Developing a culturally safe palliative care model

Palliative care should help people live as well as possible while managing advanced illness, supporting family and responding to grief. For Aboriginal and Torres Strait Islander Peoples, quality care also depends on whether services respect Country, culture, kinship, identity, spirituality and community authority.

A culturally safe palliative care model is shaped with Aboriginal and Torres Strait Islander people, rather than designed for them from outside the community. It recognises that a hospital appointment, an unfamiliar clinician or a rushed conversation can create distress when cultural obligations and family decision-making have not been considered.

In Queensland, these needs span metropolitan services in Brisbane, regional centres such as Toowoomba and Bundaberg, and remote communities across Cape York and the Torres Strait. Travel, workforce shortages, housing pressures and limited access to specialist palliative care can influence when a person receives support and where they want to be cared for.

A strong model connects Aboriginal Community Controlled Health Services, hospitals, hospices, primary care, Elders, families and specialist teams. It also uses health translation principles: research evidence is adapted with communities and embedded into everyday clinical practice.

Making cultural safety a core standard

Cultural safety is more than cultural awareness training. It asks health services to examine their own policies, assumptions and power relationships, while recognising that Aboriginal and Torres Strait Islander patients are the people who determine whether care feels safe.

The model should include culturally appropriate communication, time for yarning, access to Aboriginal and Torres Strait Islander health workers, and a clear process for involving family and community representatives. Clinicians should avoid assuming that every person has the same cultural preferences. Some people may want connection with Country, traditional healing or an Elder; others may prefer privacy or support from a particular family member.

Language matters in conversations about dying. Plain English, interpreters and trusted health workers can help families understand prognosis, advance care planning and symptom management. Staff should also recognise Sorry Business, when bereavement responsibilities may affect appointments, travel and treatment decisions.

Designing care around Country and kinship

A palliative care pathway needs to work across settings, not simply direct patients to a metropolitan service. In Queensland, a person from the Torres Strait or a remote Cape community may need aeromedical or commercial travel to reach specialist care. A family may face accommodation costs, time away from work and separation from children or Elders.

A community-led pathway can offer early palliative care through local primary care and ACCHO teams, with specialist advice available by phone or telehealth. Hospital clinicians should provide a clear handover, including the person’s goals, family contacts, cultural preferences, medication plan and preferred place of care. The person should not have to repeat difficult information each time they meet a new service.

Place of care is a personal decision. Some people may wish to remain at home or on Country, while others may feel safer in hospital or hospice. Services need practical plans for equipment, after-hours support, medicines, transport and urgent symptom relief. These plans should be discussed before a crisis, with flexibility when circumstances change.

Translating evidence into everyday practice

Research can improve palliative care when it is combined with local knowledge and tested in real clinical environments. Brisbane Diamantina Health Partners provides a useful example of how research institutes, universities and health services can work together to move evidence into practice; its work on integrated cancer rehabilitation shows how coordinated pathways can connect research with patient care.

For a culturally safe model, translation should begin with co-design. Aboriginal and Torres Strait Islander consumers, community-controlled services, clinicians, researchers and carers can identify priorities, develop resources and decide how success will be judged. Paid participation, accessible meeting formats and appropriate governance are essential. Community members should have genuine influence over decisions, not simply be asked to endorse a finished program.

Training should focus on practical behaviour. Staff need support to conduct culturally safe yarning, recognise distress, document family preferences, arrange interpreters, manage Sorry Business and respond respectfully when a person challenges the service. Supervision, reflective practice and local cultural leadership can make these expectations part of routine care.

Measuring trust, access and outcomes

Traditional measures such as hospital admissions, medication use and place of death remain important, but they do not fully show whether care is culturally safe. Evaluation should also consider whether people were able to stay connected to family, Country and community, whether their wishes were respected, and whether they felt listened to.

Data collection must protect privacy and support Indigenous data sovereignty. Communities should help decide what information is collected, who can access it and how findings are shared. Results should be returned in useful formats, such as community briefings, visual summaries and service improvement sessions, rather than remaining in academic publications.

Possible measures include time from referral to first palliative care contact, access to an Aboriginal health worker, unplanned hospital presentations, completion of advance care plans and availability of after-hours support. Qualitative feedback from patients, carers, families and Elders can explain why a pathway is working or where it is failing.

Building a sustainable partnership

A model will last when cultural safety is supported by funding, governance and accountability. Health services should establish formal partnerships with ACCHOs and local Aboriginal and Torres Strait Islander organisations, involve consumers in decision-making and include cultural safety requirements in contracts and performance reviews.

Practical priorities for service leaders include:

• Appoint Aboriginal and Torres Strait Islander community members to governance and evaluation roles.
• Create referral pathways between hospitals, ACCHOs, GPs, hospices and social and emotional wellbeing services.
• Fund Aboriginal health worker, liaison and cultural support positions as core roles.
• Provide flexible outreach, telehealth, transport and accommodation assistance across regional and remote Queensland.
• Develop care plans that record family involvement, cultural preferences, communication needs and preferred place of care.
• Train clinicians in culturally safe communication, advance care planning and respectful end-of-life conversations.
• Report outcomes back to communities and use their feedback to improve the service.

The work should sit within a broader research and health translation ecosystem, with partnerships that connect evidence, clinical expertise and community priorities. Organisations seeking collaborators, governance resources and research connections can explore Brisbane Diamantina Health Partners as part of that wider Queensland network.

Developing a culturally safe palliative care model is an ongoing relationship, not a one-off project. Health services can begin by listening locally, funding community leadership and testing small pathway changes with Aboriginal and Torres Strait Islander partners. When families can access trusted care, stay connected to what matters and make informed choices, palliative care becomes more responsive, equitable and humane.