Systematic Review of Palliative Care in the Rural Setting.

BACKGROUND: Many of the world's population live in rural areas. However, access and dissemination of the advances taking place in the field of palliative care to patients living in rural areas have been limited. METHODS: We searched 2 large databases of the medical literature and found 248 relevant articles; we also identified another 59 articles through networking and a hand search of reference lists. Of those 307 articles, 39 met the inclusion criteria and were grouped into the following subcategories: intervention (n = 4), needs assessment (n = 2), program planning (n = 3), program evaluation (n = 4), education (n = 7), financial (n = 8), and comprehensive/systematic literature reviews (n = 11). RESULTS: We synthesized the current state of rural palliative care research and practice to identify important gaps for future research. Studies were conducted in the United States, Australia, Canada, Africa, Sweden, and India. Two randomized control trials were identified, both of which used telehealth approaches and had positive survival outcomes. One study demonstrated positive patient quality of life and depression outcomes. CONCLUSIONS: Research to guide rural palliative care practice is sparse. Approaches to telehealth, community- academic partnerships, and training rural health care professionals show promise, but more research is needed to determine best practices for providing palliative care to patients living in rural settings.

Quality Measures for Community-Based, Rural Palliative Care Programs in Minnesota: A Pilot Study.

BACKGROUND: Despite the growth of palliative care programs in many urban areas, palliative care programs remain less common in rural communities. As more community-based programs emerge, particularly in rural areas, it will be important to establish a standard set of quality measures that are useful for improving care and feasible for program evaluation. OBJECTIVES: The study's objective was to identify and field test a standard set of quality measures for rural, community-based palliative care programs that reflect clinical quality, patient and family experience, and impact on inpatient and emergency department utilization. METHODS: A pilot program was conducted to test standardized quality measures for rural, community-based programs. Measures were identified through review of existing measures and input from experts in palliative care and rural health services. The study was carried out in 2012 and 2013 in five community-based palliative care programs from rural communities. A total of 138 palliative care patients were included. Measurements were chart abstraction, patient and family experience surveys, patient-level health care utilization, and program-level operations surveys. Phone interviews with each participating program were performed at the study's end. RESULTS: The participating programs found the measures feasible to collect, and the information they provided aided in assessment, comparison of structure, and process improvement for care delivery. Program staff suggested additional potential measures and expressed their desire to track the measures beyond the pilot time frame. CONCLUSION: The standard measures developed and tested were deemed feasible to collect and useful for all five participating rural, community-based palliative care programs.

Minnesota Rural Palliative Care Initiative: building palliative care capacity in rural Minnesota.

BACKGROUND: Significant gaps exist in the availability of palliative care in rural hospitals and communities, even though rural populations are often disproportionately elderly and chronically ill. Few studies have examined what models of palliative care would be sustainable in a rural community. METHODS: We studied the effects of a novel approach to palliative care program development with 10 rural Minnesota community teams over 18 months. The Minnesota Rural Palliative Care Initiative (MRPCI) included a three-prong framework consisting of community capacity theory, a learning collaborative model, and the National Quality Forum (NQF) Preferred Practices for Palliative and Hospice Care Quality. RESULTS: MRPCI confirmed the feasibility of building palliative care capacity in rural communities using this framework. By the end of the 18 months, all 10 teams had identified a target population, developed and refined an action plan, and included at least two strategies to address community needs or gaps related to NQF preferred practices. Only one community had an existing palliative care program at the start of the MRPCI. During the course of the collaborative, five additional communities built a core team to implement a palliative care program. CONCLUSIONS: Palliative care development is necessary in rural communities, and envisioning a program that combines structure, accountability, customized guidance, tools, and networking across settings is essential for success.

Oncology nurses' perceptions of nursing roles and professional attributes in palliative care.

Managing symptoms, providing information, and supporting families as well as patients are key aspects of palliative care. However, palliative care definitions and perspectives vary widely in clinical practice and often do not align with palliative care organizations' perspectives. Definitional discrepancies may result in delayed referrals and role confusion, which often limit the effectiveness of palliative care programs and contribute to gaps in care and services for patients and their families. The aim of this research study was to explore oncology nurses' perspectives of palliative care through narrative analysis of participants' descriptions of life experiences. Studying nurses' perceptions of their roles in palliative care offers an opportunity to examine and improve clinical practice. Nine focus groups were conducted with 33 oncology nurses in three medical centers in the midwestern region of the United States. Researchers inductively coded research text within each focus group session, sorted across sessions using Atlas.ti 5.2 software, and then applied categorical-content narrative analysis. Findings revealed five primary nursing roles: teaching, caring, coordinating, advocating, and mobilizing. In all five roles, seven professional attributes were described: clinical expertise, honesty, family orientation, perceptive attentiveness, presence, collaboration, and deliberateness. Integrating palliative care standards into role and attribute development and working with palliative care specialty teams are suggested.

Oncology nurses' perceptions about palliative care.

PURPOSE/OBJECTIVES: To explore oncology nurses' perceptions about palliative care. RESEARCH APPROACH: Descriptive study with narrative data analysis. SETTING: Oncology units in three midwestern hospitals. PARTICIPANTS: 33 actively practicing oncology nurses. METHODOLOGIC APPROACH: Oncology nurses participated in focus groups that elicited concrete experiences and reflections about palliative care. Researchers identified subtexts by which to sort data, worked inductively in each subtext to identify categories, resorted the text according to the categories, carefully examined the category narratives, and established narrative descriptors that captured the essence of each category. Data matrices were constructed to examine the emerging categories more closely. MAIN RESEARCH VARIABLE: Oncology nurses' perceptions about palliative care. FINDINGS: Narratives revealed 14 descriptors about palliative care. Considerable agreement occurred in nurses' descriptions about the nature of palliative care. Divergent viewpoints were evident as nurses described how palliative care intersects with other practice areas. Three descriptors of the healthcare context in which palliative care occurs were identified: limited time for addressing complex palliative care issues, health care's emphasis on prolonging life, and the challenge of coordinating care across disciplines. CONCLUSIONS: Participants clearly comprehend palliative care goals. However, divergent perspectives about the intersections of palliative care with oncology nursing may limit timely consultation with specialty palliative care teams. The current acute care context poses challenges to implementing palliative care. INTERPRETATION: Palliative care teams and oncology nurses need to develop partnership models that clearly illustrate how both partners contribute to palliative care across the continuum of oncology care. Furthermore, the partnership models must address barriers that the acute care context poses to quality palliative care.