Table 1.

Key Informant Perceptions of Barriers to Existing Cancer Supports.

Theme	Determinant	Exemplar Quotes
Access to Care	Cancer treatments only available in cities and little to no local treatment Remoteness and isolation Travel and accommodation Socioeconomic and precarious finances Racism and misunderstanding	“You might be by yourself, you might not have any family support being able to come with you, because the way the funding is provided. So, often that distance from the remote northern place to go for the treatments [is a challenge]”. “It’s sometimes very challenging for people to access care even though they live right here in the middle of Saskatoon”. “I think people are falling through the cracks quite a bit. [We need to be] ensuring that people are comfortable. Making sure that they’re connected with things like palliative care, or homecare”. “Sometimes inefficiencies in our system and limitations in our abilities as health providers, and the limitations of Western medical model are deemed racist… sometimes [my colleagues] are unfairly judged, and the limitations of their skillset or the care that we provide are deemed a cultural issue, when in fact they aren’t”.
Coordination of Care	Fragmented care Limited services in communities Communication between patients and health care providers Language barriers Lack of navigation through cancer care	“[Another point worth sharing is] working with Health Canada or Indigenous Service Canada, to be able to address jurisdictional challenges, from a Federal perspective. There’s lack of coordination between Federal and Provincial funded health services, there’s no relationship in that area. So there’s [got to] be a mechanism to allow the jurisdiction challenges to be addressed within that system [of the] Cancer Agency”. “Language is an issue. Particularly in the north, people come down to an urban center such as Saskatoon and they are not familiar with even the terminology that is used through the continuum of cancer care, let alone not being able to communicate in their own language. That’s the problem”.
Lack of Culturally Relevant Health Care Provision	Disparities between Western and Indigenous world views Traditional medicine not well supported Lack of data systems for Indigenous patients Absence of Indigenous staff	“There are cultural differences, and people don’t really appreciate or understand that. They feel that our Indigenous peoples should just fit in to the existing system, and they don’t. They never have, and that’s why there’s so much health disparity. I think the idea that we just keep doing the same for everybody is a big barrier”. “Right from governance; there’s lack of understanding around culturally appropriate practice; from a senior leadership perspective, very little if any, around relationship knowledge of culturally appropriate programming. So, from a governance and operational level, there is none”. “…there’s very little, if any, supports that are culturally appropriate programming or services that support Indigenous patients that are coming into the Cancer Institution”.
Education	Lack of education during prognosis and treatment Lack of education on how to provide culturally safe care Lack of acknowledgement of cultural differences and barriers	“The idea of access and education. They go hand-in-hand, they’re one in the same. I would say that that’s the biggest thing”. “Explaining some of the anatomy, supporting their understanding, and reassuring when you can reassure is a huge thing for [cancer] patients”. “Part of that challenge is the lack of understanding of what culturally appropriate services are actually needed. There needs to be relationships with the communities, to engage to them and get a better understanding of what the community needs [around] culturally appropriate service and adequate programs that will suffice the Indigenous community, the First Nation, M étis”. “If there’s medication that’s required, will it be covered, will it not be covered?… Do you need to take it with food, without food? If you are somebody who doesn’t necessarily have food all the time, that can be a challenge. It might seem like something simple, but [it can be] very difficult…I think there’s a lot of judgements are passed, that are based one’s own perception of what they might do. Not understanding what some of the challenges and barriers are that many of our Indigenous peoples are facing”.