An exploration of Canadian Indigenous worldviews and palliative care: An integrative review

Background: Some Indigenous people suffer from a disproportionate prevalence of life limiting conditions, with increased mortality and decreased life-expectancy compared to non-Indigenous populations. Reduced uptake of palliative care services by Indigenous populations is concerning and further cultural understanding is needed to improve delivery of palliative care services. This review explores Indigenous user experiences with palliative care in Canada through the research question: How does a worldview affect the delivery of palliative care services to Indigenous people living with life limiting conditions? Method: Seven primary source articles are analyzed concerned Inuit and First Nation and Métis perspectives on palliative care. Summative themes identified including traditional and contemporary experiences, EOL beliefs, EOL preferences, EOL communication, EOL capacity, EOL resource and policy limitations, and recommendations for palliative care improvements. Dialogue examples accompanying the themes are analysed with Hiebert's Worldview Model concerning nine worldview features including time, self-concept, space, feeling, preference, sensation, food, beliefs, emotion and ethics, values, and judgement. Results: some Canadian Indigenous people's self-concept and spiritual beliefs may conflict with western individualistic delivery of care, and serious illness conversations. Conclusion: Culturally sensitive and competent approaches to palliative care marginally improve care delivery for Indigenous populations, but the do not improve health equity. A cultural safe approach to palliative care can help address health equity for Indigenous people and lead to increased culturally accessible, accommodating, and acceptable EOL care.