Rural Nonphysician Providers' Perspectives on Palliative Care Services in Northwestern Ontario, Canada

Abstract

Most palliative care in rural remote areas is provided by nonphysicians. This paper reports a survey of interdisciplinary rural health service providers (not including physicians) to identify the strengths and weaknesses in palliative care service delivery in a rural and remote region in northwestern Ontario, Canada. Questionnaires were sent to 156 nurses, homemakers, social workers, and pastoral care workers who care for terminally ill persons and their families, and 122 were completed and returned (response rate 78%). Consistent with practice in most rural areas, 90% of respondents were generalists. Respondents identified several problems with palliative care services, including inadequate training for caregivers, inadequate support services for family and professional caregivers, inadequate human resources, and lack of organized volunteer programs. Suggestions for improvements included better education for service providers; better availability of palliative care services; more counseling and support services for patients, family members, and professionals; and greater availability of respite beds. Overall, respondents rated clients' needs as being better met than their own. The most frequently reported problems for care providers were related to the lack of supports for care provision.

Issues in Rural Palliative Care: Views From the Countryside

“…An important and novel finding of this project was related to preferred place of death. Unlike the widely accepted premise that home deaths are preferable, 15 in our data hospital deaths were sometimes viewed positively, particularly if the admission occurred in the last 48 hours of life, and if the hospital was located within the community. Participants explained that comfort with dying in hospital was related to the intimate and familiar nature of rural hospitals, where care providers were frequently known.…”

“…Limited homecare and volunteer services available to rural palliative patients related to insufficient numbers of providers, geographic distances, and difficult weather conditions 13,15 were reflected in the study communities. Participants discussed the challenges of recruiting and keeping volunteers as well as the difficulties of sustaining a palliative care program if the key champion resigned, a finding that has been reported in the literature 16,17 .…”

'It's very difficult to get respite out here at the moment': Australian findings on end-of-life care for Indigenous people

“…Recently, the government of South Australia (DHS 2004) reported that the lack of accessible respite services is an issue of concern for people with a disability living in rural areas with people with high health needs continuing to depend on metropolitanbased services for health care. The urban-rural comparison is confirmed by researches from the United Kingdom (Bradley 1996), Canada (Kelly et al . 2003) and the USA (Burman et al .…”

Planning and Providing End‐of‐life Care in Rural Areas

“…More recently, 122 rural nurses, homemakers, social workers, and pastoral care workers in the Canadian province of Ontario were surveyed about EOL care (as nonphysicians provide the majority of EOL care in rural areas). 23 Most (90%) indicated they neither specialize in nor exclusively provide palliative care. Inadequate training, support for family and professional caregivers, human resources, and volunteer programs were reported.…”