Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

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Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal people disproportionately around the world. Evidence shows that diabetes treatment strategies can effectively reduce complications related to the disease; in contrast many Aboriginal people develop these rapidly and at a young age. We conducted qualitative research on the barriers to evidence-based self-management behaviours and education from the perspectives of Aboriginal people living with type 2 diabetes and their health care providers on Manitoulin Island in Ontario, Canada. Applying the concept of structural violence, we analyzed the social and political arrangements that can put Aboriginal people with diabetes “in harm’s way” by interfering with diabetes management. Lastly, we provide recommendations for structural interventions.

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