Analysis of common barriers to rural patients utilizing hospice and palliative care services: An integrated literature review

Tara Tedder; Lydia Elliott; Karen Lewis

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Analysis of common barriers to rural patients utilizing hospice and palliative care services: An integrated literature review

Excerpt

Death is a taboo topic that has been institutionalized by healthcare providers and is often seen as failure of the provider to “fix” the patient (O’Brien & Jack, 2010; Smith, 2014). This needs to be overturned because the baby boomer generation coupled with medical advances are largely responsible for the growing elderly population of persons aged over 65. Elderly Americans could reach 88 million by 2050, nearly doubling the current population number (Artnak, McGraw, & Stanley, 2011). Not everyone cared for by modern medicine will get better; some will die despite the most advanced treatments and best quality care offered. “Most deaths are negotiated and occur after a period of employing life sustaining measures” (Artnak et al., 2011, p. 142). It has been said, “You prevent what you can, delay what you cannot, and support an optimal quality of life within the patient’s value system for as long as possible…death is certain but the timing is not” (Artnak et al., 2011, p. 141). This aging population comes with a unique set of needs and demands from the healthcare system, the complexity of which is furthered by rurality. Although the elderly are not the only patient population to utilize palliative (PC) and hospice care (HC), they are by far the largest population to do so. Because the growth rate of this population is expected to continue, it is anticipated that these services will be at an increased demand over the next several decades.
Researchers do not have one single definition of rural. The generalized definition is a geographical area not neighboring a city or town with sufficient healthcare resources, not greatly populated, with predominance of medically underserved patient populations (Lynch, 2013). The less populated a county is the higher degree of poverty and less likely there is to be a hospice agency to provide care. It is difficult to decipher how many counties in the United States do not have any HC because of the fact that some agencies provide services to multiple counties (Campbell, Merwin, & Yan, 2009).
HC and PC are support systems for patients and their families. These services enable patients with a life?limiting illness to live as “normally” as possible until death and then continue to support families during their bereavement (Ciemins, Brant, Kersten, Mullette, & Dickerson, 2015). More than just compassionate care is provided; it is care for the body, mind, and spirit. Both services provide a team approach to medical care, pain management, and emotional and spiritual support individualized to the patient, which is typically provided in the home; it neither increases nor decreases life expectancy (Azami?Aghdash, Ghojazadeh, Hossein?Aghaei, Naghavi?Behzad, & Asgarlo, 2015; Van Vorst et al., 2006).
There are some basic differences between HC and PC. Patients can be referred to PC any time throughout the course of a chronic illness. Often, it occurs when clinical decline from the illness begins and the patient begins to experience treatment failures. It focuses on chronic illness and symptom management for chronic diseases while the patient may still be pursuing curative treatments (Artnak et al., 2011). Referral can start early in the course of chronic illness without a projected time frame of impending death. This care is ongoing for chronic disease management, most often performed in the community within the patient’s home (Artnak et al., 2011; Kaasalainen et al., 2011). Many but not all agencies that offer PC services also have HC services. As the chronic illness progresses and the patient’s physician determines a prognosis of 6 months or less, the hospice referral process can begin. Transferring from one service to the other is generally a seamless process.

Journal of the American Association of Nurse Practitioners. 29(6):356–362, JUN 2017

DOI: 10.1002/2327-6924.12475

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PMID: 28560759

Issn Print: 2327-6886

Publication Date: 2017/06/01

Discussion Question Requirements:

Access an article from a journal listed below. When examining the nursing research article discuss the following:

Identify if article has a review of literature.

Determine the purpose of the article.

Describe how information in your article can be implemented into your nursing practice?

Provide your rationale for using this information in nursing practice?

Post the name of the article in APA format along with your responses to the critique questions.