“It’s Trust. That’s Everything”: Care providers’ experiences supporting Inuit participation across the Qikiqtani–Ottawa care journey

Background: Canada’s health and social care system serves people in Inuit Nunangat within a context influenced by history, geography, and care organization. These conditions create challenges for Inuit communities and providers. Shared decision making is an approach to person-centred care in which care providers and care recipients make decisions together and support autonomy and participation across the care journey. This study examined care providers’ experiences supporting Inuit travelling from the Qikiqtani region of Nunavut to Ottawa, Ontario, and factors influencing their ability to support participation in care decisions. Methods: The Not Deciding Alone team is a partnership of Inuit-led and service organizations, community partners, and academic researchers across Ontario and Nunavut. We conducted an interpretive descriptive qualitative study using interviews with care providers supporting Inuit in Ottawa and/or the Qikiqtani region. We examined how providers support care recipients across the care journey and what influences participation in decision making. A framework developed with Indigenous and Inuit partners guided the study and depicts participation as highly relational. The Inuit societal value of aajiiqatigiingniq informed the approach and supported research co-production. Inuit knowledge and shared governance were centred, with team members engaged as partners from developing research questions through interpreting and applying findings. Results: Fourteen care providers participated, with roles spanning the care journey from community to urban settings. We identified four themes: 1) actively supporting navigation within complex and fragmented systems; 2) fostering collaborative relationships within challenging care settings; 3) creating conditions for participation; and 4) relational care and trust as essential to Inuit participation. Across themes, providers showed strengths in supporting communication, continuity, navigation, and engagement, while describing system conditions that limited what they could offer. Conclusions: Inuit participation in care decisions depends on the conditions people encounter when entering care systems and on how care is organized and delivered. Care providers work within systems that can limit their ability to support participation. Shared decision making can help put person-centred care into practice. We propose understanding shared decision making as a relational practice and a systems-level lens for identifying conditions that enable or constrain care providers and care recipients to make decisions together.