Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
The Surgical Treatment and Rehabilitation Service (STARS) Aboriginal and Torres Strait Islander Endoscopy Pathway supports culturally safe care for patients undergoing endoscopy. The pathway includes gender specific staffing and tailored support.
Dates: 1 January 2025 - September 2025
Implementation sites: The Surgical Treatment and Rehabilitation Service, Metro North HHS
This project was presented as a Poster at CEQ Showcase 2026 (PDF 213KB).
Aim
To improve attendance, engagement, and the overall experience for Aboriginal and/or Torres Strait Islander patients undergoing endoscopy at STARS.
Outcomes
Results comparing the pre-pathway period (January to December 2024) with the post-pathway period:
- Increase in number of patients booked for endoscopy procedures (p=0.001)
- Increase in patients undergoing endoscopic procedures (p=0.007)
- Increased number of patients treated in time (p=0.004)
- No change to rate of missed opportunities to treat (p=0.148)
- Increase in patients attending endoscopic procedures for surveillance purposes (p=0.03)
Results from a patient experience phone survey:
- 91% (n=71) provided feedback
- 91.5% rated their overall experience as ‘very good'
- 97.1% stated their care met their expectations all of the time
- 98.6% felt the staff were culturally appropriate and respectful
- 95.7% felt their views were listened to
Background
Colorectal cancer is the fourth most common cancer in Australia and was the second most common cause of death from cancer in 2021. 1 Colorectal cancer arises from precancerous polyps (adenoma or sessile serrated lesions). The National Bowel Cancer Screening Program (NBCSP) utilises immunochemical faecal occult blood testing (iFOBT) as a screening test to detect cancerous lesions and importantly, pre-cancerous polyps (adenomas or sessile serrated lesions) in the colon. The screening program has grown considerably since its introduction in 2006 and currently offers biennial screening to eligible individuals between the age of 45 and 742.
People who have received a positive iFOBT test are referred for screening colonoscopy. Aboriginal and/or Torres Strait Islander people have a lower participation rate (34% vs 40%) and higher iFOBT positivity rate (8% vs 6%) than the overall population.2 Furthermore, First Nations Australians are diagnosed with bowel cancer at a younger age (61 vs 70 yrs) and a higher proportion are diagnosed with bowel cancer before the screening commencement age of 50 compared with non-Indigenous Australians (21% vs 9%).3 The disparities between First Nations Australians and non-Indigenous Australians extends to mortality with a 5-year survival rate following colorectal cancer, being 63% versus 70%.1
Local patterns in colonoscopy screening among Aboriginal and/or Torres Strait Islander people reflect national trends. At the Surgical, Treatment, and Rehabilitation Service (STARS), Aboriginal and Torres Strait Islander patients booked for colonoscopy experience higher rates of missed opportunity to treat (MOTT). Given the critical role of colonoscopy in identifying precancerous polyps, it became essential to explore the factors influencing endoscopy attendance in this population. This also provided an opportunity to enhance attendance by delivering care that is culturally safe, accessible and aligned with principles of health equity.
Methods
The STARS Gastroenterology Team proposed a dedicated endoscopy list specifically for STARS Aboriginal and/or Torres Strait Islander patients, supported by gender-specific staffing. Delivering culturally tailored support was central to this initiative and involved working in partnership with Indigenous Health Liaison Officers (IHLOs) and the cultural capability team.
The project was presented to Edlers and consumers from STARS, and a STARS yarning circle. Endorsement was gained from the Health Equity Committee which includes a team of consumer advisors. Final approval was sought from departmental leadership and the STARS Executive to progress implementation.
A process flow was developed to identify Aboriginal and/or Torres Strait Islander patients on the endoscopy waitlist, ensure consistent data capture, and establish a clear pathway for booking. This required close collaboration across multiple teams including the endoscopy Hub, Administration, Nursing, and Cultural Capability Teams to create a feasible and sustainable solution for identification, referral, management, and booking.
Process Flow
1.Identifying Aboriginal and/or Torres Strait Islander Patients
- New Referrals: The Endoscopy Hub identifies Aboriginal and/or Torres Strait Islander patients during the initial referral processing stage.
- Existing Waitlist Patients: Patient lists reviewed across relevant services, including Fast Track Endoscopy, CCC, Surveillance, Bowel Preparation Clinics, and Outpatient Departments (OPD), to ensure all Aboriginal and Torres Strait Islander patients are identified and included.
