A respectful and appropriate approach to advance care planning for Aboriginal and Torres Strait Islander people ensures their end-of-life journey is inclusive of their individual preferences, values and beliefs, and their cultural heritage.
Health and aged care workers need to be mindful of cultural sensitivities and develop communication techniques which build trust.
Considerations for discussing advance care planning
Many Aboriginal and Torres Strait Islander people do not engage in discussions about future medical care and advance care planning. Some may consider discussions about becoming sick or injured, or what will happen towards the end of their life, as ‘family business’ that is not to be discussed with others.
A sensitive approach
When introducing advance care planning to an Aboriginal and Torres Strait Islander person, allow adequate time to provide an appropriate and clear explanation of the benefits to the individual, family and community.
Do not be intrusive. Come back if necessary at another time to continue the conversation. Respect the person's right to not disclose or communicate. For example, you could start the conversation in a roundabout way, plant the seed and observe if the idea is accepted.
Issues of death
Some Aboriginal and Torres Strait Islander people will not engage in advance care planning due to sensitivities around issues of death. Health professionals can talk to Aboriginal and/or Torres Strait Islander health workers (for example, an Aboriginal Hospital Liaison Officer) or the person's family for help where possible.
Engaging with the health system
Hospitals and other health services may be seen as being run according to 'white' rules. Aboriginal and Torres Strait Island people may approach these services with apprehension, so it's important to help the person feel at ease within the setting.
Also, they might not feel comfortable getting involved with official paperwork or filling out forms.
Connection to country
Many Aboriginal and Torres Strait Islander people have a strong connection to their land and country and may be distressed if they need to move into care away from their community.
Documenting their preference to stay on country may be an important aspect of their advance care planning.
Family harmony may be a significant factor in whether an Aboriginal and/or Torres Strait Islander person engages in advance care planning. There will be variation in a person’s knowledge of and willingness to engage in advance care planning.
Considerations for remote communities
Health disparities can vary depending on the person's location and those in remote communities may have less access to appropriate health care.
It may be helpful for healthcare professionals to ask the aboriginal medical service, an Aboriginal and/or Torres Strait Islander health worker or a community service if the person has completed advanced care planning documents.
These services and/or professionals may have knowledge of the person and their family, and also may have knowledge of the community services the person currently uses or can access within their community. They may play an important role in the person's advance care planning.