Thursday, August 21, 2014
Researcher explores end-of-life care for Māori
Attitudes to death and dying have a cultural dimension, so how well does end-of-life and palliative care encompass Māori
culture, spiritual beliefs and traditions?
Massey University psychology doctoral student Diane Koti (Ngāti Porou, Ngāti Mainapoto, and Te Whānau ā Apanui) is
investigating how current end-of-life care models can better incorporate the needs of Māori patients and whanau.
“For many Maori, palliative care and hospice are new terms and phenomena,” she says. “Many Maori have not heard of, or
encountered, or had any need to access palliative care and hospice services.”
Ms Koti was recently awarded the Rose Hellaby 2014 Postgraduate Scholarship at a ceremony at the Auckland Art Gallery –
Te Toi o Tamaki for her research on end-of-life and palliative care for Māori. The Manawatü campus-based researcher aims
to build on her Masters research, in which she talked to terminally ill Māori patients and their whānau about their
end-of-life care experiences. Her research suggested a need for further understanding of the process of end-of-life and
palliative care, particularly from a historical perspective.
Until her grandmother passed away five years ago from terminal cancer, she says her whānau had never encountered hospice
care and were unfamiliar with what it was. In this sense, having a stranger tend to their dying relative – albeit a
kindlly professional – was at times disconcerting, she says.
Her observations sparked her interest in palliative care, and this deepened when she went to work for the hospice where
her grandmother had been a community outpatient.
While full of praise for the service and support Hospice New Zealand offers patients and families, she observed gaps in
its understanding of Māori beliefs, protocols and experiences of death and dying. These can include the involvement of a
large number of family members providing physical care, karakia (prayers), waiata (song) and tangi planning when a
person is nearing the end of their life.
She envisages her study will contribute to future planning. “The Māori population is growing,
is youthful although getting older, so it can be assumed that Maori will be potential high future users of New Zealand’s
palliative care services,” she says. “We need to ensure that palliative care and hospice services, facilities, and
health professionals are competent in meeting the needs of Maori. Health professionals should be educated in the unique
cultural needs and considerations when working with, and caring for, Maori.”
In rural areas, particularly, a lack of resources has been identified as hampering palliative care delivery, and for
urban areas palliative care is frequently detached from the appropriate cultural needs of indigenous peoples, she says.
“There’s a current lack of Māori staff in both clinical and non-clinical advisory roles,” she says.
Ms Koti hopes her research will lead to the development of a Māori model for end-of-life care based on kaupapa Māori
principles. Her ultimate dream is to establish a kaupapa Māori end-of-life care facility on the East Coast near
Gisborne, in honour of her grandmother, that caters for Māori and non-Māori and provides training in culturally
sensitive end-of-life care.
Ms Koti is supported by her supervisors Associate Professor Ross Flett, Dr Natasha Tassell-Matamua, and Dr Hukarere
Read Diane Koti’s Masters research here.