Establishing Palliative and Hospice Care in the Commonwealth of the Northern Mariana Islands (CNMI): Helping people to get good quality care at the end of life

Problem: In the Commonwealth of the Northern Mariana Islands (CNMI), a multi-cultural US jurisdiction in the western pacific, Commonwealth Cancer Coalition members identified palliative and home hospice care as an unmet need requiring education and training for healthcare professionals, legislators, and the general public. Currently people are unable to keep loved ones at home for their final days and few discussions on end-of-life wishes occur.

Methods: To reach key stakeholders, a week-long series of educational events was held. The Cancer Information Service Pacific Region provided technical assistance throughout. The largest event, a 2-day conference, was attended by 172 including cancer survivors, nursing students, and cancer coalition and community members. The program covered basics of palliative care, setting up a home hospice, and available resources. Additional trainings were held with doctors, nurses, and social workers. Informational sessions were held with legislators and religious leaders.

Results: Evaluation of the 2-day workshop showed large increases in knowledge and attitudes and feedback from other venues was very positive. A palliative care committee (PCC) was formed to oversee the creation of a palliative care plan for CNMI, including policy and legislation, establishing funding mechanisms, and implementing home hospice care.

Implications: There is high interest in CNMI for palliative care and the ability to offer home-based hospice services. The PCC is identifying funding mechanisms to allow home health agencies to provide hospice care in the home, implement community education, and identify necessary law and policy changes.