Did your loved one receive culturally appropriate palliative and end-of-life care?

Why is this indicator important to First Nations, Inuit and Métis?

Palliative and end-of-life care¹ involves helping people manage the emotional, spiritual, mental and physical (functional, practical, nutritional and rehabilitative) challenges associated with cancer progression.

In its simplest terms, it is about reducing symptoms and easing suffering and ensuring that the supports are available to ensure that this final journey is one that people can feel good about.

Many First Nations, Inuit and Métis hold unique views about health and wellbeing, the experience of illness, disease management, or taking care of their health and death. Spirituality, therefore, factors prominently in what comprises good quality care. Cultural respect and sensitivity are central to effective health service provision.²

There are distinct and very diverse cultural beliefs and values in understanding cancer and the palliative journey and end-of-life transition which can be found in the original First Nations, Inuit and Métis languages themselves.

The inclusion of cultural practices, the strong presence and involvement of family and being cared for and dying at home are central features of culturally safe palliative and end-of-life care.³  Unfortunately for many Inuit, prohibitive transportation costs and inflexible transportation policies impede them from joining their family in the community at the end-of-life transition of their loved one. In addition, First Nations, Inuit and Métis patients need open and honest communication with health professionals and respectful treatment by health service providers.

It is important to recognize the wide diversity of cultural approaches and understandings about palliative and end-of-life care.

View Indigenous determinants of health

Beginning the journey to the spirit world

A helpful resource is the Beginning the Journey to the Spirit World: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada,  a resource developed by the Canadian Partnership Against Cancer in partnership with numerous First Nations, Inuit and Métis Elders, Knowledge Carriers, community health professionals and researchers—all of whom have experience and knowledge of First Nations, Inuit or Métis approaches to palliative and end-of-life care.

This resource covers many First Nations, Inuit or Métis perspectives and considerations on palliative and end-of-life care, discusses culture as medicine and describes many promising practices. It is intended to empower both First Nations, Inuit, Métis and non-Indigenous Peoples to develop community-based models for palliative and end-of-life care.

How does this affect care and outcomes?

Improved understanding of the differences in priorities and preferences for palliative and end-of-life care can ease distress for patients and families during this difficult transition.

Sound information and understanding regarding palliative and end-of-life care and services can improve patient experiences and quality of care.

Having culturally tailored education and information for both the individual and their family as well as care providers can improve the care experience. An example of culturally tailored resources is the Canadian Virtual Hospice LivingMyCulture series of video vignettes which give insights to unique dimensions of serious illness experienced by First Nations, Inuit and Métis patients and their families.

Written materials or information communicated in simple, jargon-free ways can improve understanding and overcome language barriers. This is especially important in interpreting complex terminology or instructions.⁴

Cancer information resources which consider and reflect cultural beliefs as well as the spiritual dimension of the patient’s cancer journey are key.⁵

Care is improved when it is situated with culturally safe provision, practices, communications and planning.

Towards health equity

First Nations, Inuit and Métis patients have distinct historical and cultural contexts, which contribute to unique views of cancer, palliative care and the end-of-life journey.

To serve the unique needs of First Nations, Inuit and Métis, palliative and end-of-life care must be offered in culturally safe ways and ensure availability of supports and access to traditional and spiritual practices, including those offered through organized religion or other faith communities.

Removing barriers such as restrictive hospital visitor policies which inhibit families from gathering around their loved ones, and addressing the lack of access to home care supports and services, the lack of cultural safety and understanding on the part of health service providers and other impediments to quality, safe palliative and end-of-life care can close the gaps on quality and access and improve the patient experience.⁶

What this would mean for people in Canada

Culturally safe palliative and end-of-life care is offered through community engagement, education and training, flexibility in service structure and delivery, and a commitment to patient-centred care.

First Nations, Inuit and Métis patients and their families receive high quality and culturally safe palliative and end-of-life care and supports.

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