Culturally safe end-of-life care for First Nations persons living on reserve

Russell, Brittney; Fred, David E; Brown, Cary A.

doi:10.22605/rrh4500

Cited by 3 publications

(11 citation statements)

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“… 35 A history of government mistrust, marginalization and alienation has created hesitancy among First Nations people to seek mainstream medical care, especially in rurally isolated communities with barriers to access to care. 36 The largest difference in net costs was in the terminal phase, which may indicate that end-of-life care within First Nations communities is associated with family support rather than hospital or hospice care. 36 The lower cost of end-of-life care within First Nations communities may also be attributable to funding constraints, resulting in unavailable or limited access to end-of-life health care services.…”

Section: Discussionmentioning

confidence: 99%

“… 36 The largest difference in net costs was in the terminal phase, which may indicate that end-of-life care within First Nations communities is associated with family support rather than hospital or hospice care. 36 The lower cost of end-of-life care within First Nations communities may also be attributable to funding constraints, resulting in unavailable or limited access to end-of-life health care services. 36 In addition, 1 in 4 First Nations communities in Ontario are in remote areas accessible only by air year round or by ice road in winter.…”

Section: Discussionmentioning

confidence: 99%

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Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study

Mendlowitz

Bremner

Walker

et al. 2021

cmajo

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Background: Colonization and marginalization have affected the risk for and experience of hepatitis C virus (HCV) infection for First Nations people in Canada. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we estimated the publicly borne health care costs associated with HCV infection among Status First Nations people in Ontario. Methods: In this retrospective matched cohort study, we used linked health administrative databases to identify Status First Nations people in Ontario who tested positive for HCV antibodies or RNA between 2004 and 2014, and Status First Nations people who had no HCV testing records or only a negative test result (control group, matched 2:1 to case participants). We estimated total and net costs (difference between case and control participants) for 4 phases of care: prediagnosis (6 mo before HCV infection diagnosis), initial (after diagnosis), late (liver disease) and terminal (6 mo before death), until death or Dec. 31, 2017, whichever occurred first. We stratified costs by sex and residence within or outside of First Nations communities. All costs were measured in 2018 Canadian dollars. Results: From 2004 to 2014, 2197 people were diagnosed with HCV infection. The mean net total costs per 30 days of HCV infection were $348 (95% confidence interval [CI] $277 to $427) for the prediagnosis phase, $377 (95% CI $288 to $470) for the initial phase, $1768 (95% CI $1153 to $2427) for the late phase and $893 (95% CI −$1114 to $3149) for the terminal phase. After diagnosis of HCV infection, net costs varied considerably among those who resided within compared to outside of First Nations communities. Net costs were higher for females than for males except in the terminal phase. Interpretation: The costs per 30 days of HCV infection among Status First Nations people in Ontario increased substantially with progression to advanced liver disease and finally to death. These estimates will allow for planning and evaluation of provincial and territorial population-specific hepatitis C control efforts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study

Mendlowitz

Bremner

Walker

et al. 2021

cmajo

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“…4 The uptake of a palliative care program among First Nations communities is important, considering barriers to endoflife care, such as isolation from families, limited access to public transportation, and cultural insensitivity to optimal endoflife care for First Nations people. 14 Traumainformed care requires acknowl edgement of the historic effects of colonialism, including organizationlevel discrimination and intergenerational trauma. 14 It aims to prevent the perpetuation of discrimina tory care stemming from Western misconceptions about First Nations culture.…”

Section: Researchmentioning

confidence: 99%

“…14 Traumainformed care requires acknowl edgement of the historic effects of colonialism, including organizationlevel discrimination and intergenerational trauma. 14 It aims to prevent the perpetuation of discrimina tory care stemming from Western misconceptions about First Nations culture. 14,15 Wishes elicited from patients and families in this study aligned with traumainformed care, fostering relationships with clinicians in the wish generation process.…”

