Addressing frailties within healthcare services for American Indians and Alaska Natives (AIAN) with cancer has gained attention due to disparities in access, utilization, and quality of end-of-life (EOL) and palliative care. As resources expand and research garners clarity, underlying disparities persist, highlighting an urgent need for enhanced and culturally competent care frameworks.
Recent findings indicate substantial disparities exist for AIAN individuals in their end-of-life journey compared to other demographics. AIAN cancer patients were found more likely to face a medicalized death, marked by higher incidences of hospital or medical facility deaths as opposed to in-home deaths. Despite advancements in healthcare access, the utilization of hospice care remains markedly low compared to their White counterparts.
Research Approach: A Comprehensive Analysis
A systematic review of studies indexed in PubMed/MEDLINE, Embase, and Scopus was meticulously conducted, focusing on data collected from 2014 to 2025. By targeting English-language research that provided quantitative estimates on care quality and utilization among AIAN individuals with cancer, researchers aimed to paint a comprehensive picture. Out of 1693 records, 153 received a full-text review, ultimately leading to the inclusion of 22 significant studies.
Core Findings and Patterns
The research unveiled pronounced heterogeneities in outcomes and variables linked to EOL care: AIAN individuals experienced reduced access to in-home hospice care, heightened acute care use, and increased palliative treatment rates. Strikingly, there was no noted difference in the commencement of hospice care late in the EOL process or the prevalence of aggressive treatments during these critical periods.
The nuanced findings suggest:
- AIAN patients have significantly lower hospice and higher medical facility deaths.
- Use of anxiolytic medication is notably less frequent among AIAN individuals.
- Despite higher palliative treatment, late hospice initiation rates remain similar across groups.
Addressing these complex healthcare challenges for AIAN populations demands a nuanced understanding and culturally sensitive approaches. Enhanced methodologies in research to accurately measure and address these disparities remain imperative. Strategies must prioritize culturally aware EOL care models that resonate with AIAN traditions and experiences. Furthermore, regional, tribal, and rural-urban differences should be dissected to uncover underlying mechanisms and optimize care delivery models. Integrating traditional healing practices into modern palliative care could serve as an inclusive strategy to improve EOL experiences for AIAN individuals. Bridging these gaps requires collaborative efforts between healthcare professionals, policymakers, and AIAN communities to forge a path toward equitable healthcare access and quality care for all.
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