. It can take up to two years’”
Lack of appropriate services	“I don’t think people are getting the full services who actually need them. It’s not a luxury, it’s just simple basic services that are needed.”
	“I knew I was suffering from a really bad bout of depression and I needed resources. I needed help and it wasn’t there”
Lack of continuity in care	“In mental health, moving from counsellor to counsellor to counsellor, even in the same system, is difficult.”
	“When he was in the paediatric system he received excellent supports … Now all that investment for all these years is lost. Not only for our family but for the education and the medical system.”