Family meetings are usually a good way to interact with the indigenous patient and the family. Effective communication skills XAV 939 are needed to have effective discussions. Here the clinician needs to actively listen and give time for replies and questions. Patients and families should not feel unduly pressured to choose or embark on a particular pathway of care. It can be helpful to let the caregivers know that this is a medical recommendation and that the physician is, with their assent, primarily

responsible for the decisions. Above all it should be a shared decision making process with the patient’s best interest the primary consideration at all times. It is important to discuss cultural requirements and preferences early in the conservative management Y-27632 ic50 pathway so that the impact of family and kinship relatives can be managed. Family/kinship rules may mean that certain family members of an indigenous person, who in mainstream society would be regarded as distant relatives, may have strong cultural responsibilities to that person. It is imperative therefore to identify early in the planning stages

who is the culturally appropriate person, or persons to be involved in the decision making process so that they can give consent for treatment and discuss goals of care. Where English is not the main language of the person and/or their

family, interactions and family meetings will always need to be held in the presence of a cultural broker (aboriginal liaison officer) and or an interpreter to explain treatment pathways and care issues so that informed choices are made. Informed choices can be only made TCL in an environment where all stakeholders can participate freely. An interpreter or translator can be an invaluable resource in such situations to ensure that information is conveyed and received accurately. The use of a family member as an interpreter may not always be appropriate and the health care team should be sensitive to these issues. Given the remoteness and accessibility issues in the life of indigenous Australians, it may be sometimes difficult to bring the patients to the ‘tertiary services’. In many instances, ‘services’ may have to be taken to the patient. One effective way of doing this is by tele or video case-conferencing with the local clinic, DMO/primary GP, patient and family as well as the renal team in attendance. The range of environmental and social conditions in the remote setting may also necessitate flexible models of care and creative solutions to sourcing equipment and medications etc. Patients in the ‘remote setting’ who have chosen the non-dialysis pathway will have to be supported and cared for at home.