Table 3

Recommendations for non-indigenous care providing supportive and palliative care

I. The systems: learn history of indigenous people and relevance to healthcare today
(A) Be aware and adapt to the impact of the historic context of colonialism.	Even though practices may differ today, pain from the past reverberates and retains a resonance that must be recognised. Colonialism shaped political relationships and resources and led to discrimination and injustices including lack of respect and unequal access to care.
(B) Recognise the gaps and issues in the provision of indigenous health services.	While not a main focus of this paper, addressing health system problems is essential for the provision of culturally competent supportive and palliative care. The need to lobby to improve access, quality, comprehensiveness and continuity of care is apparent.

II. The individual: gain insight into the views of the person
(A) Make an effort to get to know the individual.	Cultural needs must be considered on an individual basis, not according to cultural assumptions or biases. Individuals are unique, even within their cultures. Dignity is individually determined. Providers should take every opportunity to build a relationship with the patient/client to enable them provide competent care. Cultural knowledge and awareness is one step in the continuum of providing quality care.
(B) Treat each situation as unique and case-specific.	A great opportunity for attaining cultural understanding is remembering that even specialised healthcare providers can expand their awareness of other cultures and learn from those they serve. Biomedical values are not always reconcilable with other cultural values. Sensitivity should be given to individual's previous experience with the medical system and models for achieving health.
(C) Recognise the value placed on trust and respect.	Sincerity is recognised as an emotional strength. Focused communication, including listening and noting responses, strengthens a relationship built on trust and respect. If trust is given to caregivers by a Mi'kmaw as a way of respecting their role, the trust should be protected, never abused or disregarded.
(D) Be aware of non-verbal communication and cues for discussion.	Minimal eye contact may not indicate discomfort. Care providers can share information to encourage discussion rather than directly asking personal, intrusive questions.
(E) Consider the role of religious beliefs and spirituality.	Spirituality, in particular feelings toward life, death and afterlife, hold varying degrees of importance. When traditional views of going to the spirit world are identified, providers should recognise that death is viewed as a transition from one state to another and not with the same finality as other worldviews concerning death. Spiritual and religious beliefs play an important role in framing processes and choices relating to values enacted at this time.