Journal of palliative medicine
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The American Indian and Alaska Native population is aging and the leading causes of death for those aged 55 and older are chronic diseases such as cancer, heart disease, and the complications of diabetes. There are limited formal palliative care services available to rural and reservation dwelling American Indians and Alaska Natives. This collaboration between a tribally operated home health care agency and a federally operated Indian Health Service hospital, with the support of a palliative care center within an academic medical center, has established a palliative care program in the Pueblo of Zuni. ⋯ The initial goal of obtaining certification as a Medicare Hospice provider has not been met and remains a goal. Meanwhile alternative mechanisms for funding the services have been found. The experience of this collaboration suggests that a tribally based, culturally proficient palliative care program can be developed within an American Indian/Alaska Native community and that it can drive the local health system toward improved end-of-life care.
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Physician training programs in undergraduate and graduate medical education strongly recommend that their trainees gain experience in helping patients and their families address end-of-life and palliative care issues with knowledge and compassion. Currently these training programs are inadequately meeting this goal. This paper describes a creative 1-day training workshop or several half-day seminars on the end of life, which are delivered as part of our family practice intern orientation. The training includes self-awareness about death, communicating bad news, guidance with paperwork and legal issues, the stages of grief, patient's perspectives on dying, hospice, and physician well-being.
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Cultural mistrust is a prominent barrier to the involvement of African Americans in hospice care. While disavowing the theory that cultural mistrust has its origin in any single factor or event, it is argued that there needs only to exist the cultural construct of community for cultural mistrust to perpetuate itself among any ethnic group. ⋯ From a perspective that accepts the existence of the phenomenon of cultural mistrust, suggestions for structuring training for cultural competence are discussed. These suggestions are relevant for workers in institutions that serve the African American community in critical health care areas in general, and administrators and staff of hospices in particular.