Rural Palliative Care: A Comprehensive Review

Abstract

Background: Access to integrated, palliative care regardless of location of residence is a palliative care standard yet we know such access is limited for those living in rural and remote settings. As a beginning step in the development of research aimed at informing policy and program development, a comprehensive review of the state of knowledge regarding palliative care in rural contexts is required. Purpose: To identify, evaluate and synthesize the published literature on rural palliative care. Design: Comprehensive review. Methods: Computer searches were conducted on PubBMed, ISI Web of Science, PsycInfo, CINAHL, and Ageline using the search terms palliative care, hospice, terminal care, end-of-life care, end-of-life, and rural or remote. Results: One hundred fifty-eight studies were retrieved. After screening using relevance and quality criteria, 79 studies were included in the review. Studies were grouped by subject matter into one of three categories: patient and caregiver perspectives; professional attitudes, knowledge and practice issues; and health care services. Conclusion: The body of research literature is small and eclectic, which means there is little strong evidence to inform palliative policy and service development in rural settings. Coordinated programs of research are clearly required to develop a body of knowledge that is adequate to support effective service and policy development.

Assessing End-of-Life Preferences for Advanced Dementia in Rural Patients Using an Educational Video: A Randomized Controlled Trial

“…2 Instead, the focus of research in end-oflife decision-making has centered around urban populations. 2,3 Nevertheless, given important differences between urban and rural populations, medical practitioners should not assume that taking care of rural patients at the end of life is no different from caring for urban patients at the end of life.…”

“…2 Instead, the focus of research in end-oflife decision-making has centered around urban populations. 2,3 Nevertheless, given important differences between urban and rural populations, medical practitioners should not assume that taking care of rural patients at the end of life is no different from caring for urban patients at the end of life. 4 With the aging of rural populations, assessing the end-of-life preferences of rural elderly patients is critical for planning and providing palliative care and hospice services for diseases that 1 this underserved population is likely to confront.…”

“…[9][10][11][12][13] Such variations may be attributed to a variety of factors including different access to medical services, 3,14-16 expectations of patients, 3 race, [17][18][19][20][21][22][23][24][25] and rural-urban cultural differences. 2,3,9 The role of culture is increasingly recognized as a vital interpretive lens through which end-of-life decision-making must be understood. [26][27][28] While much has been written about the impact of cultural differences on end-of-life preferences, there have been few studies focusing on the impact of rural-urban differences on this outcome.…”

Clinical and Financial Impact of a Palliative Care Program at a Small Rural Hospital

“…Schrader et al 2 surveyed colleagues about programs in South Dakota but did not include any program characteristics. Robinson et al 3 surveyed all the evidence in multiple countries but found little programmatic data and concluded: ''. .…”

What constitutes a good death?: implications for family nurse practitioners in rural British Columbia

“…Additionally, there are numerous resources reviewing the role of primary health practitioners in rural practice (Canadian Association for Rural and Remote Nursing, 2008;MacLeod et al, 2008 ;Misener et al , 2008;Pong & Pitblado, 2005;Romanow, 2002), along with articles reviewing palliative care needs in rural settings (Crooks, Castleden, Schuurman, & Hanlon, 2009;Downing & Jack, 2012;Evans, Stone, & Elwyn, 2003 ;Robinson et al , 2009). What has been less apparent is guidance for the unique role that FNPs have in facilitating a good death, particularly within rural settings.…”