Issues in palliative care for Indigenous communities

Abstract

All Indigenous communities in Australia have a common heritage of loss. Indigenous death rates are much higher than those for white Australians. Indigenous people use healthcare services reluctantly, and palliative care services rarely. Cultural considerations that need to be respected include Indigenous understandings of disease causation, attributions of blame for sickness, the performance of ceremonies after death and the importance of dying on traditional lands. The involvement of Indigenous health workers in clinical care increases confidence in the healthcare system as a whole.

Referral patterns to a palliative care service in rural Australia servicing indigenous Australians

“…Thus there is need for palliative care to service indigenous Australians. Palliative care in the indigenous population must take into account their culture and belief system 3,4 . In particular, indigenous Australians have a strong link with their traditional lands and preference to be cared for and die at home, and believe in the use of traditional medicines and treatments which may exacerbate the fear of, and variable compliance with, prescribed conventional treatments 5 …”

‘Finishing up’ on country: challenges and compromises

“…Many of the community clinics see one or two palliative patients per year. With a high staff turnover, it becomes difficult to educate and train community staff who can act as local ‘specialists’. Indigenous grief practices : May include vacating the dwelling where the person has lived and died . The house may be abandoned for a week, many months or even a year.…”

“…This can lead to overcrowding and impact the care of other patients who are being cared for in the same dwelling. ‘ Payback’ and ‘blame ’: These are pertinent concepts in Indigenous culture. Some family members may be hesitant to administer end‐of‐life medications for fear of poisoning. ‘Blame’ may be attributed to family members who administer these medications, and they may be subject to ‘payback’.…”

“…In certain instances, the patient may not be the key decision-maker (despite having decision‐making capacity). The appropriate clinical information – the ‘right story’ – needs to be provided to the appropriate person, the ‘right person’ . Offence and withdrawal from care may occur if clinical information and decision‐making power are not offered to the ‘right person’.…”

What can we do to help Australians die the way they want to?

“…Aboriginal people are particularly vulnerable to not dying where they would wish, given paradoxical issues of higher rates of hospitalisation compared with non‐Aboriginal people, strong cultural and spiritual beliefs, and ties to “country” that underscore a widely‐held desire to die at home 2 …”