Culturally Relevant Palliative and End-of-Life Care for U.S. Indigenous Populations: An Integrative Review

Abstract

Limitations are lack of research funding, geographic isolation, and stringent government requirements. Palliative/EOL care must draw on a different set of skills that honor care beyond cure provided in a culturally sensitive manner.

Racial and Ethnic Disparities in Palliative Care: A Systematic Scoping Review

“…A large analysis of racial/ethnic disparities in palliative care in hospitals that served either majority white, mixed, or majority minority patients found that stroke patients of any race/ethnicity were less likely to receive palliative care in a mixed or majority minority hospital (Faigle et al, 2017). The only two studies that examined palliative care for American Indians/Alaskan Natives found that rural care settings were underresourced for culturally competent, accessible palliative care for this population (Isaacson et al, 2015; Isaacson & Lynch, 2018).…”

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition

“…One review found one study of a culturally tailored inpatient palliative care consultation services reporting a postintervention increase in do-notresuscitate completion among Native American patients but did not report effect estimates. 115 Another Table 6 Cultural Aspects of Care The GRADE category is based on identified systematic reviews published between 2013 and February 2018. We used the following reasons for downgrading confidence in the evidence (downgraded by 1 or 2): Study limitation (observational studies start with a low GRADE value), Inconsistency (individual studies do not come to the same conclusions or there is only one study so inconsistency cannot be evaluated), Imprecision (there is no effect estimate, there is no measure of dispersion, or the CI is very broad); we used the systematic review authors' evaluation for other GRADE criteria if there was a formal quality of evidence assessment (see text).…”

Spirituality, Quality of Life, and End of Life Among Indigenous Peoples: A Scoping Review

“…Providing EOL care necessitates using a holistic approach, which includes attending to and recognizing patients' death rituals and communication preferences. Isaacson and Lynch (2018) and Isaacson (2018) highlighted the need for cultural awareness and cultural sensitivity when working with NA/ AN. Furthermore, acknowledging the unique spiritual beliefs and customs among various tribes of indigenous people at EOL and avoiding inclinations to generalize across native peoples can help health care providers promote a respectful and nonjudgmental environment.…”