All individuals deserve to have access to quality end-of-life care. In rural communities within the United States, significant barriers limit access to hospice and palliative care. They include issues related to geography and supply, health care system eligibility criteria, limitations of the available workforce, educational deficits, and differences in cultural values. This article examines the barriers and potential solutions to address the gaps in hospice and palliative care services in rural communities. Strategies are proposed to strengthen hospice and palliative care delivery models to enhance earlier referrals and provide better facilitation and transition to hospice and palliative care. Future research should look at patient utilization questions specific to rural communities.
National Hospice and Palliative Care Organization. NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care Organization. 2010.
2.
ConnorSRElwertFSpenceCChristakisNA. Geographic variation in hospice use in the United States in 2002. J Pain Sympt Manage. 2007;34(3):277–285.
3.
MorrisonRSMeierDE. Report Card: America's Care of Serious Illness. A State by State Report Card on Access to Palliative Care in Our Nation's Hospitals. New York, New York Center to Advance Palliative Care; National Palliative Care Research Center;2011.
4.
National Rural Health Association. Providing Hospice and Palliative Care in Rural and Frontier Areas. Kansas City, MO: National Rural Health Association. 2005.
5.
RemingtonRWakimG. A comparison of hospice in the United States and the United Kingdom. J Gerontol Nurs. 2010;36(9):16–21.
6.
ValenteSM. End of life and ethnicity. J Nurses Staff Develop. 2004;20(6):285–293.
ConnorSR. Development of hospice and palliative care in the United States. Omega: J Death Dying. 2007;56(1):89–99.
9.
CaseyMMMoscoviceISVirnigBADurhamSB. Providing hospice care in rural areas: challenges and strategies. Am J Hosp Palliat Med. 2005;22(5):363–368.
10.
VirnigBAMaHHartmanLKMoscoviceICarlinB. Access to home-based hospice care for rural populations: identification of areas lacking service. J Palliat Med. 2006;9(6):1292–1299.
11.
CampbellCLMerwinEYanG. Factors that influence the presence of a hospice in a rural community. J Nurs Scholar. 2009;41(4):420–428.
MadiganEAWiencekCAVander SchrierAL. Patterns of community-based end-of-life care in rural areas of the United States. Policy, Politics NursPract. 2009;10(1):71–81.
14.
CarlsonMDBradleyEHDuQMorrisonRS. Geographic access to hospice in the United States. J Palliat Med. 2010;13(11):1331–1338.
15.
SilveiraMJConnorSRGooldSDMcMahonLFFeudtnerC. Community supply of hospice: does wealth play a role?J Pain Sympt Manage. 2011;42(1):76–82.
16.
ConnorSR. U.S. hospice benefits. Journal of Pain & Symptom Management. 2009;38(1):105–109.
17.
TaylorDOOstermannJVan HoutvenCHTulskeyJASteinhauserK. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?Soc Sci Med. 2007;65(7):1466–1478.
ConnorSRElwertFSpenceCChristakisNA. Racial disparity in hospice use in the United States in 2002. Palliat Med. 2008;22(3):205–213.
21.
CarlsonMDAMorrisonRSBradleyEH. Improving access to hospice care: informing the debate. J Palliat Med. 2008;11(3):438–443.
22.
HeadBALaJoieSAugustine-SmithL. Palliative care case management: increasing access to community-based palliative care for Medicaid recipients. Prof Case Manage. 2010;15(4):206–217.
23.
NelsonJAGingerichBS. Rural health: access to care and services. Home Health Care Manage Pract. 2010;22(5):339–343.
24.
OlverIBrooksbankMChampionNKeeleyJ. The use of videophones to enhance palliative care outreach nursing in remote areas. Prog Palliat Care. 2005;13(5):263–267.
25.
JennettPAGagnonMPBrandstadtHK. Preparing for success: readiness models for rural telehealth. J Postgrad Med. 2005;51(4):279–285.
26.
KaufmanJFormanWB. Hospice and palliative care: an educational intervention for healthcare professionals in a rural community. Am J Hosp Palliat Med. 2005;22(6):415–418.
