Many Indigenous people who live on their traditional territory die in hospital when their preference is to enter the spirit world from their home. Indigenous people in Canada describe experiencing many barriers that prevent them from making this final choice in life. The First Nations Health Authority in British Columbia (BC), Canada, in collaboration with Douglas College, offered end-of- life doula training classes to Indigenous people in BC in 2019. The goal was to build on the strengths of community members already supporting people and their families during their final journey into the spirit world. There were 86 participants (72% identified as Indigenous) from the five health regions in BC, representing 47 Indigenous communities. Participants were overwhelmingly satisfied with the five-day course and planned to take their new learnings back to their community. It was noted, however, that this course would benefit from adaptations, including a greater emphasis on traditional Indigenous practices, facilitation tips, and strategies to support people through loss and bereavement. Furthermore, the term “end-of-life doula” is sometimes associated with a for-profit business, which is counterintuitive to traditional Indigenous practices, highlighting the necessity for a name change. Further evaluation over the next year is necessary to confirm that the course makes a positive difference in the final journey for Indigenous people.

Polypharmacy is the administration of more medications than clinically required or appropriate, and it can negatively impact wellness. Prescribers, pharmacists, nurses, and those receiving care services all have an important role to play in promoting healthy medication use and minimizing the risk related to polypharmacy. Medication management involves health care professionals regularly reviewing drug therapies with patients for any needed changes. This strategy is a key way to reduce the harms of polypharmacy. A review of the First Nations Health Authority Health Benefits Claims data in 2015 confirmed that polypharmacy is an issue for First Nations in British Columbia, Canada. This was further validated in a series of meetings held in four First Nations communities. The learnings from these meetings were that many people do not know the names of their medications, the reasons for taking them, or how to advocate for themselves during health care interactions. A unique strategy was needed to both encourage and empower First Nations and Indigenous people to discuss managing their medications, and to support health care professionals to better understand how to engage First Nations patients about their medications.