Conectar
This scoping review aimed to explore what is known about Indigenous peoples' experiences with palliative and end-of-life care in Canada.
A scoping review.
A systematic search was performed from database inception to May 2022: CINAHL, Academic Search Complete, ERIC, Cochrane, Medline, PsychINFO, Indigenous Collections, Indigenous Peoples of North America and EMBASE. No date limitations were applied. Unpublished and grey literature was searched using the Google search engine. A search update was conducted in April 2024.
This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Titles, abstracts and full text were screened for inclusion by two reviewers. Mapping and thematic analysis were used to analyse, collate and summarise extracted data.
Fifty-three sources were included in the review. While the methods, locations and context vary across the literature, common themes emerged: Disparities in Indigenous representation in palliative and end-of-life care literature, challenges in accessing palliative and end-of-life care, priorities related to palliative and end-of-life care and experiences specific to end of life.
This scoping review revealed several key insights into Indigenous peoples' experiences with palliative and end-of-life care.
Findings identify the need to enhance cultural safety in palliative and end-of-life care and support community capacity to develop and lead palliative and end-of-life care research and initiatives. Furthermore, findings suggest the need for palliative and end-of-life care initiatives that are Indigenous-led, grounded in Indigenous research methods and distinctions-based.
We have adhered to relevant EQUATOR guidelines. We followed the PRISMA-Scr in the reporting of this scoping review.
No patient or public contribution. This study did not include patient or public involvement in its design, conduct or reporting.
Stress is nearly ubiquitous in everyday life; however, it imposes a tremendous burden worldwide by acting as a risk factor for most physical and mental diseases. The effects of geographic environments on stress are supported by multiple theories acknowledging that natural environments act as a stress buffer and provide deeper and quicker restorative effects than most urban settings. However, little is known about how the temporalities of exposure to complex urban environments (duration, frequency and sequences of exposures) experienced in various locations – as shaped by people’s daily activities – affect daily and chronic stress levels. The potential modifying effect of activity patterns (ie, time, place, activity type and social company) on the environment–stress relationship also remains poorly understood. Moreover, most observational studies relied quasi-exclusively on self-reported stress measurements, which may not accurately reflect the individual physiological embodiment of stress. The FragMent study aims to assess the extent to which the spatial and temporal characteristics of exposures to environments in daily life, along with individuals’ activity patterns, influence physiological and psychological stress.
A sample of 2000 adults aged 18–65 and residing in the country of Luxembourg completed a traditional and a map-based questionnaire to collect data on their perceived built, natural and social environments, regular mobility, activity patterns and chronic stress at baseline. A subsample of 200 participants engaged in a 15-day geographically explicit ecological momentary assessment (GEMA) survey, combining a smartphone-enabled global positioning system (GPS) tracking and the repeated daily assessment of the participants’ momentary stress, activities and environmental perceptions. Participants further complete multiple daily vocal tasks to collect data on vocal biomarkers of stress. Analytical methods will include machine learning models for stress prediction from vocal features, the use of geographic information systems (GIS) to quantify dynamic environmental exposures in space and time, and statistical models to disentangle the environment–stress relationships.
Ethical approval (LISER REC/2021/024.FRAGMENT/4-5-9-10) was granted by the Research Ethics Committee of the Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg. Results will be disseminated via conferences, peer-review journal papers and comic strips. All project outcomes will be made available at https://www.fragmentproject.eu/.
The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades.
Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate.
The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets.
Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions.
FreshRSS 