Improving Palliative Care Knowledge and Intentions Among Great Plains American Indians: Efficacy Results From a Randomized Clinical Trial Testing a Culture-Centric Palliative Care Message

Background Palliative care (PC) has the potential to alleviate symptom burden and enhance quality of life, yet use of PC among American Indians lags significantly behind whites. Methods This randomized clinical trial employed a randomized, complete block, posttest-only control group design to evaluate the efficacy of a culture-centric narrative video message to increase knowledge of and communication about PC among AI adults residing in three Great Plains Reservations compared to a general PC message or no message. Measures included participants’ knowledge of and intentions to discuss PC using a posttest survey. Results N = 320 individuals completed the survey. Both the culture-centric and general messages demonstrated statistically significant results for increasing participants’ PC knowledge compared to the no message group. The culture-centric message participants had greater odds of feeling the emotions and agreeing with the characters compared to the general message; however, there were no differences noted in intentions to discuss PC. Conclusions This study demonstrates the importance of messaging to improve PC knowledge and reduce misperceptions among populations with a history of mistrust of healthcare institutions. Embedding the culture’s values and ways of understanding serious illness care can serve to break down barriers in PC acceptance and provide opportunities for improving quality of life for AIs with serious illness.