End-of-Life and Palliative Care Disparities Among American Indians and Alaska Natives with Cancer: A Scoping Review

PurposeTo identify disparities in access, utilization, and quality of end-of-life (EOL) and palliative care services for American Indians and Alaska Natives (AIAN) with cancer in the US.MethodsSystematic searches were conducted in PubMed/MEDLINE, Embase, and Scopus. English-language original research studies reporting any quantitative estimates of measures of care quality or utilization for EOL and palliative care for AIAN individuals with cancer compared to other races were included (2014-2025). Screening and data extraction were conducted by two independent reviewers and discrepancies were resolved through consensus. Findings were synthesized through iterative team discussions.ResultsOf 1693 unique records, 153 underwent full-text review, and 22 met inclusion criteria. Considerable heterogeneities were observed in EOL care outcomes and covariates included in multivariable regression models assessing disparities: Compared to White individuals, AIAN individuals with cancer had significantly lower in-home or hospice and higher medical facility deaths (9/11 studies); higher acute care use (3/4 studies); lower hospice use (2/4 studies); lower anxiolytic medication use (1/1 study); and higher receipt of any palliative treatment (3/6 studies); but no differences in late hospice initiation (0/3 studies); or aggressive treatment near the EOL period (0/6 studies).ConclusionsAIAN individuals with cancer appear more likely to experience a medicalized death. Mechanisms underlying these disparities remain poorly understood. Future studies should provide greater clarity in analytical methods to improve interpretability of disparities measures, use more consistent measures of EOL care quality, explore within-AIAN variation such as regional, tribal, and rural-urban differences, as well as cultural implications for the delivery of appropriate EOL care.