J Adv Nurs. 2022;00:1–20. wileyonlinelibrary.com/journal/jan | 1 © 2022 John Wiley & Sons Ltd. 1 | INTRODUCTION Despite 21st century medical and technological advances, access to palliative care remains tenuous, if not impossible for a majority of people living in low- and middle-income countries (World Health Organization, 2020). The World Health Organization (2020) reports that 40 million people need palliative care services worldwide, but accessibility is limited due to a lack of human or financial resources to provide services or a lack of understanding of palliative care deliv- ery goals. The Canadian Society of Palliative Care Physicians (2016) states that only 30% of Canadians have access to palliative care. Although a majority of Canadians wish to die at home, the Canadian Institute for Health Information (CIHI) underlines that “fewer than 1 in 6 people (15%) who died in 2016–2017 received palliative home care while those who received palliative care received it only in the last month of life” (CIHI, 2018, p. 6). Received: 12 January 2022 | Revised: 9 March 2022 | Accepted: 26 April 2022 DOI: 10.1111/jan.15287 REVIEW Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings Louise Racine 1 | Susan Fowler-Kerry 1 | Harini Aiyer 2 1 College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada 2 Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Correspondence Louise Racine, College of Nursing, University of Saskatchewan, Saskatoon S7N 5E5, SK, Canada. Email: louise.racine@usask.ca Funding information This research received funding from Collaborative Research Grant provided by the Saskatchewan Health Research Foundation, Saskatoon, Saskatchewan, Canada. Abstract Aims: To appraise and synthesize the empirical literature on the needs and challenges of Indigenous peoples' accessibility to palliative care in rural and remote settings. Design: Whittemore and Knafl’s updated approach to integrative reviews, PRISMA guidelines and CASP (2020) checklists for narrative analysis were followed. Data Sources: A systematic search of the published empirical literature from 1 January 2015 to 31 December 2021 was undertaken in five databases. Review Methods: Twenty-four studies met the research question and the inclusion criteria. Results: Four themes describe the findings: Respect of Indigenous cultural beliefs on death and dying, connection to the land, needs for culturally responsive care and presence of institutional and systemic barriers. These themes indicate a pressing need to increase the accessibility and utilization of palliative care. Most of the studies were qualitative and conducted by teams of Indigenous and non-Indigenous researchers. Conclusion: Integrating Indigenous knowledge and providing culturally responsive palliative care are steps towards achieving the decolonization of palliative care and responding to Indigenous people's needs of palliative care services. Institutional and systemic racism affect Indigenous peoples' access and delivery of palliative services in Canada and globally. Impact: The review highlights the need for establishing partnerships and building local capacity with Indigenous communities to develop and implement culturally re- sponsive palliative care programmes in remote locations. KEYWORDS cultural competency, cultural safety, death, dying, end-of-life care, Indigenous caregivers, Indigenous peoples, integrative review, nursing practice, palliative care