Background

Many Aboriginal and Torres Strait Islander people express a wish to be cared for, and to pass, at home or on Country surrounded by family if possible. There are many barriers to achieving this aim; one being the ability to provide timely and effective symptom control.

 

Aim 

The aim of this presentation is to report on the evaluation of new culturally-appropriate caring@home resources (packaged as a Palliative Care Clinic Box) developed for Aboriginal and Torres Strait Islander families to help them manage symptoms at home. 

Methods  

Organisations/clinical services could order a free Clinic Box via the caring@home website. A link to an anonymous survey was emailed to each recipient of a Clinic Box approximately two months after dispatch. The survey had 17 questions – 2 open-ended, 6 demographic questions, 8 Likert-scale questions, 1 Yes/No.

Completion of the survey was taken as consent to participate.

Results 

Sixty-two responses were received. Fifteen percent of respondents identified as Aboriginal and/or Torres Strait Islander; 82% percent provided direct clinical care. 

Participants agreed the resources for Aboriginal and Torres Strait Islander families:

·         Are written in appropriate language (82%)

·         Will be useful for this community (84%)

·         May contribute to effective and efficient symptom control (83.5%)

·         May contribute to enabling Aboriginal and Torres Strait Islander people to be cared for at home or on Country (87.5%)

·         Will contribute to improved quality of palliative care provided by clinical services (91%)

The overwhelming majority of participants (95%) said they will use the resources in their clinical practice.

Conclusions

Clinical services can use the resources to support quality end-of-life care. Using caring@home resources will improve the end-of-life choices for Aboriginal and Torres Strait Islander families and support end-of-life care at home or on Country.

caring@home for Aboriginal and Torres Strait Islander Families is funded by the Australian Government.

Aim: To raise awareness of the unique journey and requirements of end-of-life planning and support for Stolen Generations Survivors from Kinchela Boys Home Aboriginal Corporation

Background: This presentation showcases the 18-month journey of legacy, end of life planning and support for Stolen Generation Survivors from Kinchela Boys Home. The Kinchela Aboriginal Boys’ Training Home site is located in the Kempsey Shire region of NSW. Established in 1924, Kinchela housed young Aboriginal boys between the ages of 5 and 15 years, who had been forcibly removed from their families. Between 1924 and 1970, it is thought that between 400-600 boys lived at Kinchela. Kinchela was known as a particularly harsh and abusive environment, with formal investigations conducted into this as early as the 1940s.

Many of the survivors have died, the last generations of survivors from the boys’ home are ageing and moving towards end of life. A need to record the survivors’ legacies and provide safe spaces for end-of-life planning was identified. As a result of the survivors being forcibly removed as children from their families, and the ongoing trauma they experienced into their adulthood, their needs when it comes to legacy planning, end of life planning and support are complex and unique.

Tools:
Our presentation will showcase processes and tools that have been incorporated and developed to support end of life planning and recording legacies.

Purpose:
Our presentation showcases the:

- journey we have undertaken to ensure culturally safe processes to record the legacies of the survivors;

- challenges and moments of positivity we have encountered along the way and;

- ongoing requirements that are needed to support the remaining survivors and descents to move through end of life with respect, care and dignity.

Background

It is widely acknowledged that culturally appropriate and holistic health delivery systems improve health outcomes. Only 1.4% of people accessing palliative care services identify as Aboriginal and Torres Strait Islander, with lack of cultural safety in the healthcare system identified as one of the key barriers.

Aim

To develop locally tailored education and resources for community pharmacists and pharmacy staff to enhance the cultural safety of the palliative care support they provide to their First Nations clients. 

Method

1.      Establishment of a regional working group of predominantly Aboriginal health managers to inform workshop content and resource development. Representation included - 

-        Aboriginal Community Controlled Health Services

-        Local Health Districts

-        Primary Health Network

-        Gwandalan National Palliative Care Project

-        Program of Experience in the Palliative Approach

-        Pharmacists

2.      Development of a 90-minute interactive workshop for community pharmacy. 

3.      Engagement of a local First Nations artist to create bespoke digital artwork reflecting local culture and the role of pharmacists in supporting First Nations people on their Return to Dreaming journey.

4.      Creation of resources for community pharmacy, incorporating the new artwork and language appropriate to local First Nations people. 

Results

Workshop content was developed focussing on First Nations local context. Topics broadly included – 

1.      Overarching cultural values of Aboriginal and Torres Strait Islander communities 

2.      Culturally safe communication techniques (in the context of end of life) 

3.      Engagement strategies to connect with local Aboriginal and Torres Strait Islander people and communities.

Resources included – 

1.      Acknowledgement of Country window decal

2.      Consumer brochure to raise awareness of available pharmacy support services  

3.      Consumer-facing poster to invite palliative care yarns with the pharmacist

4.      Pharmacy contact list of local Aboriginal health workforce.

Conclusion

This project demonstrated a localised, collaborative approach to enhancing cultural safety in First Nations palliative care.

Palliative care is a well-established set of supports and care for people at the end of their lives. Its goal is to provide comfort care, rather than curative intervention, at a time when there is no prospect of recovery or cure.
For Aboriginal people in South Australia at the end of their life, palliative care services are available, but use is not necessarily at the levels expected. 

 

South Australia Aboriginal patients generally present with multiple co-morbidities, cultural and social complexities and referrals to Palliative Care often late resulting in Palliative Care services having limited ability  to adequately respond. 

Central Adelaide Palliative Care Service (CAPCS) developed a Aboriginal and Torres Strait Islander Pathway to Palliative Care to address unmet Palliative Care needs for Aboriginal and Torres Strait Islander peoples and facilitate a meaning voice for Aboriginal people in the development and implementation of a new Palliative Care model or pathway. 

 The National Palliative Care Australia Road Map 2022-2027 drives the vision and goals of the National Palliative Care Strategy 2018. At state level, there is a commitment from Palliative Care peak bodies to enact a person-centred focus at the level of service provision through approaches that are flexible, responsive and acknowledge the sociocultural context in which the patient lives. The SA Approach to Aboriginal Comfort Care project sought to develop a South Australian culturally responsive model to support Aboriginal and Torres Strait Islander people living with a life-limiting disease, ensuring equitable access and quality end of life care. 

The collaboration between Palliative Care Clinicians and Flat Track, a group of Aboriginal young men and woman who helped to deliver and instal equipment in the community.  The story of friendships that developed, of the education that was delivered in the most organic of ways. What we taught "our boys" and most importantly what they taught us.