Coming Home to Die: Six Nations of the Grand River Territory Develops Community-Based Palliative Care
Verna Fruch, Lori Monture, Holly Prince, Mary Lou Kelley (2016). Coming Home to Die: Six Nations of the Grand River Territory Develops Community-Based Palliative Care. International Journal of Indigenous Health, Volume 11, Issue 1: 50-74. DOI: 10.18357/ijih111201615303.
This paper describes the development and implementation of a community-based palliative care program in Six Nations of the Grand River Territory, Ontario, Canada. Six Nations’ innovative program is grounded in a vision to provide access to quality palliative care at home and incorporate Haudenosaunee traditional teachings. A community-based Project Advisory Committee led the development process, and a Leadership Team of local and regional palliative care partners led implementation. Using participatory action research, academic researchers supported activities and facilitated data collection and evaluation. Outcomes included: creation of a Palliative Shared Care Outreach Team, including a First Nations physician, nurse, and social worker; development of a detailed care pathway for clients who need palliative care; increased home deaths (55) as compared to hospital (22) or hospice (6) deaths; access to palliative care education and mentorship for local healthcare providers; incorporation of traditional teachings to support clients and staff dealing with death, dying, grief, and loss; and creation of a palliative care program booklet for Six Nations Health Services. This unique initiative reduces disparities in access to quality palliative home care and demonstrates that First Nations communities can successfully undertake a process of community capacity development to create unique and culturally responsive palliative care programs. Challenges included overcoming federal and provincial jurisdictional issues in provision of health services through collaborative partnerships at the local and regional level.
An Analysis of Journey Mapping to Create a Palliative Care Pathway in a Canadian First Nations Community: Implications for Service Integration and Policy Development
Jessica Koski, Mary Lou Kelley, Shevaun Nadin, Maxine Crow, Holly Prince, Elaine C Wiersma, and Christopher J Mushquash. (2017) An Analysis of Journey Mapping to Create a Palliative Care Pathway in a Canadian First Nations Community: Implications for Service Integration and Policy Development. Palliative Care: Research and Treatment Volume 10: 1–16 – https://doi.org/10.1177/1178224217719441.
Providing palliative care in Indigenous communities is of growing international interest. This study describes and analyzes a unique journey mapping process undertaken in a First Nations community in rural Canada. The goal of this participatory action research was to improve quality and access to palliative care at home by better integrating First Nations’ health services and urban non-Indigenous health services. Four journey mapping workshops were conducted to create a care pathway which was implemented with 6 clients. Workshop data were analyzed for learnings and promising practices. A follow-up focus group, workshop, and health care provider surveys identified the perceived benefits as improved service integration, improved palliative care, relationship building, communication, and partnerships. It is concluded that journey mapping improves service integration and is a promising practice for other First Nations communities. The implications for creating new policy to support developing culturally appropriate palliative care programs and cross-jurisdictional integration between the federal and provincial health services are discussed. Future research is required using an Indigenous paradigm.
Improving End-of-Life Care in First Nations Communities: Outcomes of a Participatory Action Research Project
Holly Prince, MSW, Project Manager, Centre for Education and Research on Aging & Health; Christopher Mushquash, Ph.D., C.Psych., Canada Research Chair in Indigenous Mental Health and Addiction; and Mary Lou Kelley, Ph.D., Professor Emeritus, School of Social Work, Lakehead University
- View submission to Psynopsis, Canada’s Psychology Magazine (2 page pdf)
- View published article in Psynopsis, Canada’s Psychology Magazine (article begins on page 17 in the magazine pdf)