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. 2022 Sep;64(3):276-286.
doi: 10.1016/j.jpainsymman.2022.05.011. Epub 2022 May 23.

Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians

Alexander Soltoff  1 , Sara Purvis  2 , Miranda Ravicz  2 , Mary J Isaacson  3 , Tinka Duran  4 , Gina Johnson  4 , Michele Sargent  5 , J R LaPlante  6 , Daniel Petereit  5 , Katrina Armstrong  7 , Bethany-Rose Daubman  8
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Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians

Alexander Soltoff et al. J Pain Symptom Manage. 2022 Sep.

Abstract

Context: Despite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land.

Objectives: This study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs.

Methods: Three authors recorded and transcribed interviews with 21 specialty and 17 primary clinicians. A data analysis team of seven authors analyzed transcripts using conventional content analysis. The analysis team met over Zoom to engage in code negotiation, classify codes, and develop themes.

Results: Qualitative analysis of interview data revealed four themes encompassing factors influencing palliative care delivery and access for Great Plains American Indians: health care system operations (e.g., hospice and home health availability, fragmented services), geography (e.g., weather, travel distances), workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), and historical trauma and racism.

Conclusion: Our findings emphasize the importance of addressing the time and cost of travel for seriously ill patients, increasing home health and hospice availability on reservations, and improving trust in the medical system. Strengthening the AI medical workforce, increasing funding for the Indian Health Service, and transitioning the governance of reservation health care to Tribal entities may improve the trustworthiness of the medical system.

Keywords: Alaska Native; American Indian; barriers; facilitators; hospice; palliative care; qualitative research.

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Figures

Figure 1.
Figure 1.
Factors Influencing Palliative Care Impede the Formation of Trust
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