Advance Care Planning in Indigenous Populations: A Scoping Review

Area of Science:

• Public Health
• Indigenous Health
• End-of-Life Care

Background:

• Advance care planning (ACP) improves end-of-life care by incorporating patient preferences.
• Indigenous populations in North America and Oceania exhibit low participation rates in ACP.
• Culturally unsafe services contribute to hesitancy and mistrust in end-of-life care.

Purpose of the Study:

• To conduct a gap map scoping review of literature on ACP and palliative care in Indigenous populations.
• To assess the prevalence and characteristics of ACP and palliative care in North America and Oceania.
• To identify research gaps concerning Indigenous end-of-life care preferences and interventions.

Main Methods:

• Searched five databases for articles published between 2013 and 2023.
• Included 28 articles from the United States, Canada, New Zealand, and Australia.
• Analyzed studies with qualitative, observational, mixed-method, and interventional designs.

Main Results:

• High frequency of family involvement in end-of-life decision-making was consistently reported.
• Awareness of culturally unsafe end-of-life services leads to hesitancy and mistrust.
• Studies were predominantly qualitative, indicating a need for more intervention research.

Conclusions:

• Significant gaps exist in research on Indigenous peoples' end-of-life needs and preferences.
• There is a paucity of evidence regarding effective advance care planning and palliative care interventions for Indigenous populations.
• Addressing cultural safety is crucial for improving end-of-life care participation and outcomes.