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UBC Theses and Dissertations

Palliative care for First Nations people in British Columbia Falk, Miranda


Background: First Nations people in Canada experience higher rates of chronic illness among an aging Aboriginal population, highlighting the importance of exploring palliative care for First Nations people. Methods: The aim of this qualitative descriptive study, which was informed by Indigenous methodologies and guided by the 4 R’s (respect, relevance, reciprocity and responsibility), was to explore capacities, barriers and cultural safety in the delivery of palliative care for First Nations people. Data were collected from seven Aboriginal Patient Liaisons/Navigators from two regional health authorities in British Columbia using semi-structured interviews. Findings: Participants identified important aspects of palliative care for First Nations people they had worked with: cultural and spiritual diversity; the importance of family and community at end of life (EOL); the importance of ceremony at EOL; and the effects of colonialism and associated trauma at EOL. Participants provided recommendations for health care providers (HCPs), considering these important aspects of care. Participants also described the “spinoff” of practicing in a culturally safe, trauma-informed way with First Nations people at EOL as a good way to practice with all people across diversity through understanding power relationships, the significance of trauma and focusing on communication and respect. However, several contextual and environmental factors were described that further facilitated or constrained access to quality palliative care for First Nations people: challenges coordinating palliative care services and funding across jurisdictions; variability and uncertainty in palliative care services across First Nations communities; physical and organizational environments constraining or facilitating comfort at EOL; poverty as a compounding stress; and timeliness issues relating to unpredictability and vulnerability of palliative trajectories. Discussion: These findings can inform HCPs in their approaches and practices; however, several contextual and environmental factors influenced palliative care access and quality for First Nations people. Policy implications exist at the provincial level to improve cross-jurisdictional complexity and palliative care programming as well at the institutional level to improve cultural safety for First Nations people at EOL. Given the priority for family and community involvement at EOL, future research should explore how to better support First Nations families to be together at EOL.

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