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End-of-Life Healthcare Experiences of Indigenous People and Ethnic Minorities: The Example of Canada

  • Carrie Bourassa
Living reference work entry

Abstract

This chapter will explore understandings of culture, ethnicity, indigeneity, intergenerational trauma, and othering and how they relate to health outcomes, experiences with illness and death, accessing healthcare and palliative care, and patient/practitioner interactions predominantly in Canada. Discussions will define indigenous and ethnic minorities and examine the commonalities in health disparities experienced by both groups. Although commonalities will be discussed, they will be paired with the continual need to avoid “pan-Indigenous” or “pan-cultural” understandings that oversimplify the reality of diverse populations. Culture, spirituality, the desire to provide palliative care within the home and community, and subsequent barriers to doing so will be introduced. Though rumblings of culturally safe models of care continue to grow throughout the country, they are often overpowered by stories of mistreatment, discrimination, and colonial behaviors in the healthcare system. In an effort to overcome these barriers and provide the best possible end-of-life care to individuals, a brief overview of cultural safety and culturally safe models of palliative care will be introduced. Finally, recommendations and best practices are presented along with a case study highlighting the importance of patient/practitioner communication when offering culturally safe palliative care.

References

  1. Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev. 2015;6. Retrieved from http://onlinelibrary.wiley.com/store/10.1002/14651858.CD009905.pub2/asset/CD009905.pdf?v=1&t=j3gbpho4&s=291adc390c578895da6e001e23e3655211305159
  2. Arnup K. Death, dying and Canadian families: contemporary family trends. Ottawa: The Vanier Institute of the Family; 2013.Google Scholar
  3. Barter-Godfrey S, Taket A. Othering, marginalisation and pathways to exclusion in health. In: Taket A, Crisp BR, Nevill A, Lamaro G, Graham M, Barter-Godfrey S, editors. Theorising social exclusion. Abingdon: Routledge; 2009. p. 166–72.Google Scholar
  4. Baydala A, Hampton M, Kinunwa L, Kinunwa G, Kinunwa L. Death, dying, grieving and end of life care: understanding personal meanings of aboriginal friends. Humanist Psychol. 2006;34:159–76.CrossRefGoogle Scholar
  5. Bellamy G, Gott M. What are the priorities for developing culturally appropriate palliative and end-of-life care for older people? The views of healthcare staff working in New Zealand. Health Soc Care Commun. 2013;21:26–34.CrossRefGoogle Scholar
  6. Brascoupe S, Waters C. Cultural safety: exploring the applicability of the concept of cultural safety to aboriginal health and community wellness. J Aborig Health. 2009;5(2):6–41.Google Scholar
  7. Browne AJ. Critical cultural perspectives and health care involving aboriginal peoples. Contemporary Nurse. 2006;22(2):155–67.CrossRefGoogle Scholar
  8. Browne AJ, Varcoe CM, Wong ST, Smye VL, Lavoie J, Littlejohn D, et al. Closing the health equity gap: evidence-based strategies for primary health care organizations. Int J Equity Health. 2012;11:15–1.CrossRefGoogle Scholar
  9. Busolo D, Woodgate R. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol. JBI Database System Rev Implement Rep. 2015;13:99–111.CrossRefGoogle Scholar
  10. Canadian Hospice Palliative Care Association. Hospice palliative care in Canada: a brief to the Special Senate Committee on Aging. 2007. Retrieved from http://www.chpca.net/media/7487/Brief_to_Spec_Sen_Comm_on_Aging-HPC_in_Canada.pdf
  11. Castleden H, Crooks VA, Morgan VS, Schuurman N, Hanlon N, Inter Tribal Health Authority. Dialogues on aboriginal-focused hospice palliative care in rural and remote British Columbia, Canada. Halifax: Dalhousie University; 2009.Google Scholar
  12. Clarke V, Holtslander LF. Finding a balanced approach: incorporating medicine wheel teachings in the care of aboriginal people at end of life. J Palliat Care. 2010;26(1):34–6Google Scholar
