Palliative Care for Cancer Patients in American Samoa. Development of a Culturally-Grounded Resource-Appropriate Training Curriculum

PURPOSE. Prior research in American Samoa (AS)documents the presentation of late stage cancers at diagnosis, unavailability of advanced treatments, insufficient funding for offshore treatment, absence of comfort care resources, and patients intermittent use of indigenous Samoan and Western medicine. A palliative program is beneficial in American Samoa. > METHODS. Research questions were to identify necessary groups, organizations for development of palliative program. Identify community knowledge, attitudes and practices regarding palliative care. An ad hoc committee (through Cancer Coalition), identified participants for group or individual interviews. Snowball sampling was used to identify additional participants. Interviews were taped, transcribed verbatim, and examined using Content Analysis. > RESULTS. Diverse stakeholder groups (healthcare and social services personnel, indigenous healers, religious and village leaders) and organizations (health department, hospital, ministers association) were identified for inclusion in establishing a culturally-grounded, resource-appropriate palliative care program. Suggested units for training included: indigenous health beliefs and medicine, communication about end-of-life issues, pain and symptom management at home, and role of volunteers and families. Also suggested were opportunities for discussion between diverse stakeholder groups and separate sessions for clinicians. > CONCLUSIONS. AS lacks treatment options across the cancer care continuum. The status of palliative care could be improved by a program integrating available resources and establishing inter-disciplinary teams of those trained in bio-medical and social science, as well as indigenous healers and volunteers. Training tailored to diverse groups is essential to program success and ultimately, offers hope of enhanced quality of life for those affected by cancer.