The Need for Rural and Regional Aboriginal Palliative Care Models

¹The University of Newcastle, Newcastle, New South Wales, Australia

²Monash University, Melbourne, Victoria, Australia

³Hunter New England Local Health District, New Lambton, New South Wales, Australia

*Corresponding Author:

O’Brien AP
The University of Newcastle, Newcastle
New South Wales, Australia
E-mail: Tony.O’Brien@hnehealth.nsw.gov.au

Received date: June 11, 2013; Accepted date: July 23, 2013; Published date: July 31, 2013

Citation: O’Brien AP, Bloomer MJ, Clark K, Martin T, Lock M, et al. (2013) The Need for Rural and Regional Aboriginal Palliative Care Models. J Palliative Care Med 3:152. doi: 10.4172/2165-7386.1000152

Copyright: © 2013 O’Brien AP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Palliative Care & Medicine

The history of Aboriginal health is littered with statements such as ‘disastrous, appalling, damning, shameful, and disgraceful’ about the greater rate of Aboriginal peoples’ mortality. As Mick Dodson stated “We die silently under these statistics” [1]. This brief paper provides a voice to the needs of Aboriginal people at End of Life (EOL). The term ‘Aboriginal’ in this paper, includes ‘Torres Strait Islander’ people, in keeping with the NSW Health Policy Directive [2].

Death Rates and Geographic Location

In the 5 year period to 2010, 2,903 Aboriginal and Torres Strait Islander people died in NSW [3,4]. The identification of Indigenous status is known to be poor in the New South Wales mortality data collection however, so this data is an approximation [4]. It is apparent from the population statistics for Aboriginal people in need of PC in the rural and regional areas of New South Wales, such as Moree Plains, Armidale, Tamworth, Gunnedah and Narrabri, that distance from mainstream services is often problematic [5].

Furthermore, people living in remote NSW diagnosed with cancer are approximately 35% more likely to die in the first 5 years once diagnosed, than people with greater access to services [6]. Despite the fact that PC treatment and services are available to those who are dying from chronic illnesses, patients with cancer are much more likely to receive admission to a PC unit [7]. Moreover, statistics from 2008-09 indicate that just over 60% of patients who received PC treatment had a principal diagnosis of cancer [8,9]. Aboriginal people are more likely to have a poorer prognosis, often a later presentation and as a result they are twice as likely to die from cancer as non-Aboriginal Australians [6,10].

The evidence is compelling, with Aboriginal people dying at younger ages, with a higher infant mortality rate (5.2 per 1,000 births) and more Indigenous people under 25 years dying than in the non- Aboriginal population, compared with 2% of deaths for the same age group among non-Aboriginal people. In 2007 the NSW Aboriginal male death rate compared to females was 48 percent higher [4] . Aboriginal people die younger than their non-Aboriginal counterparts and because of this and the higher proportion of younger people in the Aboriginal population many families are left without grandparents, aunts, uncles, siblings and parents. When an Aboriginal person dies, grief and bereavement are experienced throughout the whole community, regardless of the cause of death [11,12].

In the context of Aboriginal EOL, besides the provision of palliative care to enable a dignified death, the issues of cessation of life support, organ donation and autopsy requirements from an Aboriginal perspective, are yet to be documented [12] . Notwithstanding the medical intervention required in the palliation of a terminal illness, it is the cultural needs at the time of death and the Aboriginal community’s capability and capacity to provide PC to their own people, which need to be a key focus of service development.

References

1. Berk M, Callaly T, Hyland M (2003) The evolution of clinical audit as a tool for quality improvement. J Eval Clin Pract 9: 251-257.
2. Aboriginal Health (2005) Aboriginal and Torres Strait Islander peoples - Preferred terminology to be used. Department of Health, North Sydney, NSW.
3. Australian Bureau of Statistics (2010) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples.
4. NSW Department of Health (2011) Health statistics New South Wales. Selected Reports, NSW Health.
5. Hunter New England Aboriginal Health Partnership (2007) Aboriginal Health Plan 2007-2011. HNE Health Planning Unit, New Lambton.
6. Jong KE, Smith DP, Yu XQ, O'Connell DL, Goldstein D, et al. (2004) Remoteness of residence and survival from cancer in New South Wales. Med J Aust 180: 618-622.
7. Thompson GN, McClement SE, Daeninck PJ (2006) "Changing lanes": facilitating the transition from curative to palliative care. J Palliat Care 22: 91-98.
8. Australian Institute of Health and Welfare (2011) Trends in palliative care in Australian hospitals. Canberra, Australian Government.
9. Australian Bureau of Statistics (2006) 4822.0.55.001 - Cancer in Australia: A snapshot, 2004-05.
10. Croager EJ, Eades T, Pratt IS, Slevin T (2010) Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia's Aboriginal health professionals. Aust N Z J Public Health 34: 76-79.
11. O'Brien AP (2000) The Development of Mental Health in Koori Adolescents: Stories and Memories from their Youth. University of New England, Armidale.
12. O'Brien AP, Bloomer MJ, McGrath P, Clark K, Martin T, et al. (2013) Considering Aboriginal palliative care models: the challenges for mainstream services. Rural Remote Health 13: 2339.