Mary J. Isaacson

Insights From Health Care Professionals Regarding Palliative Care Options on South Dakota Reservations

Purpose: Palliative care options are limited for Native Americans (NA) in South Dakota (SD). This exploratory study offers the perspectives of Native and non-Native health care professionals regarding palliative care specific to NAs. Design: Semi-structured interviews were conducted (N = 7) with participants representing NA (4) and non-Native (3) ethnicities. Non-Native participants were practicing health care professionals in palliative medicine, whereas the NA health care professionals had experience with palliative care. Findings: Concept analysis revealed two main themes and five subthemes: (a) barriers to palliative care, for example, insufficient funding, lack of infrastructure, and misconceptions; and (b) implementation strategies, for example, openness and listening and creating the right team. Discussion: Genuine interest and concern exists for the provision of palliative care to NA communities using collaborative and innovative approaches. Implications: To address the health disparities of the NA population specific to palliative care, public health policy reform and education for health professionals are necessary.

Culturally Relevant Palliative and End-of-Life Care for U.S. Indigenous Populations: An Integrative Review

Purpose:American Indians/Alaska Natives (AIs/ANs) have higher rates of chronic illness and lack access to palliative/end-of-life (EOL) care. This integrative review ascertained the state of the science on culturally acceptable palliative/EOL care options for Indigenous persons in the United States. Design: Databases searched: CINAHL, PubMed/MEDLINE, SocINDEX, PsycINFO, PsycARTICLES, ERIC, Health Source: Nursing/Academic Edition, and EBSCO Discovery Service 1880s-Present. Key terms used: palliative care, EOL care, and AI/AN. Inclusion criteria: peer-reviewed articles published in English. Findings/Results: Twenty-nine articles were identified, 17 remained that described culturally specific palliative/EOL care for AIs/ANs. Synthesis revealed four themes: Communication, Cultural Awareness/Sensitivity, Community Guidance for Palliative/EOL Care Programs, Barriers and two subthemes: Trust/Respect and Mistrust. Discussion/Conclusion: Limitations are lack of research funding, geographic isolation, and stringent government requirements. Palliative/EOL care must draw on a different set of skills that honor care beyond cure provided in a culturally sensitive manner.

Cancer survivorship care plans: Processes, effective strategies, and challenges in a Northern Plains rural state

OBJECTIVES Health systems face resource and time barriers to developing and implementing cancer survivorship care plans (SCPs) when active cancer treatment is completed. To address this problem, the South Dakota (SD) Department of Health partnered with two of SDs largest health systems to create the SD Survivorship Program. The purpose of this program evaluation study was to describe and compare SCP development and implementation at the two health systems. DESIGN & SAMPLE A descriptive qualitative design was used. Interview participants were instrumental in the development and implementation of SCPs within their respective health system. MEASURES Content analysis was used to analyze the interview data. RESULTS The two health systems used similar processes for (a) early designation of program personnel, (b) developing SCP templates, (c) provider/staff input, and (d) identifying/tracking eligible patients. In contrast, they developed differing processes for SCP completion and delivery. The two health systems also identified effective strategies and challenges in SCP development and implementation. CONCLUSION This evaluation suggests that partnerships between state health departments and local health systems could be key for meeting the nation-wide goal of universal SCP implementation. Particularly, other low-population rural states like SD can use the findings to help build their SCP programs.

Addressing palliative and end-of-life care needs with Native American elders

BACKGROUND Life-limiting illness plagues Native Americans, yet access to palliative and end-of-life care, including hospice care, is severely limited. AIM This study aimed to explore palliative and hospice care with Native American elders and tribal health educators on a Northern Plains reservation in the US. METHODS Using a community-based participatory approach, participants discussed the cultural acceptability of palliative and hospice care in their tribal community. Monthly talking circles were held over a 5-month period. RESULTS Opportunities were present for improving cultural awareness and advance directive education to elders. Challenges raised were related to infrastructure, tribal government and the Indian Health Service. Needs identified included cultural awareness and language education for health-care providers and advance directive education. CONCLUSION Community-based participatory research is useful when working with indigenous populations. Health professionals providing services to Native American communities must embrace cultural differences, seeking to learn from the culture itself how to best meet its peoples needs.