Purpose of reviewThis article provides an informed perspective on cardiovascular disease (CVD) and palliative care need among Ma ¯ori New Zealanders. High Ma ¯ori CVD risk factors will contribute to a sharp increase in older Ma ¯ori deaths which has implications for health and palliative care service provision.
Recent findingsCVD is New Zealand's leading cause of premature deaths and disability among Ma ¯ori. A projected rise in older Ma ¯ori deaths within the next 30 years will require increased palliative care. However, accessing palliative care and obtaining and understanding information can be challenging for families who are already often overburdened with high social and economic disadvantages. Meeting the high financial costs associated with end-of-life care make living with CVD challenging. Engaging with the health system's biomedical approach when holistic care is preferable can be a major barrier.
SummaryMa ¯ori families provide the bulk of care at end-of-life, but they can become fatigued with the challenges that accompany long-term progressive illnesses, such as CVD. They are also burdened by the financial costs associated with end-of-life. It is often difficult for Ma ¯ori to access palliative care and to obtain and understand information about the illness and treatment. Navigating an unfamiliar and complex health system, low health literacy among Ma ¯ori and poor relationship building and communication skills of health professionals are significant barriers. Cultural safety training would help to increase health and cardiovascular professionals' cultural understanding of Ma ¯ori and their holistic end-of-life preferences; this could go some way to strengthen rapport building and communication skills necessary for effective engagement and informational exchanges. Increasing the Ma ¯ori palliative care workforce and introducing cultural safety training among health professionals could help to bridge the gap. A current study to gather traditional care customs and present these to wha ¯nau and the health and palliative care sectors in the form of an online resource could contribute to this decolonizing objective.
Informal end of life caregiving will increase over the next 30 years in line with the anticipated increase in older Māori deaths. Of concern, New Zealand’s neo-colonial trajectory (loss of lands, cultural disenfranchisement, urban migration, ethnic diversity, global diaspora and changing whānau (family, including extended family) compositions) has restricted some indigenous whānau from retaining their end of life care customs. This article reports on a qualitative pilot study on Māori whānau end of life care customs undertaken to explore how those care customs contribute towards strengthening whānau resilience and bereavement. Five whānau, including thirteen individuals from diverse iwi (tribes), took part in one of six face to face interviews. Kaupapa Māori research methods informed the analysis. The findings report a high level of customary caregiving knowledge among older whānau carers as well as a cohesive whānau collective support system for this group. Tribal care customs were handed down via 1) enculturation with tribal principles, processes and practices 2) observing kaumātua processes and practices and 3) being chosen and prepared for a specific care role by kaumātua. Younger participants had strong cultural care values but less customary care knowledge. The pilot concluded the need for a larger systematic qualitative study of Māori tikanga (customs) and kawa (guidelines) as well as the development of participant digital stories to support a free online educational resource to increase understanding among whānau, indigenous communities and the health and palliative care sectors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.