Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings

Abstract

Despite 21st century medical and technological advances, accessto palliative care remains tenuous, if not impossible for a majority of people living in low-and middle-income countries (World Health Organization, 2020). The World Health Organization (2020) reports that 40 million people need palliative care services worldwide, but accessibility is limited due to a lack of human or financial resources to provide services or a lack of understanding of palliative care delivery goals. The Canadian Society of Palliative Care Physicians (2016) states that only 30% of Canadians have access to palliative care.Although a majority of Canadians wish to die at home, the Canadian Institute for Health Information (CIHI) underlines that "fewer than 1 in 6 people (15%) who died in 2016-2017 received palliative home care while those who received palliative care received it only in the last month of life" (CIHI,

Guaranteeing the right to a safe and culturally appropriate death: the meaning of occupations in the life-death-rebirth triad from the Colombian indigenous perspective

“…Palliative care therefore develops by adopting the forms of care and transition rites; from the moment man becomes aware of the meaning of death, from his cosmogony as a cycle of lifedeath-spiritual rebirth. Now, delving into the contemporary dynamics given by the Western health system, the care of indigenous communities towards death is linked to the purpose of palliative care; this approach has had several practical approaches in Anglo-Saxon indigenous communities (Prince et al, 2019;Thompson et al, 2019;Racine et al, 2022;Woods et al, 2020). In Colombia so far, we have not found any palliative care practice with indigenous communities.…”

Garantizar el derecho a una muerte segura y culturalmente adecuada: el sentido de las ocupaciones en la tríada vida-muerte-renacimiento desde la visión indígena Colombiana

“…Ahora bien, ahondando la dinámica contemporánea dada por el sistema de salud occidental, el cuidado de las comunidades indígenas hacia la muerte está vinculada al propósito de los cuidados paliativos, este abordaje ha tenido varios acercamientos prácticos en las comunidades indígenas anglosajonas (Prince et al, 2019;Thompson et al, 2019;Racine et al, 2022;Woods et al, 2020). En Colombia hasta el momento, no encontramos ninguna práctica de cuidados paliativos con las comunidades indígenas.…”

Palliative Care Clinician Perspectives on Person-Centered End-of-Life Communication for Racially and Culturally Minoritized Persons with Cancer

“…Palliative care provision and outcomes for racially and culturally minoritized persons (e.g., Black and Native American people) with serious illness are substandard when compared to non-minoritized persons. For instance, care inequities for Black and Native American patients and their caregivers exist across the palliative care spectrum, including but not limited to poorer symptom management, disparate medically indicated treatments for pain (e.g., equitable opioid prescribing and monitoring practices) [ 6 , 7 , 8 , 9 , 10 , 11 ], discriminatory and biased clinician behaviors and communication [ 12 , 13 , 14 ], poor integration of patients’ spiritual and cultural values into care delivery [ 15 , 16 ], less high-quality evidence and documentation of advance care planning [ 17 , 18 , 19 ], and significant mistrust of the health system [ 20 , 21 ] that impacts patients’ decision making and relationships with clinicians. Such disparities lead to poorer clinical outcomes for patients (e.g., pain, goal discordant care) and caregivers (e.g., bereavement).…”