title: End-of-life issues for American Indians/Alaska Natives: insights from one Indian Health Service area.
abstract: BACKGROUND
  In the United States, the American Indian and Alaska Native (AI/AN) population is aging and the leading causes of death for those 55 and older are chronic diseases such as cancer, heart disease, and the complications of diabetes. Since 1955, the federally directed Indian Health Service, along with Tribal governments has been providing comprehensive health care to over 500 AI/AN communities.
  
  
  OBJECTIVE
  This is the first study to examine end-of-life and palliative care issues broadly at selected Indian Health Service facilities in the Albuquerque area.
  
  
  METHODS
  Retrospective medical records review identified from randomized New Mexico Department of Health American Indian resident death certificates, 50 years of age and over, from 1994-1998. Interviews with hospital administrators, medical records personnel, and cultural advisors regarding end-of-life policies and procedures were conducted.
  
  
  RESULTS
  The study documents very limited formal palliative care services available to rural and reservation-dwelling American Indians and Alaska Natives. However, new initiatives and training in palliative care are emerging.
  
  
  CONCLUSIONS
  Recommendations for fostering expansion of end-of-life and palliative care services for AI/AN persons are discussed.
authors.affiliation: Soros Foundation, Project on Death in America Faculty Scholar, Palliative Care Section, Department of Internal Medicine, Division of Geriatrics, University of New Mexico Health Science Center, Albuquerque, New Mexico, USA. jkitze@salud.umn.edu
authors.forename: Judith
authors.initials: J
authors.lastname: Kitzes
authors.forename: Lawrence
authors.initials: L
authors.lastname: Berger
mesh_terms: D000368:Aged; D000413:Alaska; D002908:Chronic Disease; D006287:Health Planning Guidelines; D006303:Health Services, Indigenous / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D014481:United States; D016549:United States Indian Health Service