Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: A comprehensive review

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas

The Credit Crunch and Insider Training

This paper examines the behaviour and information content of insiders’ trades before and after the credit crunch and, in particular, examines the extent to which some insiders anticipated the market crash and took action to protect their positions. In part, the market crash was brought about by the excessive borrowing of financial institutions. Our results point to the view that a number of insiders, primarily directors, were aware that the excessive use of leverage by financial institutions would ultimately have a detrimental impact on the economy. These insiders acted by selling their shares prior to the market collapse and subsequently buying them back at a lower price. Supportive evidence for the above view is provided through both graphical evidence and regression analysis. In particular, we demonstrate a link between insider behaviour and the rapid decline in share values. Further evidence is also provided of a link between insider behaviour and future risk as measured by the CDS premium. In short, we argue that this selling was not motivated by liquidity or other contrarian strategies but was a result of understanding how higher levels of leverage and excessive trading in new risky derivatives could lead to higher levels of risk, an insight possessed only by a subset of insiders