Examining Barriers and Facilitators to Palliative Care Access in Rural Areas: A Scoping Review

Abstract

Background: Despite the growth of palliative care (PC), access to PC remains challenging for rural Americans living with chronic diseases. Given the demand and benefits of PC, a comprehensive view of PC access would inform policymakers in developing PC services in rural areas. Objective: This scoping review aimed to understand the barriers and facilitators to PC access in rural areas from the voices of service users and service providers during the past decade. Methods: A scoping literature review was conducted from 2010 to 2020 using MEDLINE, CINAHL, and PsychINFO databases. Results: Twenty-eight studies met inclusion criteria. Barriers to PC access in rural areas mostly arose in structural issues: (1) the inadequate knowledge and awareness of PC among both service users and providers and (2) the poorly structured PC system. Other barriers included communication gaps/challenges between providers and patients/families and cultural barriers. The facilitators mainly originated in patients/families’ connectedness with local providers and with other social networks such as friends. Conclusions: These findings highlight the need for funding support to increase provider competency, service availability and accessibility, and the public knowledge and awareness of PC in rural areas. A holistic and tailored PC model that standardizes care delivery, referral and coordination, including family caregiver support programs, can improve care access. Future practice and research are warranted to implement and evaluate innovative approaches, such as a coordinated community-based approach, to the successful integration of PC in rural communities.

Understanding Unmet Care Needs of Rural Older Adults with Chronic Health Conditions: A Qualitative Study

“…Rural communities have limited access to medical specialist services. Depending on the size of the community, there may be limited health infrastructure, limiting acute and chronic medical care for the diagnosis and management of complex diseases [ 7 ]. Rural older Australians experience higher rates of complex multimorbid health conditions than their urban counterparts [ 8 ].…”

“Hard to Say Goodbye Over iPad”

“…5 A recent scoping review showed that most rural areas in the United States have limited access and provision of PC services because of lack of awareness, accessibility issues such as transportation or weather, shortage of trained staff, and limited funding and resources. 3 Consequently, rural communities are more vulnerable to PC disparities in the management of chronic illness than their urban counterparts. 6 As aforementioned, the pandemic-imposed restrictions have further intensified such inequities and require immediate attention toward the provision of accessible and adequate PC services in rural communities.…”

“…2 Especially in small towns and rural communities, PC faced additional constraints due to limited funding support, resources, and facilities, resulting in the discontinuation of or inadequate PC services for patients and families in rural clinics and hospitals. 3 Rural communities demonstrate unique needs, attitudes, and behaviors toward health and illness. Individuals with advanced chronic illnesses have complex physical, psychological, social, and existential needs 4 and therefore require integrated PC services.…”

“…Individuals with advanced chronic illnesses have complex physical, psychological, social, and existential needs 4 and therefore require integrated PC services 5 . A recent scoping review showed that most rural areas in the United States have limited access and provision of PC services because of lack of awareness, accessibility issues such as transportation or weather, shortage of trained staff, and limited funding and resources 3 . Consequently, rural communities are more vulnerable to PC disparities in the management of chronic illness than their urban counterparts 6 .…”

“…Health care professionals remained unable to provide timely consultations and treatment options and facilitate decision making and psychosocial support to critically ill and dying patients and their families 2 . Especially in small towns and rural communities, PC faced additional constraints due to limited funding support, resources, and facilities, resulting in the discontinuation of or inadequate PC services for patients and families in rural clinics and hospitals 3 …”