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Objectives: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. Methods: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. Results: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

Self-efficacy and confidence levels among newly graduated nurses who participated in an end-of-life simulation were compared with nurses who had been practicing for no more than a year but had not participated in an end-of-life simulation. The study included a pretest-and-posttest evaluation of an end-of-life simulation intervention during a new graduate residency program among newly graduated nurses to improve self-efficacy and confidence with end-of-life care. Nurses who had been in practice for no more than a year but had not been exposed to an end-of-life simulation intervention were also surveyed. The Palliative Care Evaluation Tool Kit was adapted and used for this project. The 2 groups of nurses were compared in terms of self-efficacy and confidence levels regarding end-of-life care. An end-of-life simulation intervention was successful in improving self-efficacy and confidence levels among newly graduated nurses, in regard to views about end of life and death and dying compared with the nurses who did not receive the end-of-life simulation intervention. The results of this study have implications for both schools of nursing and hospital training programs.