Section: Researchmentioning

confidence: 99%

“…14 It aims to prevent the perpetuation of discrimina tory care stemming from Western misconceptions about First Nations culture. 14,15 Wishes elicited from patients and families in this study aligned with traumainformed care, fostering relationships with clinicians in the wish generation process. Moreover, the 3WP is a primarily patient and familyled initiative, promoting the unique and culturally informed needs of all dying patients.…”

Section: Researchmentioning

confidence: 99%

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Community implementation of the 3 Wishes Project: an observational study of a compassionate end-of-life care initiative for critically ill patients

Dennis¹,

Longo²,

Heels‐Ansdell³

et al. 2021

cmajo

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Background:The 3 Wishes Project (3WP) promotes a personalized dying experience by eliciting and facilitating individualized terminal wishes for patients, families and the clinicians caring for them. We aimed to evaluate the adaptability of the 3WP to a community intensive care unit (ICU), and to describe the patients cared for with this palliative approach, as well as local implementation strategies. Methods:The 3WP was implemented in a 15-bed community hospital ICU in southern Ontario from 2017 to 2019. In this observational, descriptive study, we invited adult patients (≥ 18 yr) whose risk of death was deemed to be 95% or greater by the attending physician, or patients undergoing withdrawal of life-support to participate. We abstracted patient data from medical records, as well as the type, timing and cost of each wish, which person or service made and facilitated each wish, and if and why wishes were completed or not. We summarized data both narratively and quantitatively. Results:The 3WP helped to realize 479 (99.2%) of 483 terminal wishes for 101 dying patients. This initiative was introduced as an interprofessional intervention and championed by nursing staff who were responsible for most patient enrolment and wish facilitation. Wishes included humanizing the ICU environment for the patient with belongings and blankets, musical performances, smudging and bathing ceremonies, and keepsakes. The cost was $5.39 per patient (standard deviation $22.40), with 430 (89.8%) wishes incurring no cost. Wishes made directly by patients accounted for 30 (6.2%) of wishes; those from family members and ICU staff accounted for 236 (48.9%) and 238 (49.3%) of wishes, respectively. The program comforted patients and their loved ones, motivating clinicians to sustain this end-of-life intervention. Interpretation:We documented successful implementation of the 3WP in a community hospital, showing program adaptability and uptake outside of academic centres at relatively low cost. The lack of strict protocolization and personalized design of this intervention underscores its inherent flexibility, with potential to promote individualized end-of-life care in nonacademic hospital wards, homes or hospice.

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Indigenous Peoples and Occupational Therapy in Canada: A scoping review

Bauer¹,

Neal²,

Lizon³

et al. 2022

Can J Occup Ther

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Background. Calls to Action outlined by the Truth and Reconciliation Commission (TRC) necessitate critical reflection and urgent action to improve occupational therapy with Indigenous Peoples in Canada. Purpose. This scoping review aims to synthesize the literature related to Indigenous Peoples and occupational therapy practice, research, and education in Canada, and appraise empirical research using adapted Indigenous Health Research criteria. Method. A scoping review was conducted across published academic and grey literature with additional appraisal of empirical studies. Findings. A total of 6 themes emerged from 47 articles spanning from 1970 to 2020: recognizing colonial history, responding to the TRC, participating in personal and professional reflection, identifying Western ideologies, engaging in partnership in practice, and recognizing social and systemic barriers. Empirical studies met appraisal criteria inconsistently. Implications. To meaningfully engage in reconciliation, the profession of occupational therapy must generate Indigenous-led and relevant research, critically transform curricula, and address tensions between themes in practice.

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Culturally safe end-of-life care for First Nations persons living on reserve

Cited by 3 publications

References 0 publications

Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study

Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study

Community implementation of the 3 Wishes Project: an observational study of a compassionate end-of-life care initiative for critically ill patients

Indigenous Peoples and Occupational Therapy in Canada: A scoping review

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