‘Where do I go from here’? A cultural perspective on challenges to the use of hospice services

Abstract

Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care services for patients and families and provide consultative services to primary healthcare providers in the community.

Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review

“…electricity) required for palliative care management can be prohibitive because the community may lack the economies of scale that make such provisions cost‐effective (McGrath,; Willis, ). Although some of these disparities in palliative care services may be explained by geography, disparities between Indigenous and non‐Indigenous communities suggest that other factors (Kelly & Minty, ), such as systemic discrimination (Frey et al., ; Shahid et al.,), may also play a role. Notably, front‐line healthcare workers often do not account for these environmental and contextual factors when planning or providing palliative care for Indigenous families (Shahid et al.,).…”

Dysregulation of the NF-κB pathway as a potential inducer of bipolar disorder

“…The observed increase in the peripheral pro-inflammation particularly during mood swings led a growing number of authors to propose that ongoing inflammation and related processes like neuronal death (apoptosis) may account for the observations reported in neuroimaging studies where at least a subset of BD patients exhibit a cortical thickness reduction (Rajkowska et al 2001, Jung et al 2011), significant loss of gray and white matter volumes (McDonald et al 2004, Haznedar et al 2005, Lyoo et al 2006, and changes in morphology and integrity of white matter tracts (López-Larson et al 2002, Connor et al 2011, Sprooten et al 2013. The possibility that chronic inflammation leads to structural brain abnormalities and cognitive deficits in BD patients raised hopes that biochemical markers can be utilized to detect the illness at early stages (Jones and Thomsen 2013) instead of carrying patient interviews and self-report questioners, which lack objectivity and biological validation (Frey et al 2013). Thus far, however, efforts have met with limited success suggesting that a more thorough understanding of the immunoregulatory mechanisms in BD is necessary.…”

Working bi-culturally within a palliative care research context: the development of the Te Ārai Palliative Care and End of Life Research Group

“…For example, it was only in 1986 that the national coordinating body for New Zealand hospices was established, inspired by the globalisation of hospice movement from the 1960s onwards (Mercy Hospice Auckland, 2015; Saunders, 2001;Swarbrick, 2012). Consequently, hospice and palliative care services in New Zealand, whilst paying increasing attention to the specific needs of Māori, are still arguably orientated towards achieving a 'good death' as defined from a Western socio-political perspective (Frey et al, 2013;Moeke-Maxwell et al, 2013;Ngata, 2005). In contrast, Māori often prefer to prioritise the observance of cultural and spiritual practices associated with end of life care and dying, such as the karakia (incantations), waiata (song) and speech making.…”