Abstract
Background: The New Zealand population is rapidly ageing and the need for palliative care in New Zealand is increasing (Ministry of Health, 2017b). Pacific people in New Zealand are known to have low rates of palliative care service use including hospice use. The reasons for this are largely unknown due to the limited research on palliative health for Pacific peoples in New Zealand (Bellamy & Gott, 2013). However within health, Pacific peoples are known to experience barriers to accessing equitable care, experience poor health outcomes and premature mortality (Ministry of Health, 2014). Conversely Pacific peoples have high rates of tertiary care use (Ministry of Health, 2014) and a recent report suggest higher than the national average primary care use (Ministry of Health, 2018). The limited data suggests Pacific people have low rates of palliative care referrals or if they are referred they are referred late (Cottle, Hughes, & Gremillion, 2013; Merryn Gott et al., 2013).
Research aim: The aim of this research was to develop understanding on the experiences of Pacific peoples who utilise palliative care services. To identify the barriers faced by Pacific peoples utilising palliative care services. To determine the strengths and enablers for Pacific peoples who access palliative care services and to determine how palliative care services, including home based palliative care services could better serve this community.
Method: A qualitative descriptive design was utilised to undertake the research using the talanoa methodology to guide interviews. Interviews were undertaken using a semi-structured question guide (see Table 2). Participant criteria included persons who had cared for a family member while palliative within the last three years, of Pacific descent. Nine participants in total were interviewed. The interviews were recorded and transcribed verbatim. The data collected was analysed using thematic analysis to determine the key findings of the research.
Findings: The findings from the research showed, Pacific families who chose to utilise palliative care services experienced many barriers to receiving care along the palliative care journey. The barriers faced by Pacific families included delayed diagnosis, access to equipment, access to information on palliative care services, access to family members, miscommunication and lack of cultural safety. These barriers were overcome by the families within this study by advocating strongly for the rights of their family member. Additionally, this study has highlighted that participation of the family was fundamental to the provision of care for families. Family determination was significant to ensure Pacific families were able to provide care to their family member. Communication between providers and families determined adequacy of care.
Conclusion: The research found cultural safety was essential for safe delivery of care for Pacific families. However cultural safety, which is reliant on individual clinicians to maintain culturally safety, was insufficient. Cultural safety needs to be incorporated and implemented in institutional policy, management and institutional culture to be effective. Clinicians need to be mindful of the difference between relational and individualistic cultures and organizational and health policies need to reflect this. The Pacific workforce within palliative care needs to grow to increase access to Pacific clinicians for Pacific families. More education is needed on the health and palliative care needs of Pacific families. Education material in Pacific languages about palliative health care, need to be developed and disseminated to Pacific communities. The strengths of Pacific peoples need to be recognised and a plan for Pacific peoples with palliative care developed, which includes models of palliative care services for Pacific peoples.