My Journey Needs Round: Creating culturally safe and person-centred palliative care for Aboriginal and Torres Strait Islander People

An article written by Gage Brewer, Palliative Care Nurse Practitioner Candidate, Northern Adelaide Palliative Service (NAPS)

Palliative care is at its strongest when care is person-centred, culturally safe, and guided by the individual and their loved ones. Unfortunately, Aboriginal and Torres Strait Islander people often face significant barriers when accessing care at the end of life such as misunderstandings around palliative care, feelings of not being heard, and culturally inappropriate communication.

Recognising this, the team, Sheree Cross, Zena Bonney and myself, launched a quality improvement initiative in early 2024 called My Journey Needs Round. This culturally informed palliative care needs round was co-designed and implemented in collaboration with an Aboriginal-run aged care facility, with the goal of improving how care is delivered for Aboriginal and Torres Strait Islander residents living with life-limiting illness.

A new approach to an established model

Palliative care needs rounds are structured, multidisciplinary meetings that identify residents nearing the end of life, ensuring care plans are in place and anticipatory medications are prescribed. They are widely used and well evidenced, improving outcomes such as reduced hospital transfers and better quality of dying. But until now, little had been done to tailor this model to meet the cultural and spiritual needs of Aboriginal and Torres Strait Islander communities. The My Journey Needs Round helps to change this.

Co-designing with community

The foundation of this initiative was built on listening to the residents, families, and staff. We asked a simple question, ‘How can the Northern Adelaide Palliative Service help support the residents and clinical staff?’ Themes emerged of culture, family, communication, community, and respect, which we used to shape the project.

One resident told us: ‘It’s our journey, our life. We want to be around family, our culture and be listened to’.

These insights led to the team utilising:

• Clinical Yarning – an approach developed in Western Australia as a central communication approach, integrating social, diagnostic, and management yarns for meaningful and culturally safe person-led conversations.
• Culturally safe tools like the Palliative Care Australia Aboriginal and Torres Strait Islander Discussion Starter Booklet to guide advance care discussions.
• Cultural expression through an original engagement artwork piece with Aboriginal artists, Meiwi Aboriginal Art; Samantha Gollan and Kellie Tancock. This resulted in an art piece undertaken by the residents and their families that symbolises the life cycle. The art helps us to have open dialogue with residents when discussing future care wishes.

Importantly, the presence of Zena, our Aboriginal Cultural Advisor, at each round has ensured that spiritual, cultural, and community needs are not only acknowledged but prioritised.

Building evidence, closing gaps

As part of the project, we undertook a literature review. We found no existing studies focused specifically on culturally informed palliative care needs rounds for Aboriginal and Torres Strait Islander peoples in aged care settings. My Journey Needs Round appears to be the first to help bridge this evidence gap, and its findings will help to inform national practice.

As the project moves into an evaluation phase, the voices of those who have participated including residents, families, staff remain central. We are fortunate to have Associate Professor Aileen Collier guiding and supporting us in the evaluation of this service within a research context. Her expertise has been instrumental in translating this quality improvement project into meaningful and relevant research.

Looking ahead

The My Journey Needs Round is more than a clinical initiative, it demonstrates the power of respectful collaboration, cultural wisdom, and genuine partnership. By grounding our practice in Aboriginal and Torres Strait Islander perspective, it not only improves end-of-life care, but also honours the lives, stories, and journeys of those nearing the end of theirs.

To learn more about the project or to participate in the study’s evaluation phase, please reach out to the My Journey team via email.

Research team; Gage Brewer, Palliative Care Nurse Practitioner Candidate, NAPS; Dr Sheree Cross, Medical Consultant, NAPS; Zena Bonney, Aboriginal Cultural Advisor, Northern Adelaide Local Health Network; A/Prof Aileen Collier, Northern Adelaide Local Health Network/Flinders University. 

Authors

Gage Brewer

Palliative Care Nurse Practitioner Candidate

Northern Adelaide Palliative Service (NAPS) on behalf of Northern Adelaide Local Health Network research team