Advance Care Planning in Indigenous Populations: A Scoping Review.

Abstract

Advance care planning has proven to be beneficial to medical care as it elicits patient preferences at the end of life, yet Indigenous populations have low rates of participation. This gap map scoping review serves to assess the current literature regarding the prevalence of advance care planning and palliative care characteristics in Indigenous populations of North America and Oceania. Articles were identified from searches performed in five databases spanning the period from 2013 to 2023. Twenty-eight articles met the inclusion criteria, representing studies conducted in the United States (<i>n</i> = 15), Canada (<i>n</i> = 2), New Zealand (<i>n</i> = 7), and Australia (<i>n</i> = 4). The included articles varied in study design, comprising qualitative (<i>n</i> = 16), observational (<i>n</i> = 7), mixed method (qualitative and quantitative) (<i>n</i> = 4), and interventional (<i>n</i> = 1). Two major findings endorsed across studies were (1) a high frequency of family involvement in end-of-life decision making and (2) awareness of culturally unsafe end-of-life services, creating hesitancy and mistrust. These results map the gaps in the existing research literature exploring the needs and preferences of Indigenous peoples in end-of-life decisions, palliative care, and advance care planning while highlighting a paucity of known effective interventions for Indigenous people.