Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study

Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings

“…Although dying at home or in the community emerges as a favourite choice, some Indigenous communities may vary. Results from a recent Canadian retrospective study show that Indigenous peoples mostly die in acute care units due to a lack of access to physicians' palliative home care visits (Funnell et al, 2021). Dying at home could be seen as a Western normative view of a good death (Gott et al, 2017; Oetzel et al, 2015) but not for others (Funnell et al, 2021; Spelten et al, 2021).…”

“…Results from a recent Canadian retrospective study show that Indigenous peoples mostly die in acute care units due to a lack of access to physicians' palliative home care visits (Funnell et al, 2021). Dying at home could be seen as a Western normative view of a good death (Gott et al, 2017; Oetzel et al, 2015) but not for others (Funnell et al, 2021; Spelten et al, 2021). In some Navajo and Māori communities, dying at home may not be the favourite place for dying (Gebauer et al, 2016; Gott et al, 2016; Terpstra et al, 2021).…”

“…In some Navajo and Māori communities, dying at home may not be the favourite place for dying (Gebauer et al, 2016; Gott et al, 2016; Terpstra et al, 2021). Mistrust towards Western health care practices and health professionals may also explain Indigenous peoples' preferences to die at home (Caxaj et al, 2018) yet data show that they die in acute settings despite discrimination (Funnell et al, 2021). Due to the diversity of Indigenous beliefs on death and dying, it is crucial to contextualize palliative and end‐of‐life care to meet the physical, psychological and cultural needs of Indigenous peoples (Bernardes et al, 2021; Shahid et al, 2018).…”

“…Lack of funding, shortage of health care providers, paucity of general palliative care training among health practitioners, absence of health infrastructures in remote areas, misconceptions about pain management and use of opioids, limited caregivers' support, and the idea that palliative care is only provided at end‐of‐life to cancer patients hinder access to palliative care for those living with life‐limiting illnesses (Castleden et al, 2010; Caxaj et al, 2018; Fruch et al, 2016; Sawatzky et al, 2016; Spelten et al, 2021; Watson et al, 2020). In Canada and globally, Indigenous peoples' lack of access to palliative care represents a health inequity leading to patients' and families' increased unmet physical, emotional, spiritual needs (Bernardes et al, 2021; Colclough & Brown, 2019; Dennis & Washington, 2018; Duggleby et al, 2015; Funnell et al, 2021; Galloway et al, 2020; Gebauer et al, 2016; Gott et al, 2018, 2019; Government of Australia, 2018; Health Canada, 2019; Isaacson, 2018; Moeke‐Maxwell et al, 2020; Shahid et al, 2018; Watson et al, 2020).…”