Abstract
Life-limiting illness plagues Native Americans, yet access to palliative and end-of-life care, including hospice care, is severely limited. This study aimed to explore palliative and hospice care with Native American elders and tribal health educators on a Northern Plains reservation in the US. Using a community-based participatory approach, participants discussed the cultural acceptability of palliative and hospice care in their tribal community. Monthly talking circles were held over a 5-month period. Opportunities were present for improving cultural awareness and advance directive education to elders. Challenges raised were related to infrastructure, tribal government and the Indian Health Service. Needs identified included cultural awareness and language education for health-care providers and advance directive education. Community-based participatory research is useful when working with indigenous populations. Health professionals providing services to Native American communities must embrace cultural differences, seeking to learn from the culture itself how to best meet its people's needs.
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