Culturally Responsive Palliative Care Messaging for American Indians: An Efficacy Trial

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Palliative care is specialized patient-/family-centered care designed to reduce suffering and enhance quality of life for persons with serious illness. Culturally responsive palliative care can ease serious illness burden experienced by American Indians (AIs) and improve seriously ill AIs end-of-life decision-making. However, for seriously ill Northern Plains AIs, specifically those in South Dakota (SD), access to and use of culturally responsive palliative care is severely limited. To address this need, we will form a multidisciplinary, tribally-driven collaborative team consisting of Great Plains Tribal Leaders Health Board, active AI community advisory boards at the following reservations: Cheyenne River, Rosebud, and Pine Ridge, Massachusetts General Hospital, and South Dakota State University. Our team will conduct a campaign messaging efficacy test using the narrative as culture-centric health promotion model (NCHP) to create and test culture-centric narrative messaging that improves knowledge of palliative care and encourages participants to engage in formal and informal communication about palliative care. The NCHP model is an evidence-based innovative approach to enhance AI’s knowledge and intentions to talk formally and informally about palliative care, because it provides guidelines for how to construct culture-centric narratives which identify the features of effective narratives and the mechanisms by which the narratives work to transform cognitive and behavioral outcomes. In Phase 1A of our project, we will conduct talking circles to elicit traditional health narratives. In Phase 1B, those narratives will be transformed into culture-centric narrative health messaging. In Phase 2A we will conduct a randomized trial to test the efficacy of the NCHP model for increasing AI tribal members’ palliative care knowledge and intentions to discuss palliative care. In Phase 2B, we will identify barriers and facilitators for implementation of the culture-centric narrative messaging campaign to inform future scalable efforts. Our project aims to: 1) develop culture-centric narrative messages to promote palliative care; 2) test the efficacy of culture- centric narrative messaging about palliative care; 3) identify facilitators and barriers to campaign implementation and sustainability. Data from this R21 will provide evidence for an R01 to implement a messaging intervention with three AI tribes in SD, to increase palliative care utilization. The approach of, and findings from, this study can also be used to develop culture- centric messaging for different target groups, including the 500+ nationally recognized tribes in the US, to improve AI's confidence using or recommending palliative care.