Creating 'safe spaces': A qualitative study to explore enablers and barriers to culturally safe end-of-life care.

backgroundInternationally, efforts are being made to promote equity in palliative and end-of-life care for Indigenous peoples. There is a need to better understand the experiences of Indigenous service users and staff.

aimTo explore the views of Māori health practitioners and whānau (family group) caregivers regarding barriers and enablers to culturally safe palliative and end-of-life care.

designA Kaupapa Māori qualitative study. SETTING/

participantsInterviews were conducted with 103 participants from four areas of the North Island of Aotearoa New Zealand. Participants comprised bereaved whānau (family) of Māori with a life limiting illness and Māori health practitioners.

resultsMāori health practitioners undertake cultural and connecting work to promote culturally safe palliative and end-of-life care for Māori patients and their whānau. This work is time-consuming and emotionally and culturally demanding and, for most, unpaid and unrecognised. Non-Māori staff can support this work by familiarising themselves with te reo Māori (the Māori language) and respecting cultural care customs. However, achieving culturally safe end-of-life care necessitates fundamental structural change and shared decision-making.

conclusionsOur findings indicate that efforts to support equitable palliative care for Indigenous people should recognise, and support, the existing efforts of health practitioners from these communities. Colleagues from non-Indigenous populations can support this work in a range of ways. Cultural safety must be appropriately resourced and embedded within health systems if aspirations of equitable palliative and end-of-life care are to be realised.