• Len Kelly, Barb Linkewich, Helen Cromarty, Natalie St Pierre-Hansen, Irwin Antone, and Chris Giles.
• Northern Ontario School of Medicine, Sioux Lookout, Ontario. lkelly@mcmaster.ca
• Can Fam Physician. 2009 Apr 1; 55 (4): 394395.e7394-395.e7.

ObjectiveTo understand cross-cultural hospital-based end-of-life care from the perspective of bereaved First Nations family members.DesignPhenomenologic approach using qualitative in-depth interviews.SettingA rural town in northern Ontario with a catchment of 23 000 Ojibway and Cree aboriginal patients.ParticipantsTen recently bereaved aboriginal family members.MethodsSemi-structured interviews were conducted, audiotaped, and transcribed. Data were analyzed using crystallization and immersion techniques. Triangulation and member-checking methods were used to ensure trustworthiness.Main FindingsFirst Nations family members described palliative care as a community and extended family experience. They expressed the need for rooms and services that reflect this, including space to accommodate a larger number of visitors than is usual in Western society. Informants described the importance of communication strategies that involve respectful directness. They acknowledged that all hospital employees had roles in the care of their loved ones. Participants generally described their relatives' relationships with nurses and the care the nurses provided as positive experiences.ConclusionCross-cultural care at the time of death is always challenging. Service delivery and communication strategies must meet cultural and family needs. Respect, communication, appropriate environments, and caregiving were important to participants for culturally appropriate palliative care.

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