Values and preferences for future end-of-life care among the indigenous Sámi.

INTODUCTION Research with Indigenous peoples internationally indicates the importance of socio-cultural contexts for end-of-life (EoL) preferences. However, knowledge about values and preferences for future EoL care among the Indigenous Sami is limited. AIM We investigated if and how a Swedish adaptation of the English-language GoWish cards, DoBra cards, supports reflection and discussion of values and preferences for future EoL care among the Sami. METHODS This qualitative study is based on interviews with 31 self-defined Sami adults who used DoBra cards at four events targeting the Sami population, between August 2019 and February 2020. Using directed content analysis, we examined aspects of interviews addressing Sami-specific and Sami-relevant motivations for choices. Data about individuals' card rankings were collated and compiled on group level to examine variation in card choices. FINDINGS All 37 pre-formulated card statements were ranked as a top 10 priority by at least one person. The cards most frequently ranked in the top 10 were a wild card used to formulate an individual preference and thus not representing the same statement, and the pre-formulated card 'to have those I am close to around me'. Reactions to interviews varied, with some participants commenting on the taboo-laden nature of discussing EoL issues, although many commented positively about EoL conversations in general, and the benefit of using the DoBra cards in particular. We categorised reasoning about Sami-specific and Sami-relevant values and preferences under the themes: Attributes of contemporary Sami culture, Spirituality, Setting for death, Maintaining identity, Preferences related to death, Dying and EoL care and After death. CONCLUSIONS The DoBra cards were found to be easy-to-use, understandable and a flexible tool for initiating and supporting conversations about EoL values and preferences. The open formulations of cards, with wild cards, enable discussions about individual values and preferences, with potential to reflect life as a Sami in Sweden.