Shawn Renee Hordyk1, Mary Ellen Macdonald2, Paul Brassard3,4. 1. 1 Department of Psychoéducation, Université de Montréal , Montréal, Québec, Canada . 2. 2 Oral Health and Society Research Unit, Faculty of Dentistry, McGill University , Montreal, Quebec, Canada . 3. 3 Department of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University , Montreal, Quebec, Canada . 4. 4 Centre for Clinical Epidemiology, Jewish General Hospital , Montreal, Quebec, Canada .
Abstract
BACKGROUND: Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of awareness of factors to consider in providing care to Inuit populations. OBJECTIVE: To better understand the factors shaping EOL care in Nunavik to support the development of a sustainable model of care. METHODS: Using focused ethnography, we conducted participant observations and informal and semistructured interviews with 103 participants (community members, healthcare practitioners, and administrators) across Nunavik and in Montreal, the affiliated tertiary care center. Data domains included the following: care trajectories; patient and family experiences receiving and providing EOL care; local and urban resources and challenges; and ways forward. RESULTS: Sociocultural, historical, and geographic factors shape EOL care in Nunavik, presenting a complex set of challenges for Inuit patients, families, and healthcare providers. A sustainable model of EOL care requires building on shared initiatives, capitalizing on the existing strengths in communities, and attending to the multiple bereavement needs in the region. DISCUSSION: Building a sustainable model of EOL care requires respectful collaboration among governing structures, healthcare institutions, and community members. It must centrally value local knowledge and initiatives. To ensure Inuit families and patients are supported throughout the dying process, future initiatives must centrally include local stakeholders in both the design and evaluation of any changes to the current healthcare system.
BACKGROUND: Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of awareness of factors to consider in providing care to Inuit populations. OBJECTIVE: To better understand the factors shaping EOL care in Nunavik to support the development of a sustainable model of care. METHODS: Using focused ethnography, we conducted participant observations and informal and semistructured interviews with 103 participants (community members, healthcare practitioners, and administrators) across Nunavik and in Montreal, the affiliated tertiary care center. Data domains included the following: care trajectories; patient and family experiences receiving and providing EOL care; local and urban resources and challenges; and ways forward. RESULTS: Sociocultural, historical, and geographic factors shape EOL care in Nunavik, presenting a complex set of challenges for Inuit patients, families, and healthcare providers. A sustainable model of EOL care requires building on shared initiatives, capitalizing on the existing strengths in communities, and attending to the multiple bereavement needs in the region. DISCUSSION: Building a sustainable model of EOL care requires respectful collaboration among governing structures, healthcare institutions, and community members. It must centrally value local knowledge and initiatives. To ensure Inuit families and patients are supported throughout the dying process, future initiatives must centrally include local stakeholders in both the design and evaluation of any changes to the current healthcare system.
Authors: Tracey Galloway; Sidney Horlick; Maria Cherba; Madeleine Cole; Roberta L Woodgate; Gwen Healey Akearok Journal: Int J Circumpolar Health Date: 2020-12 Impact factor: 1.228
Authors: Vincent Paquin; Glenda Sandy; Gentiane Perrault-Sullivan; Gabriel Fortin; Michel Cauchon; Christopher Fletcher; Jean Ouellet; Mélanie Lemire Journal: Int J Circumpolar Health Date: 2019-12 Impact factor: 1.228