• Alexander Soltoff, Sara Purvis, Miranda Ravicz, Mary J Isaacson, Tinka Duran, Gina Johnson, Michele Sargent, J R LaPlante, Daniel Petereit, Katrina Armstrong, and Bethany-Rose Daubman.
• Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA. Electronic address: asoltoff@mgh.harvard.edu.
• J Pain Symptom Manage. 2022 Sep 1; 64 (3): 276286276-286.

ContextDespite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land.ObjectivesThis study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs.MethodsThree authors recorded and transcribed interviews with 21 specialty and 17 primary clinicians. A data analysis team of seven authors analyzed transcripts using conventional content analysis. The analysis team met over Zoom to engage in code negotiation, classify codes, and develop themes.ResultsQualitative analysis of interview data revealed four themes encompassing factors influencing palliative care delivery and access for Great Plains American Indians: health care system operations (e.g., hospice and home health availability, fragmented services), geography (e.g., weather, travel distances), workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), and historical trauma and racism.ConclusionOur findings emphasize the importance of addressing the time and cost of travel for seriously ill patients, increasing home health and hospice availability on reservations, and improving trust in the medical system. Strengthening the AI medical workforce, increasing funding for the Indian Health Service, and transitioning the governance of reservation health care to Tribal entities may improve the trustworthiness of the medical system.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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