  13. Crosato K, Ward-Griffin C, Leipert B. Aboriginal women caregivers of the elderly in geographically isolated communities. Rural Remote Health. 2007;7:796.PubMedGoogle Scholar
  14. De Maio FG, Kemp E. The deterioration of health status among immigrants to Canada. Glob Public Health. 2008;5:462–78.CrossRefGoogle Scholar
  15. DeCourtney C, Branch PK, Morgan K. Eleanor McMullen’s story. J Palliat Care. 2010a;26:67.PubMedGoogle Scholar
  16. DeCourtney C, Branch P, Morgan K. Gathering information to develop palliative care programs for Alaska’s aboriginal peoples. J Palliat Care. 2010b;26:22–31.PubMedGoogle Scholar
  17. Duggleby W, Kuchera S, MacLeod R, Holyoke P, Scott T, Holtslander L, Chambers T. Indigenous people’s experiences at the end of life. Palliat Support Care. 2015;13(6):1721–33.CrossRefGoogle Scholar
  18. Guilfoyle J, Kelly L, St Pierre-Hansen N. Prejudice in medicine: our role in creating health care disparities. Can Fam Physician. 2008;54:1511–3.PubMedPubMedCentralGoogle Scholar
  19. Hampton M, Baydala A, Bourassa C, McKay-McNabb K, Placsko C, Goodwill K, Boekelder R. Completing the circle: elders speak about end-of-life care with aboriginal families in Canada. J Palliat Care. 2010;26:6–14.PubMedGoogle Scholar
  20. Health Council of Canada. Empathy, dignity, and respect: Creating cultural safety for Aboriginal people in urban health care. 2012. Retrieved from http://www.healthcouncilcanada.ca/tree/Aboriginal_Report_EN_web_final.pdf
  21. Johnson JL, Bottorff JL, Browne AJ, Grewal S, Hilton BA, Clarke H. Othering and being othered in the context of health care services. J Health Commun. 2009;16:255–71.CrossRefGoogle Scholar
  22. Johnston G, Vukic A, Parker S. Cultural understanding in the provision of supportive and palliative care: perspective in relation to an indigenous population. Support Palliat Care. 2012.  https://doi.org/10.1136/bmjspcare-2011-000122.
  23. Kelly L, Minty A. End-of-life issues for aboriginal patients: a literature review. Can Fam Physician. 2007;53:1459–65.PubMedPubMedCentralGoogle Scholar
  24. Kelly L, Linkewich B, Cromarty H, St. Pierre-Hansen N, Antone I, Gilles C. Palliative care of first nations people: a qualitative study of bereaved family members. Can Fam Physician. 2009;55:394–5.PubMedPubMedCentralGoogle Scholar
  25. Khan M, Kobayashi K, Kee S, Vang Z. (In)visible minorities in Canadian health data and research. Population Change and Lifecourse Strategic Knowledge Cluster Discussion Paper Series. 2015; 3 (1)Google Scholar
  26. King M, Smith A, Gracey M. Indigenous health part 2: the underlying causes of the health gap. Lancet. 2009;374:76–85.CrossRefGoogle Scholar
  27. Kirmayer LJ. Rethinking cultural competence. Transcult Psychiatry. 2012;49:149–64.CrossRefGoogle Scholar
  28. Kirmayer LJ, Brass G. Addressing global health disparities among indigenous peoples. Lancet. 2016;388:105–6.CrossRefGoogle Scholar
  29. Kobayashi KM, Prus S, Lin Z. Ethnic differences in self-rated and functional health: does immigrant status matter? Ethn Health. 2008;13:129–47.CrossRefGoogle Scholar
  30. McGrath P. Family caregiving for aboriginal peoples during end-of-life: findings from the northern territory. J Rural Trop Public Health. 2008;7:1–10.Google Scholar
  31. McGrath P. The living model: an Australian model for aboriginal palliative care. J Palliat Care. 2010;26:59–64.PubMedGoogle Scholar
  32. Palmater PD. Beyond blood: rethinking indigenous identity. Saskatoon: Purich Publishing; 2011.Google Scholar
  33. Statistics Canada. Aboriginal peoples in Canada: first nations people, Métis and Inuit National Household Survey, 2011. 2013. Retrieved from http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.pdf
  34. Tang SY, Browne AJ. ‘Race’ Matters: racialization and egalitarian discourses involving aboriginal people in the Canadian health care context. Ethn Health. 2008;13:109–27.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Indigenous & Northern HealthHealth Sciences North Research InstituteSudburyCanada
  2. 2.Institute of Indigenous Peoples’ HealthCanadian Institute of Health ResearchSudburyCanada

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