A culture of whānau inclusion in decision-making is embedded in all services and organisations that provide supportive care to people affected by cancer.
Services provide training to the health and supportive care workforce to implement whānau-related policy and undertake effective whānau engagement.
Equity: For people affected by cancer the social determinants of health play an important role (WHO)
In line with a holistic understanding of health is an understanding that we are supporting the whānau regardless of who has the cancer diagnosis. Healthy families (Whānau Ora) is a key factor in creating healthy individuals both in terms of lifestyle support as well as care-giving responsibilities. Whānau commitments can impede engagement and need to be addressed in order to minimise distress. Assumptions around the level of whānau support should not be based on cultural stereotyping, but rather an open-minded enquiry into the person’s support network.
A Clear understanding of any custodial issues and parental responsibilities need to be documented where appropriate. Consideration of the provision of resources which fit the context and age of the children involved is required. Staff need to have an understanding of whānau-based policies such as Enduring Powers of Attorney (EPOA) and Advanced Care Planning (ACP). Assisting with anticipatory guidance around whānau issues can be beneficial for the person affected by cancer and staff, especially in times of unplanned admission.
Research has also begun to indicate that at times it can be the partner or main caregiver, including those who are in a relationship with young people with cancer, whose needs are not recognised
(these needs may be significant). The needs of this group require ongoing consideration and input.
Whānau make up a large portion of our unpaid care-giving workforce and require input as part of the support network. With societal shifts, the whānau network can be geographically spread, so consideration needs to be given to new methods of engagement for information giving and support.
Good Practice Points
· Work needs to be undertaken by the organisation to ensure a standard of practice is followed for whānau meetings including, the facilitation and recording of outcomes.
· The workforce treats every health encounter as an opportunity to improve overall whānau health.
· Systems are in place which proactively address issues that arise about family violence and an awareness of the organisation’s policies and procedures for response, if required, is promoted.
· Policies around death and dying should be reflective of Tikanga practices and the inclusion of whānau in decision-making and service provision.
· Polices need to reflect that information is shared, with consent, with whānau in a way that they can also understand and be supported with, to help with decision-making.
· Elderly couples, in particular, need to be assessed in terms of their dependence on each other and systems need to be in place to identify and respond to this population proactively.
· Adolescents and young adults need to be considered in light of their age and development to ensure that their whānau involvement is in line with their wishes.
Good Practice Points System
· Include Whānau Ora concepts in supportive care service policy development and research.
“Close family support
is very important –
whānau and aroha.”
Cancer Stories Aotearoa –
Kahui Korero Taumahatanga o Te Mate Pukupuku
· Undertakes interventions which support whānau functioning and needs.
· Is aware of the importance of Enduring Power of Attorney and who to refer to for additional advice and assistance.
· Undertakes Level One Advanced Care Planning training and is able to identify appropriate staff to assist the person further.
· Proactively addresses issues that arise about family violence and is aware of the organisation’s policies and procedures for response.
· Is aware of the signs of abuse, including elder abuse and neglect, and is able to refer appropriately.
· Is aware of resources to support the wider whānau including children, adolescents and older adults.
· Is aware of the impact of age and capability on consent giving.
· Participates in family meetings and is aware of their role and function.
· Knows how to access support for complex family dynamics appropriate to their role.
Training and Resources Available
· Enduring Power of Attorney – Summary – Buddle Findlay
· A diagram which explains the concepts behind Whānau Whānau Ora.
· Level One free training on understanding advance care planning.
· www.skylight.org.nz Resources on Grief and Loss for children.
· Cancer in the Family Booklet available from the Cancer Society which provides advice on talking to children.
Last Updated October 2016