Improving Palliative Care Services in a BC First Nation

A BC First Nation has been able to come up with innovative solutions to address the increased healthcare demands such as improving high speed internet access to facilitate access to telehealth. However, there are still significant barriers that remain that make it difficult for the community to provide its surging palliative care population with optimal care. Indigenous patients already experience unique social, cultural and economic barriers to accessing quality healthcare, including palliative care. The modern day effects of colonialism, Indian hospitals, and residential schools are demonstrated through the health inequities present in Indigenous communities. Indigenous patients are more likely to have a chronic health condition such as diabetes, cancer, and have complications sooner that leads them to pursue palliative care. For many Indigenous communities, death is not just a physical process, but a social and spiritual event. As a result, significant improvements need to be made to change the course of declining palliative care services.

According to our community partner, the deterioration in care is due to many factors such as communication breakdowns, lack of integration of Indigenous cultural practices and insufficient staffing support. As many of these deficiencies in care can be resolved through improved integration of the various palliative care services available within the community, our project aims to bridge the gap between the different healthcare facilities. These include the local health department, Vancouver Coastal Health (VCH) palliative care team, the pharmacy and local practitioners.

不列颠哥伦比亚（British Columbia）第一民族社区已提出创新解决方案，以应对日益增长的医疗需求——例如通过提升高速互联网接入率，助力远程医疗（telehealth）的可及性。然而，该社区仍面临诸多显著障碍，难以向激增的姑息治疗（palliative care）需求人群提供优质护理。原住民患者在获取包括姑息治疗在内的优质医疗服务时，本就面临独特的社会、文化与经济层面障碍。殖民主义、印第安医院（Indian hospitals）以及原住民寄宿学校（residential schools）的当代遗留影响，正通过原住民社区存在的健康不平等（health inequities）显现出来。原住民患者更易罹患糖尿病、癌症等慢性疾病，且更早出现并发症，因此更早需要接受姑息治疗。对许多原住民社区而言，死亡不仅是生理过程，更是一场社会与精神层面的事件。因此，亟需做出重大改进，以扭转姑息治疗服务不断下滑的态势。据我们的社区合作伙伴称，护理质量下滑源于多重因素，包括沟通不畅、原住民文化实践融合不足以及人员支持匮乏。由于社区内现有各类姑息治疗服务的整合度提升可解决诸多此类护理缺陷，本项目旨在弥合不同医疗保健机构之间的鸿沟。这些机构包括当地卫生部门、温哥华海岸卫生局（Vancouver Coastal Health, VCH）姑息治疗团队、药房以及本地执业医师。