The first study is a scoping review aimed to synthesize existing research on Indigenous peoples’ experiences with palliative and end-of-life care (PEOLC) in Canada. Across First Nations, Inuit, and Métis communities, the findings revealed shared relational and spiritual frameworks that influence end-of-life experiences. Death is viewed as a collective social and spiritual transition, and often involves community and ceremony. There was a consistent preference for receiving care in the home and community, as well as for culturally grounded relationships with care providers. However, this preference was often undermined by structural inequities, such as limited service availability in rural and remote Indigenous communities. Many individuals are relocated to institutional care settings, causing disruption to family and support systems that nurture customary death practices. Findings also revealed that care for the body and associated practices are highly diverse and vary across communities and families, which stresses the inadequacy of standardized biomedical approaches to end-of-life care. The key priorities include strengthening community-based capacity for care delivery, expanding access to culturally-aligned and community-specific services, and integrating holistic models of care. Lastly, the findings show the need to improve communication processes and to enhance education for healthcare providers regarding Indigenous worldviews and end-of-life practices.
The second study was an integrative interview review, examining studies with a focus on Indigenous palliative care needs and challenges in rural and remote settings. While the study was global in scope, it emphasized Canada. The overarching themes identified within this study included the importance of respecting Indigenous cultural beliefs surrounding death and dying, the connection to the land, the necessity for culturally responsive care, and the presence of institutional and systemic barriers. Most studies were qualitative and involved mixed teams of Indigenous and non-Indigenous researchers. The findings indicated that historical trauma and colonization impacted healthcare access and resulted in later diagnoses and shorter survival rates for Indigenous populations compared to their non-Indigenous counterparts. A call to address systemic racism serves as a fundamental and overarching premise to guarantee equitable care for Indigenous populations. This requires a decolonial transformation of healthcare systems to promote community-led, culturally aligned Indigenous knowledge and practices.
The third study was a qualitative research project using semi-structured focus groups and interviews that examined the experiences and perspectives of various health professionals (medicine, nursing, allied health, and Indigenous hospital liaison officers) in providing palliative care for Indigenous Australians. They found four overarching themes:
- Intersection of cultures: A cultural disconnect in care delivery arises from fundamental differences between Indigenous peoples’ health perspectives and biomedical approaches to palliative care.
- Critical role of Indigenous Hospital Liaison officers (IHLOs): They serve as a crucial bridge between the two cultural systems, working at the intersection to facilitate communication and understanding between patients/families and healthcare providers, and to help ensure cultural needs are met.
- Devolution of responsibility: Health professionals tended to delegate responsibility for providing culturally appropriate care, with a likely over-reliance on IHLOs rather than developing personal cultural competence.
- Need for holistic and culturally-aware care: The study described opportunities to build more comprehensive and culturally-responsive palliative care approaches.
The study highlights that achieving cultural safety in palliative care for Indigenous people necessitates systemic change, shared responsibility among healthcare providers to develop cultural competence, increased flexibility in healthcare policies, adequate support for Indigenous Health Liaison Officers (IHLOs), and a holistic approach that incorporates cultural and spiritual dimensions of health, while addressing institutional racism and structural barriers to care.
The fourth study was a program evaluation that tracked the work of individual Indigenous
palliative care nurse navigators. Moreover, these nurse navigators supported Indigenous patients with life-limiting illnesses. The major findings were that the navigator’s responsibilities were organized into three domains: social vulnerabilities, mainstream palliative care navigation, and barriers to palliative care for Indigenous people. And then 16 categories captured the scope of their responsibilities and demonstrated effectiveness in addressing multiple barriers to care. This model integrates patient navigation, which has been proven effective in both Indigenous and palliative contexts. The key takeaway was that Indigenous palliative care navigation is an effective intervention, and it addresses numerous barriers experienced by Indigenous individuals facing life-limiting illnesses. However, further research is needed on quality outcomes and cost-effectiveness.
The fifth study was an integrative interview review that examined 7 studies on the use of traditional therapies in palliative care for Australian First Nations peoples. The major findings were five themes that supported a holistic approach, developing culturally appropriate care, conflict with the Western medical model, regulatory issues, and geographical barriers. The dearth of the current literature on traditional therapies in palliative care, and the benefits of including traditional therapies are positive, although significant barriers exist, including conflict with Western medicine and regulation. The key takeaway here is the critical need for more research on the integration of traditional therapies into palliative care with attention to resolving conflicts between Western and Indigenous care models.
