EndofLife Care in Indian Country

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End-of-Life Carein Indian Country

• Tracy Schroepfer, PhD, MSW, MA
• University of Wisconsin-Madison

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Topic Areas

• American Indian Tribes in Wisconsin
• Societal, Cultural Intergenerational Challenges
• Research Plan for Three Wisconsin Tribes

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American Tribes in Wisconsin
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(No Transcript)
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Description

• 11 rural tribes and 1 urban center
• Diverse tribes with commonalities
• Isolated, low income, history of oppression, and
  less access to technology
• Public Law 638

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Challenges to Palliative Care in Indian Country
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Impact of Societal Change

• Lengthier dying process
• Less flexibility and opportunity to practice
  traditions
• Less knowledge of cultural practices and beliefs

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Intergenerational Issues

• Some elders believe dying and death should not
  be discussed
• Stoicism regarding end-of-life care
• Younger generations feel the need to have these
  conversations

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Difficult Conversations

• Informal and formal caregiver preparation
• Family member and terminally ill individuals
  challenges resources
• Practice techniques
• Self care before, during and after difficult
  conversations

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End-of-Life Care Services

• Closeness of community
• Inclusion of cultural beliefs traditions
• Fragmentation and availability
• Distance and cost
• Difficulties facing professionals
• Bereavement services

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Research Plans
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Holistic Approach

• Physical Component
• Emotional Component
• Social Component
• Spiritual Component
• Cultural Component

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Assessing at Multiple Levels

• Macro Level
• GIS mapping of resources
• Assessment of pain and policy issues
• Mezzo Level
• Healthcare professionals
• Micro
• Terminally ill individuals
• Family caregivers

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Setting Priorities Intervention

• Set Priorities
• Identify potential resource partner(s)
• Develop intervention
• Implement intervention test
• Re-evaluate