2.Entering patient information into Enterprise Scheduling Management (ESM)
- To support accurate tracking, the following details must be entered:
- Use consistent terminology across systems.
- Record the reason for appointment.
- Clearly identify Aboriginal and/or Torres Strait Islander status when scheduling or updating patient information.
- d.Ensure identification is also documented within the colon consent patient assessment for visibility across the care pathway.
3.Booking Lists and use of Aboriginal and Torres Strait Islander identification
- The nurses from Colon Consent Clinic (CCC) book Aboriginal and Torres Strait Islander patients onto a procedure list.
- Patients are offered a place on the pathway, with participation optional. Document responses as 'Accepted' or 'Declined.'
- The CCC provides patient lists to IHLOs before the scheduled procedure date to enable timely outreach.
4.Provision of Tailored Support
- HLO's contact patients ahead of their scheduled procedure to provide culturally tailored support, discuss any factors that may affect attendance, and utilise available resources to promote engagement. Patient concerns identified during this contact are escalated to clinical teams to ensure appropriate support is in place on the day of the procedure.
- An IHLO officer attends the monthly STARS Aboriginal and Torres Strait Islander Endoscopy Pathway list to provide in-person assistance from admission through to discharge.
Once the Process Flow was established, a pilot endoscopy list was initiated with support from multiple teams and disciplines to ensure all pathway requirements were met. The pilot provided an opportunity to review the new processes in practice and assess feasibility and long term sustainability. Following this review, the STARS Aboriginal and Torres Strait Islander pathway was formally implemented, and regular dedicated lists commenced. The pathway was supported by information materials featuring Aboriginal and Torres Strait Islander artwork.
Discussion
The success of the project relied on strong support and active involvement from key stakeholders at STARS and within the local Aboriginal and Torres Strait Islander community. Collaboration was essential to establishing a clear, sustainable, and culturally appropriate pathway from referral through to discharge. A supportive organisational environment enabled effective multidisciplinary cooperation and flexible operational planning to support personalised care. In addition, staff capability, cultural awareness, and a welcoming clinical environment enhanced patient comfort and engagement, ensuring the pathway was both practical and culturally safe. The department reinforced a sense of belonging through culturally visible elements, including Aboriginal and Torres Strait Islander artwork already present in the space, and staff wearing Indigenous designed T-shirts.
Before this project was implemented, there was no efficient way to review waitlist data and identify Aboriginal and/or Torres Strait Islander patients scheduled for endoscopy. This created a barrier to prioritising care, as these patients could not be readily recognised early in the referral process. Successful implementation therefore depended on clear identification from the beginning of the patient journey through to discharge.
While the project aimed to enhance attendance and overall patient experience, there were limitations to the level of cultural and practical support that could be offered within the current workforce capacity. The project may benefit from increased cultural support in the pre-procedure period to reduce missed opportunity to treat (MOTT) rates and cancellations. The project also reinforced the importance of clear communication pathways, adequate lead time for gender specific staffing, and ongoing organisational commitment to sustain culturally safe practices.
This project has the potential to be implemented across other Queensland Health services that provide gastroenterology care. The pathway could also be adapted for use in other health departments where culturally safe, gender specific, and supportive models of care are relevant. Aligning the pathway with existing Aboriginal and Torres Strait Islander health programs and community focused gastroenterology health initiatives may further enhance attendance, engagement, and overall patient experience.
To support the implementation of enhanced cultural and practical support, the pathway has secured funding through an RBWH Foundation grant. This funding will enable the integration of additional cultural liaison and nursing resources to strengthen pre-procedure engagement and attendance support. A formal evaluation of these supports is planned, with future work focusing on measuring their impact on attendance, experience, and sustainability.
References
1. Australian Institute of Health and Welfare. Cancer in Australia 2021. Canberra: AIHW; 2021. doi:10.25816/ye05-nm50
2. Australian Institute of Health and Welfare. National bowel cancer screening program monitoring report 2024. Canberra: AIHW; 2024. Accessed 29/07/25 https://www.aihw.gov.au/reports/cancer-screening/nbcsp-monitoring-2024/summary
3. Lew J-B, Feletto E, Worthington J, Roder D, Canuto K, Miller C, D'Onise K, Canfell K. The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: modelling study. J Cancer Policy. 2022;32:100325. doi.org/10.1016/j.jcpo.2022.100325
Key contact
Dr Enoka Gonsalkorala
Director
Surgical Treatment and Rehabilitation Service (STARS)
Metro North Hospital and Health Service