Coming Home to Die: Six Nations of the Grand River Territory Develops Community-Based Palliative Care

Abstract

This paper describes the development and implementation of a community-based palliative care program in Six Nations of the Grand River Territory, Ontario. Six Nations innovative program is grounded in their vision to provide access to quality palliative care at home and incorporate Haudenosaunee Traditional teachings. A community Project Advisory Committee led the development process, and a Leadership Team of local and regional palliative care partners led implementation. Using participatory action research, academic researchers supported activities and facilitated data collection and evaluation. Outcomes included: creation of a Palliative Shared Care Outreach Team, including a First Nation’s physician, nurse and social worker; development of a detailed care pathway for clients who need palliative care; increased home deaths (55) as compared to hospital (22) or hospice deaths (6); access to palliative care education and mentorship for local health care providers; incorporation of Traditional teachings to support clients and staff around death, dying, grief and loss; and creation of a palliative care program booklet for Six Nations Health Services.  This unique initiative reduces disparities in access to quality palliative home care and demonstrates that First Nations communities can successfully undertake a process of community capacity development to create unique and culturally responsive palliative care programs. Challenges included overcoming federal and provincial jurisdictional issues in provision of health services through collaborative partnerships at the local and regional level.