Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member

Jungyoon Kim, PhD

Second Committee Member

Stephen Peters, MA

Third Committee Member

Fabio A. Almeida, PhD


Advance Care Planning is understudied in Native American and Alaskan Natives communities. There is a strong need for further research on culturally adapting advance care planning (ACP) for indigenous communities. Specifically, for the Ponca Tribe, culturally adapting the ACP used would ideally increase the acceptance of ACP in that community. This systematic literature resulted in identifying four themes other tribes have utilized to culturally adapt their ACP, advance directive, palliative and/or end-of-life processes in an effort to increase completion rates. The four themes were involving the elders with the adaptation process, increasing education efforts and awareness of ACP and ADs, adapting the language and imagery used in the educational materials used, and focusing on training the providers so that they feel more comfortable in addressing ACP with elders in a more culturally sensitive way. These approaches can serve as starting points that the Ponca Health Services can use to begin their cultural adaptations of their current ACP process to help increase ACP completion rates.

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