Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas

Abstract

Mounting evidence supports oncology organizations’ recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports

“…For instance, evidence shows that palliative care education, in general, and palliative care nursing education, specifically, are paramount to ensure access to adequate palliative care, particularly in countries with populations living in rural and remote areas. 50,66–72 A possible explanation for within-country variations could be that some respondents, although identified as experts by their peers, were not well aware of the situation in their countries. Moreover, within-country variations mostly occurred in countries with larger number of respondents or having an administrative structure that permits the establishment of regional frameworks and regulation.…”

“…For instance, evidence shows that palliative care education, in general, and palliative care nursing education, specifically, are paramount to ensure access to adequate palliative care, particularly in countries with populations living in rural and remote areas. 50,[66][67][68][69][70][71][72] A possible explanation for within-country variations could be that some respondents, although identified as experts by their * Not in all European countries were respondents unanimous in their judgement of whether a certain level of education was available. The decision rule on how we dealt with unanimous information is provided above in the text.…”

Can you hear me now?: Improving palliative care access through telehealth

“…Another key consideration is the limited access and utilization of technology that affect LMIC and rural areas (Gray et al, 2020). With the expansion of broadband access and services, it is imperative that states implement legal, practical, and strategic plans to provide PC via telehealth for everyone everywhere (Bakitas, Allen Watts, et al, 2020), especially in underserved rural areas where there are existing healthcare disparities (Gray et al, 2020). As the telehealth field grows, we must continue to monitor potential disparities among underserved groups, to ensure all groups have equal access to this service.…”

Telemedicine in Otolaryngology in the COVID‐19 Era: Initial Lessons Learned

“…6,8 The use of telemedicine in otolaryngology has been previously described as a lifeline for patients during Hurricane Katrina, delivering compassionate care to palliative patients, and largely on a trial basis for rural or postoperative patients. [10][11][12] However, these experiences were in the context of barriers to care, such as natural disasters and large distances to care, and not necessarily addressing routine visits under normal circumstances. 13,14 Although the COVID-19 pandemic is similar to previous natural disasters with a disruption of standard operations, it differs from past natural disasters, such as Hurricane Katrina, in that it represents a situation where the normal infrastructure for the delivery of care is still in place.…”

“…The use of telemedicine in otolaryngology has been previously described as a lifeline for patients during Hurricane Katrina, delivering compassionate care to palliative patients, and largely on a trial basis for rural or postoperative patients 10–12 . However, these experiences were in the context of barriers to care, such as natural disasters and large distances to care, and not necessarily addressing routine visits under normal circumstances 13,14 .…”