title: Understanding death and dying in select first nations communities in northern Manitoba: issues of culture and remote service delivery in palliative care.
abstract: OBJECTIVE
  The purpose of this study was to delineate and describe the local palliative care services available to residents of remote Aboriginal communities in northern Manitoba; to identify attitudes and beliefs about death, dying and palliative care in these communities; and to explore obstacles related to palliative care service delivery from the perspectives of culture and geographic isolation.
  
  
  METHODS
  Forty-four in-depth semi-structured interviews were conducted with a reputational sample of key informants including Aboriginal people resident in remote communities, community elders and religious leaders, doctors, nurses and allied health care providers working in First Nations Communities, as well as specialist service providers in Winnipeg. Thematic qualitative analysis was done on the data collected. Data collected from interviews with northern physicians and nurses was coded and analyzed.
  
  
  RESULTS
  Currently, many Aboriginal people living in remote communities are transported to large urban centers to die, isolated from friends, family and their culture. However, the majority of Aboriginal people and health care providers interviewed reported that Aboriginal people living in remote communities would prefer to die at home. The issues surrounding palliative care provision in remote Aboriginal communities are cultural and geographic. Culturally sensitive care requires that patients have access to family supports and traditional services if requested. Geographic isolation requires that: 1. patient-specific care plans be created for use in the remote community; 2. effective lines of communication are established between remote health care providers and urban specialists; 3. health care providers and family care-givers be properly trained to fill their respective roles; and 4. appropriate guidelines and resources be available in the community to support this type of care.
  
  
  CONCLUSIONS
  Providing the equipment, supports and education necessary for home-based palliative care in remote Aboriginal communities can be an effective way of addressing the medical, psycho-social, and spiritual needs of these patients.
authors.affiliation: Department of Family Medicine, University of Manitoba. ken_hotson@medscape.com
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Hotson
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Macdonald
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Martin
mesh_terms: D003643:Death; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006303:Health Services, Indigenous / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008350:Manitoba; D008519:Medicine, Traditional; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D012424:Rural Population