Systematic Review of Palliative Care in the Rural Setting

Bakitas, Marie; Elk, Ronit; Astin, Meka; Ceronsky, Lyn; Clifford, Kathleen; Dionne‐Odom, J. Nicholas; Emanuel, Linda L.; Fink, Regina; Kvale, Elizabeth; Levkoff, Sue E.; Ritchie, Christine; Smith, Thomas J.

doi:10.1177/107327481502200411

Cited by 93 publications

(123 citation statements)

References 49 publications

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“…Being able to communicate the benefits of transitioning from curative to PC and comfort care services can be a difficult conversation for many providers to have with their patients. Providers may often feel they have failed their patient by being unable to cure their terminal disease (Bakitas et al., ). These are difficult conversations that without proper training are easily deferred because they often come with negative reactions from patients and families when they face the idea that they will not get better.…”

Section: Literature Reviewmentioning

confidence: 99%

Analysis of common barriers to rural patients utilizing hospice and palliative care services

Tedder

Elliott

Lewis

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose The aim of this literature review is to explore barriers and potential solutions related to hospice (HC) and palliative care (PC) services among rural residents. Although the healthcare system is continually advancing, healthcare providers may not be optimizing HC and PC referrals for the growing rural population who underutilize these services. Suggested methods to close the utilization gap between HC and PC services among rural patients appear feasible, but universal effectiveness cannot be determined. Methods An integrative literature review was conducted to evaluate diverse sources of literature. An electronic literature search was carried out using databases MEDLINE, CINAHL, Cochrane, PsycINFO, and Pubmed. The search was limited to English only, full text, peer reviewed, and published between 2010 and 2016. Search terms included rural, hospice, palliative, care access, and barriers. Conclusion There are several barriers that interrelate to decreased utilization of PC and HC for rural populations and there are many options for overcoming them to equalize care. Implications for practice Although advances to the general healthcare system are expediently rising, the rural patient population seems to fall short of these important life‐changing services, especially in the realm of PC/HC. Beginning in primary care, this patient population can be affected and included in a positive manner.

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Section: Literature Reviewmentioning

confidence: 99%

Analysis of common barriers to rural patients utilizing hospice and palliative care services

Tedder

Elliott

Lewis

2017

Journal of the American Association of Nurse Practitioners

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“…One voice that remains largely unheard is that of rural palliative care patients and their families (Bakitas et al . ).…”

Section: Introductionmentioning

confidence: 97%

“…Ideally, it must reflect the needs of the community and in particular those of the dying person and their carers (Cottrell & Duggleby 2016). One voice that remains largely unheard is that of rural palliative care patients and their families (Bakitas et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Rural residents' perspectives on the rural ‘good death’: a scoping review

Rainsford

MacLeod

Glasgow

et al. 2016

Health Soc Care Community

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The 'good death' is one objective of palliative care, with many 'good death' viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the 'good' rural death through the perspectives of rural residents, including rural patients with a life-limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand-searched. Twenty articles (for 17 studies and one systematic review) were identified after a two-phase screening process by two reviewers, using pre-determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life-limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a 'good death' is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a 'good death', there is a need for further studies to elicit rural patient and family caregiver perspectives.

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“…Authors have acknowledged the potential contribution that telehealth could play in palliative care for patients in rural and remote areas [15], the role that mobile technologies could play [16], and opportunities for specific population groups such as paediatrics [17] or lung cancer [18]. However, reviews and trials have also highlighted the need to build the evidence around palliative care telehealth in the community [12–14, 19, 20].…”

Section: Introductionmentioning

confidence: 99%

Using telehealth to support end of life care in the community: a feasibility study

et al. 2016

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BackgroundTelehealth is being used increasingly in providing care to patients in the community setting. Telehealth enhanced service delivery could offer new ways of managing load and care prioritisation for palliative care patients living in the community. The study assesses the feasibility of a telehealth-based model of service provision for community based palliative care patients, carers and clinicians.MethodsThis study was a prospective cohort study of a telehealth-based intervention for community based patients of a specialist palliative care service living in Southern Adelaide, South Australia. Participants were 43 community living patients enrolled in the Southern Adelaide Palliative Service. To be eligible patients needed to be over 18 years and have an Australian modified Karnofksy Performance Score > 40. Exclusion criteria included a demonstrated inability to manage the hardware or technology (unless living with a carer who could manage the technology) or non-English speaking without a suitable carer/proxy. Participants received video-based conferences between service staff and the patient/carer; virtual case conferences with the patient/carer, service staff and patient’s general practitioner (GP); self-report assessment tools for patient and carer; and remote activity monitoring (ACTRN12613000733774).ResultsThe average age of patients was 71.6 years (range: 49 to 91 years). All 43 patients managed to enter data using the telehealth system. Self-reported data entered by patients and carers did identify changes in performance status leading to changes in care. Over 4000 alerts were generated. Staff reported that videocalls were similar (22.3%) or better/much better (65.2%) than phone calls and similar (63.1%) or better/much better (27.1%) than face-to-face. Issues with the volume of alerts generated, technical support required and the impact of service change were identified.ConclusionsThe trial showed that patients and carers could manage the technology and provide data that would otherwise not have been available to the palliative care service.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000733774 registered on 02/07/2013.

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Systematic Review of Palliative Care in the Rural Setting

Cited by 93 publications

References 49 publications

Analysis of common barriers to rural patients utilizing hospice and palliative care services

Analysis of common barriers to rural patients utilizing hospice and palliative care services

Rural residents' perspectives on the rural ‘good death’: a scoping review

Using telehealth to support end of life care in the community: a feasibility study

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