Providing Palliative Care for American Indians: The University of New Mexico's Experience (516)

Abstract

1.Develop awareness of the "myths" or stereotypes that may impede the provision of palliative care to American Indians.2.Discuss if Native American patient ethnicity affected the rates of palliative care consultation or outcomes of consultations.3.Identify communication skills and other techniques to provide more "culturally-appropriate" palliative care to American Indian patients and families. The University of New Mexico Hospital admits the highest percentage of American Indian (AI) patients of any hospital in the country (13%). It is the only tertiary care hospital/Level IV trauma center in New Mexico and serves as a safety-net hospital for the entire state. Additionally, it is the the referral center for all Indian Health Service facilities in New Mexico and three surrounding states. Given this background, it is an ideal setting to study the provision of palliative medicine to American Indians. There are common myths and stereotypes that American Indian patients refuse to speak about death or plan for end-of-life care. Obviously these beliefs would prevent AI patients from accessing palliative care services, which are known to improve quality of care. We began an inpatient palliative care consultation service at UNMH in Jan, 2009. During this session, we will present our findings from the >400 consultations we performed in the first year of our clinical service. We found that patient ethnicity (Hispanic, Non-Hispanic Caucasian, American Indian, and "other") did not affect rates of consultation among all admitted patients and admitted patients with high predicted mortality. Primary diagnosis, primary service, age, and predicted mortality were associated with differing rates of consultation. Outcomes of consultation (code status and holding a family meeting) also did not vary by patient ethnicity. This information challenges the myths that American Indians will not participate in discussions about death or end of life care. Our service intentionally used techniques to provide "culturally appropriate" palliative consultations for AI patients. The use of these techniques may have created settings in which it was more comfortable or culturally appropriate to discuss end of life care issues. We will review multiple techniques that may help other clinicians to provide more "culturally-appropriate" consultations for American Indian patients.