Translating Research into Practice: Developing Cross-Cultural First Nations Palliative Care

Pierre-Hansen, Natalie St; Kelly, Len; Linkewich, Barb; Cromarty, Helen; Walker, Roger

doi:10.1177/082585971002600109

Cited by 9 publications

(14 citation statements)

References 7 publications

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“…Throughout the literature, the need to collaborate and to engage meaningfully with communities [ 6 , 14 , 22 – 28 ] and families [ 14 , 24 , 25 , 29 – 34 ] before designing and implementing any program was highlighted as a fundamental prerequisite for progress. Most of the studies were conducted in rural or remote locations where EOL care provisions were often not well-developed or well-understood.…”

Section: Resultsmentioning

confidence: 99%

“…In most cases, evaluations of these service models have been included in the published literature, with the following positive short-term outcomes reported (Table 4 ): symptom management, medication adherence and patients’ QoL improved [ 4 , 7 , 11 , 48 , 51 , 52 ]; total health care costs moderately decreased [ 7 ]; emergency department (ED) attendances and hospital admissions diminished [ 52 ]; service use and patient satisfaction increased [ 34 , 52 ]; number of deaths at home increased [ 2 , 49 ]; and families and caregivers reporting positive experiences with the services [ 4 , 9 , 51 ]. Kelly et al, [ 33 ] reported there would be ongoing qualitative evaluation.…”

Section: Resultsmentioning

confidence: 99%

“…Some had built partnerships with local services, some had involved Elders from the communities in the program design and materials development, others reported that they had explored community palliative care needs before designing the projects [ 2 , 7 , 23 ], while some promoted services that were already well-established in the local communities. One study reported that an eight person Elders’ Council had influenced strategic planning and operations, and that this Council had shaped the program in the locality [ 34 ]. Elders also provided patient support by visiting patients in their residences and as interpreters.…”

Section: Resultsmentioning

confidence: 99%

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Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review

et al. 2018

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BackgroundIndigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern.ObjectivesTo examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care.MethodsA comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research.ResultsOf 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements.ConclusionsThe results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0325-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review

et al. 2018

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“…The physical structure and regulations of health care institutions are routinely hostile to Indigenous people. This is relevant in urban settlements because most of us will die in hospitals, despite our stated preferences to die at home (Kelly et al, 2009;McGrath, 2007;St Pierre-Hansen, Kelly, Linkewich, Cromarty, & Walker, 2010). Dying at home can be challenging given the high degree of mobility, precarious housing, and homelessness affecting urban Indigenous communities (King, Smith, & Gracey, 2009;Snyder & Wilson, 2015).…”

Section: Physicalmentioning

confidence: 99%

The End of Life is an Auspicious Opportunity for Healing

Anderson¹,

Woticky

2018

IJIH

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The majority of Indigenous peoples on Turtle Island (North America) now live in urban settlements, and likely may die in urban spaces. Based upon academic and grey literature searches in 2018 of Indigenous death, dying, grieving, and palliative care in Canada, there is a near absence of information exploring this pivotal life event in the urban context. The diversity of urban Indigenous identities, lived experiences, and degree of connection to Indigenous culture highlights the complexity of the interconnection of death, Indigeneity, and urbanity. Fortunately, signs exist of Indigenous cultural and ceremonial revitalization in urban spaces, and the end of life offers an auspicious opportunity for healing from the intergenerational trauma arising from colonization. Despite the plurality of cultures in urban settlements on Turtle Island, colonization informs and dominates most systems, including the framing of death and dying as a medical event. However, in my experience, death is more about culture and community. Reconciliation for urban Indigenous communities involves negotiating this challenging paradox between colonial and Indigenous worldviews. Rather than developing new strategies, I posit that existing knowledge – the Medicine Wheel and the Two Row Wampum – offer a vision for restoring respect, balance, and spirit to the end-of-life journey. The Medicine Wheel and the Two Row Wampum teachings offer an Indigenous theoretical framework to consider the complex space created by the interconnection of death, Indigeneity, and urbanity and offers a strength-based approach to guide future end-of-life research, policy, and practice to improve the end-of-life experience for urban Indigenous communities.

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Section: Physicalmentioning

confidence: 99%