<p class="abstract"><strong>Background:</strong> Delayed admission to palliative and hospice services is prevalent and, especially in rural areas, contributing to poor quality of care, caregiver stress and burden, reducing patients’ and their caregivers' quality of life and increasing healthcare costs. A reliable and sensitive screening tool would help clinicians identify patients in need of palliative care services. The purpose of the study is to develop and test a screening tool to be used by healthcare professionals in rural clinics and hospitals to identify patients with progressive, multiple chronic illnesses in need of primary palliative care services.</p><p class="abstract"><strong>Methods:</strong> A longitudinal, sequential mixed-method methods design will be used to achieve the purpose of the study. A rural community hospital and its affiliated community clinics in the Midwestern United Sates are selected for the study. In Phase I, we will conduct a cohort study using existing electronic health records. The cross-sectional and correlational quantitative data analysis will be used to test the psychometric properties of the current and modified palliative care screening tools. In Phase II, we will prospectively collect functioning and physical activity level data from the patients admitted to the palliative care program over time (monthly for 6 months). Again, the primary focus is to conduct correlational quantitative analysis to evaluate the psychometric properties of the modified palliative screening tool</p><p><strong>Conclusions:</strong> The implication of this project is to 1) reduce healthcare disparities, 2) improve quality of care for rural patients with chronic serious illness; 3) inform the development of a hybrid (both inpatient and outpatient) screening tool for identifying palliative care needs that can be integrated into primary palliative care programs; and 4) enhance our understanding of mechanisms and relevant variables related to palliative care in rural patients living with chronic serious illness, leading to future program research in this field.</p>
