Assessing the Impact of an Indigenous Palliative Care Nurse Navigator: A Program Evaluation.

Introduction: Indigenous peoples in Canada face significant health disparities rooted in colonization and experience inequitable access to palliative care. Patient navigation has proven effective in both Indigenous and palliative contexts, but integration of these roles has not been studied. This evaluation defines the scope of a patient navigator specializing in palliative care for Indigenous peoples and explores how it addresses service gaps. Methods: A program evaluation tool was developed to track key performance indicators (KPIs) of an Indigenous Palliative Care Nurse Navigator (IPCNN) over six months. Responsibilities were organized into three domains: (1) social vulnerabilities, (2) mainstream palliative care navigation, and (3) barriers to palliative care for Indigenous peoples. Sixteen categories further captured the scope of responsibilities. KPIs were classified as either "working" indicators, reflecting activities undertaken for future outcomes, or "outcome" indicators, which tracked the achievement of results. A single IPCNN provided care to 164 Indigenous patients across Alberta, Canada with a prognosis of less than 24 months, conducting initial assessments and maintaining ongoing contact through home visits, clinic appointments, and phone calls every two to four weeks. KPIs were tabulated and analyzed by frequency (low, moderate, and high), domain, category, and classification. Results: One IPCNN logged 714 activities across three domains: social vulnerabilities (191), mainstream palliative care navigation (394), and barriers to palliative care for Indigenous peoples (129). Most KPIs (77%) were "working" activities, reflecting upstream tasks required to achieve outcomes. The majority of KPIs addressing barriers to palliative care for Indigenous peoples were high-frequency activities. Discussion: The IPCNN role supports Indigenous patients to navigate gaps in palliative care delivery, including distrust of health care providers, jurisdictional challenges, and incongruencies between Indigenous culture and Western medicine. These findings underscore the potential of Indigenous palliative care navigation as an effective intervention to improve the accessibility and quality of palliative care for Indigenous peoples.