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Outcomes
1. Describe nephrology and palliative care providers’ beliefs and experiences in engaging in palliative care conversations with American Indians
2. Examine the role of provider stereotypes in cultivating American Indian trust, engaging with family members, evaluating end-of-life preferences, and negotiating community resources
Importance
American Indians with chronic kidney disease are twice as likely to develop end-stage renal disease. Palliative care is underused by American Indian patients, although studies show that it is not due to an unwillingness to engage in conversations about the end of life.
Objective(s)
The aim of our study was to explore the experiences and beliefs of nephrology and palliative care providers of one tribal community with respect to engaging patients and family members in palliative care.
Method(s)
Using an interview guide, individual, in-depth interviews were conducted between March and August 2019 with eligible participants. We used constant comparative analysis of interview transcripts.
Results
Our study sample included 8 participants, including 4 nephrology providers and 4 palliative care providers. We identified five themes: providers’ stereotypes, patients’ mistrust of providers, patients’ end-of-life preferences, available community resources, and patients’ family dynamics. Stereotypes were present in every theme, although most participants did not acknowledge the role that the stereotypes played in establishing trust and building therapeutic relationships conducive to end-of-life discussions.
Conclusion(s)
Providers who serve American Indian patients with kidney disease should consider training in trauma-informed care and cultural sensitivity. Stereotypes of American Indian patients may impact providers’ ability to build trust, a key component of end-of-life conversations, and contribute to misperceptions related to family dynamics, end-of-life preferences, and available community resources.
Impact
Our findings illustrate the need to develop and test culturally appropriate approaches to palliative care for American Indian patients. Future research efforts should adopt a community-based approach that engages tribal members and incorporates traditional approaches, cultural sensitivity training, and education about the role of provider stereotypes and implicit biases. Efforts to increase palliative care access to American Indians should be expanded to other specialties such as oncology, pulmonology, and cardiology.
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Identification
Copyright
© 2022 Published by Elsevier Inc.
