Use of traditional therapies in palliative care for Australian First Nations peoples: An integrative review

Abstract

Aims and objectives To conduct an integrative review of the literature to understand how the incorporation of traditional therapies affect First Nations people's utilisation of palliative care services. Background First Nations peoples face many barriers related to accessing and utilising specialised health services such as palliative care. Whilst culturally appropriate care has been shown to improve these outcomes, there is little evidence regarding how this may be achieved. Design Integrative review. Methods A systematic search was conducted using electronic databases CINAHL, Joanna Briggs, Medline, Scopus, ScienceDirect InformitHealth and ProQuest between the years of 2005 ‐ 2021 databases were searched for papers with full text available and published in English. Papers were included if they were primary‐based research and focused on the topics of the use of traditional therapies in a palliative care context by First Nations persons. The Critical Appraisal Skills Programme principles were used to assess the methodological quality of the selected articles. Results Seven studies met the inclusion criteria and were included in the review. The review included six qualitative studies and one quantitative study. From these studies, five themes were identified in the literature: supporting a holistic approach, developing culturally appropriate care, conflict within a Western medical model, regulatory issues, and geographical barriers. Conclusion There is a dearth of current literature available discussing the utilization of traditional therapies in palliative care. From the literature analysed, the benefits of including traditional therapies are overall positive, however, there are barriers including conflict with the Western model of medicine and regulation. More research is required in the provision of traditional therapies in palliative care. Relevance to Clinical Practice The incorporation of traditional medicines within a palliative care setting could help nurses provide holistic and culturally appropriate care, especially in rural and remote areas where they make up the majority of the healthcare force.

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

“…The co‐habitation of mixed belief systems underlines the need to let Indigenous patients choose the spiritual practices that bring them comfort and peace (Colclough & Brown, 2019; Dennis & Washington, 2018; Gebauer et al, 2016; Terpstra et al, 2021). Elders' counselling, family gatherings, prayers, smudging ceremonies, tobacco offerings, consumption of traditional foods, singing of songs and connecting with the land of the ancestors constitute healing practices that remove physical, emotional or spiritual obstacles hindering the peaceful release of the spirit to the metaphysical sphere (Colclough & Brown, 2019; Dennis & Washington, 2018; Gebauer et al, 2016; Gott et al, 2019; Moeke‐Maxwell et al, 2018; Rooney et al, 2021; Terpstra et al, 2021).…”

“…Moeke‐Maxwell et al (2018) point out that for Māori, “visiting ancestral homes and other places of whanau or tribal significance in preparation to their passing” (p. 35). Dying at home enables the connection with the land through the presence of family members, the performance of traditional ceremonies, the consumption of traditional foods and medicines, and the presence of the Elders (Oetzel et al, 2015; Rooney et al, 2021).…”

“…Significant environmental, contextual and institutional barriers remain to be addressed to increase accessibility. Limited geographic access, need to travel long distances for accessing and receiving care in urban tertiary hospitals, lack of transportation, lack of existing palliative services and a lack of culturally and linguistically responsive palliative care explain the underutilization of palliative care among rural and remote Indigenous communities (Caxaj et al, 2018; Duggleby et al, 2015; Galloway et al, 2020; Gott et al, 2019; Rooney et al, 2021; Shahid et al, 2018; Watson et al, 2020). As a result, increasing accessibility and adapting palliative care to Indigenous people's cultural needs represent a global health priority (Gott et al, 2017; Rosa, 2017).…”

“…Studies indicate Indigenous peoples die in Western health care centres due to lack of access or absence of palliative care services in their regions or mistrust in Western palliative care programmes and services (Bernardes et al, 2021;Rooney et al, 2021;Watson et al, 2020). Studies point to a desire to die in the communities, but highlight the need to increase Indigenous caregivers' support in remote locations (Bernardes et al, 2021;Caxaj et al, 2018;Colclough & Brown, 2019;Gott et al, 2018Gott et al, , 2019Shahid et al, 2018).…”

“…Colonial erasures disrupted Indigenous spiritual, cultural, social and economic traditions undermining spiritual practices related to the dying process (Colclough & Brown, 2019;Moeke-Maxwell et al, 2018;Rooney et al, 2021). The local and global contexts affecting Indigenous palliative care call for a review of the empirical literature to locate evidence and generate guidance.…”