Table 1 Challenges, gaps in services, and barriers to care

• “I feel comfortable having many difficult discussions about death and dying and depression but finances, I probably feel less comfortable with just because it's not something we're taught, and I don't want to make the patient feel uncomfortable, even though it's probably something they need to talk about. And because I don't know what to do for them sometimes, I mean besides sending them to someone else or the social worker. I don't always feel like I know how to improve that situation, so it's a hard conversation to have.” CI4

• “Cause that was one of the main things that really was on my mind almost every day. Is, I can go without a car. I can, you know, I have family I that I can stay with if it ever came to not being able to pay rent…but, you know, something to eat is something else” PT6

• “Well, we are on uh social security. And so, we only get so much a month and to come down here to Oklahoma City, it costs us anywhere from $150 to $200 dollars if we spend the night. For gas, motel, and eats. And we don’t eat much, you know, we just eat out cheaply.” PT8

• “I had a patient who…needed surgery and we had it scheduled, and the tribe actually wanted to get him on Medicare expansion…to cover it…We sort of got that message late and then it delayed the surgery once and then…we didn’t get told that that change had happened, and so it delayed the surgery a second time. And I just felt really horrible for the poor guy.” CI5