Inequities in access to palliative care and community-based indigenous palliative care programs in Canada: a scoping review

Abstract

Introduction: Approximately two-thirds of deaths in Canada require palliative care. Indigenous Peoples continue to experience inequities in access to culturally safe, community-based palliative and end-of-life care. This scoping review examined experiences of care, barriers to access, and community-based palliative care programs among Indigenous Peoples in Canada to identify key gaps and inform future research and practice. Methods: This review was guided by the Arksey and O’Malley framework and reported in accordance with PRISMA-ScR guidelines. Searches of Medline, PubMed, Google Scholar, Indigenous Collections, and Indigenous Peoples of North America databases were conducted from inception to May 2026. Results: Thirty-four studies met the inclusion criteria, including studies on stakeholder experiences and community-based programs and interventions. Four overarching themes were identified: structural barriers and patterns in palliative care; cultural safety, communication, and misalignment with Western models of care; end-of-life preferences and experiences; and community-led approaches and capacity building. Indigenous Peoples have fewer home care nursing hours, physician home visits, and an increased likelihood of dying in an acute care setting. Indigenous participants consistently described preferences for home and community-based dying, family involvement, and integration of spiritual and cultural practices within care. Significant research gaps were also identified, including the absence of Métis-specific studies, limited research involving urban Indigenous populations, and lack of long-term evaluation of community-based programs. No identified studies were from Prince Edward Island or New Brunswick, despite the presence of Mi’kmaq and Wolastoqiyik communities in these provinces. Discussion: Current research exploring palliative care for Indigenous Peoples in Canada remains limited despite increasing attention toward health reconciliation. Community-led and culturally safe palliative care models have the potential to improve end-of-life experiences and align care with Indigenous values. Indigenous-led models show promise, but longer-term evaluations are needed to assess their effectiveness and applicability beyond small pilot settings.