Culturally appropriate palliative care and end-of-life care

It is important to understand the cultural and spiritual considerations of Aboriginal and Torres Strait Islander people and their families when providing person-centred palliative care [29818][43533]. A set of specific principles assist in the delivery of culturally appropriate palliative care for Aboriginal and Torres Strait Islander people, including:

• equity of access (i.e. equal opportunity for accessing care)
• empowerment and autonomy (i.e. individual choices and shared decision making)
• trust (i.e. trusting relationships can be developed by acknowledging and demonstrating a person’s spiritual and cultural beliefs)
• cultural respect [15970][35441].

There are many Aboriginal and Torres Strait Islander language groups in Australia and healthcare providers should recognise that cultural and spiritual practices and individual choices may vary across these groups [29818][21898][44594]. Such practices to consider when providing palliative care to Aboriginal and Torres Strait Islander people include, but are not limited to:

• kinship – recognise that Aboriginal and Torres Strait Islander kinship systems extend beyond immediate family members
• communication – be mindful of verbal and non-verbal communication styles and that plain language explanations are often preferable to medical jargon
• Country – understand that some Aboriginal and Torres Strait Islander people approaching end-of-life may wish to pass away on Country
• Sorry Business – a period after the loss of a person where many Aboriginal and Torres Strait Islander people follow traditional practices and/or ceremonies [29818][35441][42770][40671].

Directly referring to ‘death’ and ‘dying’ may make some Aboriginal or Torres Strait Islander people uncomfortable and the use of alternative terms such as ‘finishing up’, ‘passed on’ and ‘not going to get better’ may be more culturally appropriate [29818]. It is important to ask a sick person who they would like their health matters to be discussed with, as it is often the responsibility of the family, not the individual. The family may express specific preferences, such as the use of traditional medicine [44449], additional space to accommodate more than one person to stay overnight and request multiple visitors at once. Supporting people to observe their traditions at the end of someone’s life can assist the person with a life-limiting illness, as well as help their family and community with their grief and bereavement [43533].