Evaluation of a scheme to enhance palliative cancer care in rural Wales

Rural Palliative Care: A Comprehensive Review

Abstract Background: Access to integrated, palliative care regardless of location of residence is a palliative care standard yet we know such access is limited for those living in rural and remote settings. As a beginning step in the development of research aimed at informing policy and program development, a comprehensive review of the state of knowledge regarding palliative care in rural contexts is required. Purpose: To identify, evaluate and synthesize the published literature on rural palliative care. Design: Comprehensive review. Methods: Computer searches were conducted on PubBMed, ISI Web of Science, PsycInfo, CINAHL, and Ageline using the search terms palliative care, hospice, terminal care, end-of-life care, end-of-life, and rural or remote. Results: One hundred fifty-eight studies were retrieved. After screening using relevance and quality criteria, 79 studies were included in the review. Studies were grouped by subject matter into one of three categories: patient and caregiver perspectives; professional attitudes, knowledge and practice issues; and health care services. Conclusion: The body of research literature is small and eclectic, which means there is little strong evidence to inform palliative policy and service development in rural settings. Coordinated programs of research are clearly required to develop a body of knowledge that is adequate to support effective service and policy development.

General practitioners' attitudes to palliative care: A Western Australian rural perspective

BACKGROUND

People with a terminal illness and their families who live in rural or remote areas of Australia face difficulties in accessing palliative care services as a result of physical isolation. This leads to rural general practitioners (GPs) carrying the burden of care, which is often exacerbated by a lack of support staff.

OBJECTIVE

This research addressed the following questions: What are GPs' attitudes to palliative care in a rural center of Western Australia? What factors contribute to GPs' attitudes to palliative care in a rural center of Western Australia? What are the perceived barriers to the provision of palliative care in a rural center of Western Australia?

DESIGN

A qualitative in-depth research design was used for this study due to the exploratory nature of the research. A model of attitudes that considers an attitude as a summary evaluation of an issue based on: cognitive information, (thoughts and beliefs), affective or emotional information, and information concerning behavior, was used.

PARTICIPANTS

Participants were 10 registered GPs located within the Greater Bunbury Division of General Practice in Western Australia.

RESULTS

Six themes emerged from the research: maintaining patients' quality of life, providing continuity of care, experiencing emotional issues, collaborating with a multidisciplinary team, acknowledging the need for education and training, and dealing with the wider context.

CONCLUSION

Education and training for rural GPs needs to be relevant to the local context and needs to focus on emotions and beliefs.

Systematic review of educational interventions in palliative care for primary care physicians

BACKGROUND

A literature review of educational interventions in palliative care (PC) for primary care physicians (PCP) was performed, to evaluate its impact in changing professional practice.

METHODS

Studies undertaking any educational intervention in PC by PCP, published between 1966 and February 2005, identified through Medline, EMBASE, Cochrane Database of Systematic Reviews and Clinical Trials, Educational Resources Information Centre, Research and Development Resource Base in Continuing Medical Education, Spanish Medical Index, using a combined text word and MESH heading search strategy.

RESULTS

Eighteen articles were included with 1653 physicians. Educative methods were: role model training, small group discussions, and distribution of guidelines. Quality of the studies was low. Opioids prescription improved in two studies. Discrepancies were shown between the perception of PCP in symptom management, determined through questionnaires, and the data concerning opioids prescription. Knowledge improved in all studies. Some benefit of multifaceted approach was stated. Carers were satisfied, in general, with the PCP care, but dissatisfied with patients' pain control.

CONCLUSION

PC education for PCP is poorly studied. Adequate research designs are necessary in future studies with objective outcomes and patient opinion.