In 2016, an estimated 787,000 Australians identified as Indigenous (3.3% of the population). Of this group, 91% were of Aboriginal origin, 5% were of Torres Strait Islander origin and 4.1% identified as both Aboriginal and Torres Strait Islander origin.[1, 2] Quality care at the end of life can only be achieved when it is culturally safe and appropriate to the particular needs of individuals and communities– which includes families, kinships and clans.
A culturally safe approach is central to care for Aboriginal and Torres Strait Islander communities. This person-centred approach to care recognises that:[4-10]
- Aboriginal and Torres Strait Islander peoples’ view of ‘health’ involves not only the physical wellbeing of an individual, but the social, emotional and cultural wellbeing of the whole community and includes a cyclical concept of life-death-life.
- The place of dying and death is culturally and spiritually significant for many Aboriginal and Torres Strait Islander peoples. The need to ‘return to country’ is often very important at the end-of-life – which can involve a physical return, or other elements from country to symbolise a ‘return to country’ where a physical return is not practical or possible.
- The heterogeneity of Aboriginal and Torres Strait Islander culture means models of care need to be flexible to address the specific needs of different groups and individuals.
- Contemporary models of palliative and end-of-life care in Australia, which are dominated by Western traditions and the biomedical paradigm, need to integrate Aboriginal and Torres Strait Islander traditions, values and cultural practice relating to palliation and end-of-life transitions, as appropriate for each individual.
- Palliative and end-of-life care services need to respect the basic rights and culture of Aboriginal and Torres Strait Islander peoples to ensure equity of access for all Australians.
- Community-based local approaches to end-of-life care should be encouraged.
- Aboriginal and Torres Strait Islander health professionals should have a significant role in the delivery of quality end-of-life care.
- Aboriginal and Torres Strait Islander communities have a common heritage of loss and trauma. The impact of loss and grief for Aboriginal and Torres Strait Islander peoples is often compounded by earlier experiences. These experiences may impact an individual’s willingness and ability to access and trust the Australian health system. Working to overcome such challenges is vital to enabling optimal palliative care for all Australians.
This video tells the story of first-hand experience of the barriers to accessing palliative care faced by Aboriginal and Torres Strait Islander peoples. As you watch the video, consider this question, “What actions can you take as a health professional to break down the access barriers to mainstream healthcare, experienced by Aboriginal and Torres Strait Islander peoples?”
- Compare the main causes of death within the Aboriginal and Torres Strait Islander community with the rest of the Australian population. What contributes to these differences?
- How does understanding the historical journey and its influence on the contemporary society of Aboriginal and Torres Strait Islander peoples help you to provide culturally safe palliative care?
- How can community-based local approaches to palliative care by Aboriginal and Torres Strait Islander health professionals promote culturally safe palliative care?
- How can loss and trauma potentially prevent Aboriginal and Torres Strait Islander communities from accessing palliative care services?
- Australian Bureau of Statistics. Cultural Diversity in Australia. 2016 Census Data Summary. 2017 April 2018]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Cultural%20Diversity%20Data%20Summary~30.
- Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. AUS 221 2018 09/06/2015 [cited 2018 24/06/2019]; Available from: https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/data.
- Aboriginal and Torres Strait Islander Health Branch, Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. 2011, Queensland Health.
- Indigenous Allied Health Australia, Cultural Responsiveness In Action: An IAHA Framework. 2015.
- Palliative Care Australia. Improving access to quality care at the end of life for Aboriginal and Torres Strait Islander Australians. 2015; Available from: http://palliativecare.org.au/wp-content/uploads/2015/08/PCA-Palliative-care-and-Indigenous-Australians-position-statement-updated-16-8-11.pdf.
- Taylor, K. and P. Guerin, Health care and indigenous Australians: cultural safety in practice. 2010: Palgrave Macmillan.
- Richardson, S. and T. Williams, Why is cultural safety essential in health care? Med Law, 2007. 26(4): p. 699-707.
- Bozorgzad, P., et al., Cultural Safety: An Evolutionary Concept Analysis. Holist Nurs Pract, 2016. 30(1): p. 33-8.
- Phiri, J., E. Dietsch, and A. Bonner, Cultural safety and its importance for Australian midwifery practice. Collegian, 2010. 17(3): p. 105-11.
- Laverty, M., D. R McDermott, and T. Calma, Embedding cultural safety in Australia’s main health care standards. Vol. 207. 2017. 15-16.