This report describes key barriers and promising approaches for improving Aboriginal and Torres Strait Islander peoples’ experience of palliative care in Australia. It covers advance care planning and ways the palliative care sector can improve access and quality of care for Aboriginal and Torres Strait Islander peoples.
As with all under-served populations—and the general population—a lack of awareness and understanding of palliative care may be a common barrier to access for Aboriginal and Torres Strait Islander peoples, including what it is, how it could help, which professionals are involved and what services are available.
As for most under-served population groups, a lack of or late referrals was reported to hamper Aboriginal and Torres Strait Islander people’s access to specialist palliative care services. More broadly, and as for all underserved populations, there may be a lack of early recognition of palliative care need and initiation.
Language and communication barriers— discussed in detail above—are relevant on the service side as well as consumer side. In some cases, health professionals may not feel comfortable raising the topic of death and dying with Aboriginal and Torres Strait Islander peoples.
A lack of Aboriginal and Torres Strait Islander peoples in the workforce in relevant sectors (including palliative care and health care more broadly) also maintains—if not creates—barriers to palliative care. While Aboriginal Health Workers (AHWs) and Aboriginal Liaison Officers (ALOs) are theoretically in an ideal position to ‘bridge the gap’, they may feel torn by cultural and professional obligations, and fear blame for involvement in a person’s death. In hospitals, they may be isolated from other staff, or not have good relationships with the palliative care team. Community relationships may be of benefit in this role, but may also raise challenges.
While ‘culturally-appropriate care’ is often suggested in the context of care for Aboriginal and Torres Strait Islander peoples, interpretation of the term often ‘views culture as static and unchanging’, ‘fails to account for diversity within groups’, and leads to ‘stereotyping and a failure to identify the needs of the individual receiving care’. 19 Person-centred care for Aboriginal and Torres Strait Islander peoples should be culturally appropriate, but exactly what this means will vary between communities and individuals.