A study by the University of Hawaiʻi at Mānoa's Hā Kūpuna – National Resource Center for Native Hawaiian Elders sheds light on the end-of-life care preferences of Native Hawaiian kūpuna (elders). Led by Assistant Professor Miquela Ibrao, UH researchers and ALU LIKE, Inc., the study identifies culturally tailored strategies to honor kūpuna values.
Published in the Journal of Palliative Medicine , the research is based on interviews with kūpuna in rural areas across Hawaiʻi. It highlights four key themes:
Death is not an end but a transition that honors relationality, ancestors and the land.
—Miquela Ibrao
- Cultural traditions in healthcare: Kūpuna often use lāʻau lapaʻau (herbal medicine) and lomilomi (massage) as integral parts of their care.
- Family-centered decisions: ʻOhana (family) plays a crucial role in healthcare choices, extending to deceased ancestors and the ʻāina (land), which are seen as sources of guidance and healing.
- Preference for home-based care: Many kūpuna wish to age and die at home but fear burdening their families. Limited long-term care options in rural areas add to the challenge.
- Trust in providers: Kūpuna value healthcare providers who "talk story" and understand their culture, fostering trust and respect.
"Death is not an end but a transition that honors relationality, ancestors and the land," said Ibrao. "Decolonizing end-of-life care means respecting cultural beliefs and embracing Indigenous wisdom about healing and living well."
The researchers recommend cultural humility training for providers, increasing Native Hawaiian representation in healthcare, and including cultural practitioners in care teams. These strategies aim to ensure kūpuna receive compassionate care that aligns with their traditions.
Ha Kūpuna, one of three National Resource Centers for Native Elders funded by the U.S. Administration on Aging, is housed in the Thompson School of Social Work & Public Health .
