Whether your role in the Australian health care workforce is based in a hospital, hospice, residential aged care, or a primary health care or community care setting, you will at some point go on a palliative care journey with an Aboriginal or Torres Strait Islander person and their family. Many different members of the health care workforce can contribute to end of life care for an Aboriginal or Torres Strait Islander person. The health care workforce roles that may be involved in their palliative care journey might include palliative care specialists, doctors, nurses, residential aged care workers, Aboriginal and Torres Strait Islander health workers, health practitioners and liaison officers, and allied health practitioners such as physiotherapists, occupational therapists, social workers, psychologists and speech pathologists. Traditional healers may also play a role for some Aboriginal and Torres Strait Islander people. Therefore, working together as a multidisciplinary team to provide interprofessional care is essential to ensuring the best possible palliative care journey for Aboriginal and Torres Strait Islander patients and their families.
Aboriginal and Torres Strait Islander people are involved in the Australian health care workforce in many different roles. Many are part of the medical, nursing and allied health practitioners who provide care in hospital and in primary care or community care settings. Others contribute to improving health outcomes by working as Aboriginal and Torres Strait Islander Health Practitioners or Health Workers or Liaison Officers.
Aboriginal Health Workers and Health Practitioners are the cornerstone for the delivery of health services to Aboriginal and Torres Strait Islander people, particularly in rural primary care settings. Their role is crucial to the health of Aboriginal and Torres Strait Islander people and they play a vital role in the primary health care workforce. They are often the first health care worker an Aboriginal or Torres Strait Islander patient would see.
While many Aboriginal and Torres Strait Islander Health Practitioners and Health Workers are employed in Aboriginal Community Controlled Health Organisations (ACCHOs) or the Government Health Sector, many also work within mainstream services such as general practices and other non-government organisations. These positions and roles exist in metropolitan, regional and remote areas. For example, many hospitals and health services employ Aboriginal Liaison Officers and Health Workers who offer cultural expertise and a cultural lens for engagement with Aboriginal and Torres Strait Islander patients and their families. They provide cross-cultural advocacy for these families and form a vital part of the interdisciplinary team who care for Aboriginal and Torres Strait Islander peoples. Their involvement increases the likelihood of a patient feeling culturally safe in the health service. They also help to ensure that the patient has a good understanding of the diagnosis and treatment advice.
During the difficult time when palliative care becomes necessary, the involvement of Aboriginal and Torres Strait Islander health workers, health practitioners, liaison officers, doctors, nurses, and allied health professionals as part of the multidisciplinary care team can help ensure Aboriginal and Torres Strait Islander patients receive culturally responsive palliative care.
The following resources provide more information on the role of the Aboriginal and Torres Strait Islander health care workforce:
The Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) has developed a resource to support staff and organisations working with ACCHOs - Aboriginal Community Controlled Health Organisations in practice: Sharing ways of working from the ACCHO sector.
Our indigenous health workers . . . if we didn’t have them I just don’t know what we would do. They are just brilliant.
Quote from Northern Territory Health Care provider.
Source: McGrath PD, Patton MA, Ogilvie KF, Rayner RD, McGrath ZM, Holewa HA. The case for Aboriginal Health Workers in palliative care. Aust Health Rev. 2007 Aug;31(3):430-9. Page 436.
A 48-year old Aboriginal woman from a remote community was referred for `terminal care’ by the renal team ... She was admitted with newly diagnosed End Stage Renal Failure but declined haemodialysis and left the hospital prematurely following the death of a relative, also from advanced renal disease. There were concerns that she had not had a full opportunity to consider her decision, so the renal outreach and palliative care nurses made a joint visit to her community, six hours drive along a rough, unsealed road, where the patient and her family were further counselled with the help of local interpreters. Despite family opposition, she again declined dialysis, stating that she wished to remain on her traditional country. The community primary care team were therefore provided with relevant education and equipment to assist in her further care. She was managed at home, with regular telephone review and support from both the palliative care and renal teams, and maintained a good quality of life, enjoying family hunting excursions and community ceremonial life, despite increasing symptoms from fluid retention. During her final illness, she and her family became frightened and requested evacuation to hospital. Although she died before aerial transport arrived, the situation was manageable due to the previous discussions and continuing support, and it was considered she had had a good death. This case illustrates the scope of services provided ... including participation in end-of-life decision making, support for patients and their families, and the organization of multidisciplinary care by a cross cultural team in a remote context. It also flags some particular concerns of our Aboriginal patients, including the impact of epidemic End Stage Renal Failure on personal and community life, the importance of family decision making, and their frequent wish to remain on traditional country for terminal care.
A doctor's case history.
Source: Fried O. Palliative care for patients with end-stage renal failure: reflections from Central Australia. Palliat Med. 2003 Sep;17(6):514-9. Page 517.
One of the good things was having the support of Steve (Aged Care Clinical Nurse Consultant) and Annie (Palliative Care Clinical Nurse Consultant) and Bay and Basin Nursing Group (ie. the Primary Health Nurses from St Georges Basin). I could call them any time to talk about things. Sometimes this was several times a day. We were grateful that Dr David Goldberg from Aboriginal Medical Service was able to be there to help and support us 24/7. Without him it wouldn’t have been possible to have Dad at home until his final stages. Violet (Aboriginal Liaison Officer) organised a couple of family conferences so that all the family could understand what was going to happen with Mum and Dad’s care. It was really good for everyone to be involved. Another important thing I learned was that Palliative Care isn’t just about David Berry Hospital (Karinya). It’s about the services that can be provided at home too. The OT spoke to us about organising equipment, and they spoke to Illaroo Aboriginal Corporation about getting a hospital bed for Dad at home. They also helped with making sure Dad had the right medication, and offered a social worker for us to talk to. There were lots of support services.
A Daughter's story of her father's journey. From 'No Regrets'
Source: Illawarra Shoalhaven Local Health District: Shoalhaven Palliative Care and Aboriginal Health Building Relationships Committee. In our care into your hands: Aboriginal stories about approaching the end of life (762kb pdf). Illawarra Shoalhaven: Illawarra Shoalhaven Local Health District, NSW Government; 2015. Page 4.
Last updated 25 March 2022