PCC4U Core Module 3: Assessing and managing symptoms provides detailed information about assessment to determine a person and their family’s physical, emotional, social, cultural and spiritual needs. Management of symptoms in palliative care is focused on providing comfort and supporting the best possible quality of life.
Common symptoms that people can experience include:
- Nutrition and hydration problems
- Delirium and confusion.
For many Aboriginal and/or Torres Strait Islander people, the end-of-life journey is an important spiritual time; their focus may be on passing on cultural knowledge to family and community members. There is often a desire to stay alert in order to spend time with people, especially as many people – family, friends and community members – are visiting to pay their respects.
For this reason, there can be a reluctance to take strong analgesics, such as morphine (which is often used to manage pain and breathlessness) due to the possible side-effects of becoming tired, drowsy or confused. Concerns about becoming addicted to pain medications can also be common.
Information to help Aboriginal and/or Torres Strait Islander people understand morphine, and how and when it is used, is important to provide. For example: Understanding morphine – Cancer Council Qld1
It is important for healthcare professionals to be aware of possible nonverbal signs of distress and pain as this might not always be communicated verbally by Aboriginal and Torres Strait Islander peoples. There can be a reluctance to ask for help, fearing that they would be “too much trouble” for staff. They may also be worried about sharing personal information with staff. IPEPA Cultural Considerations2
Asking direct, open-ended questions, and giving the person time to answer can be helpful, such as:
- It looks to me like you’re in pain. Tell me about the pain?
- You seem worried. What’s worrying you?
- Is there anything you’re worried about at the moment?
Key Video Resource: Tom’s Story (Part 2) with expert commentary (6:09)
In this PCC4U Case Scenario video, the story of Tom and his family continues. Sarah and Nancy go to see Tom together. They talk about using morphine to help manage Tom’s symptoms. Tom and his family talk about what is important to them.
Check the thinking points below for some questions to consider with regard to this video.
The multidisciplinary team
Many different members of the healthcare team are involved in providing palliative care for Australian Indigenous peoples. These include palliative care specialists, general practitioners and other medical specialists, nurses, care workers, and allied health professionals, such as physiotherapists, occupational therapists, social workers, psychologists, pharmacists, paramedics and speech pathologists.
Traditional healers (also called Ngangkari or Maparn) may also be involved in the care of some Aboriginal and/or Torres Strait Islander people. More information about traditional healing is included in Activity 16.
Traditional language interpreters, working with the family spokesperson, may also be involved in providing care, particularly with supporting advance care planning conversations.
Local support networks that the person and family are already connected with in their community, such as an Aboriginal Medical Service or Community Controlled Health Service, will also be involved in providing palliative care. Maintaining open communication with all the various members of the healthcare team is an important part of ensuring continuity of care for people, especially across transitions of care – between home / community care, hospital and/or residential care facility.
Aboriginal and/or Torres Strait Islander health professionals
If available, the services and support Aboriginal and/or Torres Strait Islander health workers and practitioners should be offered in providing palliative care. They play a vital role in helping people navigate the healthcare system, providing cultural brokerage and supporting family liaison. These professions are integral to the delivery of culturally-safe and responsive care. They can play an important role in helping to ensure cultural considerations are incorporated into care, particularly at end of life.
- Review the video, ‘Tom’s Story (Part 2)’ and consider the expert commentary:
- Reflect on how you would approach a conversation about using morphine for pain and symptom management in a situation like this where there was an obvious reluctance
- Write down the explanations you would use as well as other communication techniques that demonstrate respect and support the person to feel culturally-safe.
- Find out about the kinds of roles that Aboriginal and/or Torres Strait Islander health professionals have in clinical practice settings in your state / territory.
- Find out if there is an Aboriginal and/or Torres Strait Islander Community Controlled Health Service in your area. If there is, find out what their involvement is in caring for people affected by life-limiting illness.
- Cancer Council Queensland, Understanding Morphine. 2021.
- PEPA Project Team, Cultural Considerations: Providing end-of-life care for Aboriginal peoples and Torres Strait Islander peoples. 2020, Program of Experience in the Palliative Approach.