American Indians (AIs) on the Great Plains do not have access to culturally appropriate palliative care (PC), despite this need being well-known. There is a dearth of literature identifying certain factors impacting PC access & delivery for AI patients living on reserve territory, despite the fact that doctors caring for AIs in the Great Plains have long recognized significant impediments to critical disease treatment. For a study, researchers sought to investigate the variables affecting PC distribution and access on tribal property in the Great Plains to help establish culturally appropriate PC services for AIs.

Interviews with 21 specialty and 17 primary clinicians were recorded and transcribed by 3 writers. Seven writers worked on a data analytic team that conducted a traditional content analysis on transcripts. The analysis team convened via Zoom to negotiate codes, organize codes, and create themes.

About 4 themes emerged from the qualitative analysis of interview data that covered the following topics: workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), geography (e.g., weather, travel distances), historical trauma and racism, and operations of the health care system (e.g., hospice & home health availability, fragmented services).

The research highlighted the significance of addressing the time and expense of travel for very sick patients, expanding the provision of home health & hospice on reservations, and enhancing patient confidence in the healthcare system. The Indian Health Service’s budget should be increased, the medical personnel should be strengthened, and Tribal organizations should take over the management of reserve health care.