A Longitudinal Pilot Study for Examining Symptom Reduction in Patients With Cancer in a Palliative Care Program: A Primarily Rural Northeast Texas Population

Patient and family perspectives on rural palliative care models: A systematic review and meta-synthesis

BACKGROUND

Almost half the world's population lives in rural areas. How best to provide palliative care to rural populations is unclear. Privileging rural patient and family voices about their experiences of receiving care delivered via rural palliative care models is necessary.

AIM

To identify the key palliative care elements that rural patients with palliative care needs and their families perceive to be critical to receiving the care and support they need to live well.

DESIGN AND DATA SOURCES

A systematic review and meta-synthesis registered with Prospero (CRD42020154273). Three databases were searched in June 2024. Raw qualitative data were extracted and analysed using Thomas and Harden's three-stage thematic synthesis methodology. Findings reported according to the PRISMA statement.

RESULTS

Of the 10,834 identified papers, 11 met the inclusion criteria. Meta-synthesis of extracted, raw quotes (n = 209) revealed three major themes: (1) Honouring the patient's existing relationship with their General Practitioner (GP); (2) strategically timed access to specialist services, clinicians and equipment is critical; and (3) a need to feel safe, prepared and supported.

CONCLUSION

The strategic inclusion of specialists alongside primary care providers is integral to optimising rural palliative care models. General Practioners are central to these models, through being embedded in their communities and as the conduit to specialist palliative care services. Rural palliative care patients and families value responsive care, trajectory signposting, effective communication, 24/7 support and recognise the value of virtual health. Globally, positive public policy and funding is critical to ensuring access to GP-led, specialist-supported, rural palliative care models.

Evidence-based models of rural palliative care: A systematic review

BACKGROUND

Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes.

AIM

To identify the key care elements that optimise palliative care for people in rural communities.

DESIGN AND DATA SOURCES

A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework.

RESULTS

Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing.

CONCLUSIONS

A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs.Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273.

What is the impact of specialist palliative care outpatient consultations on pain in adult patients with cancer? A systematic review

PURPOSE

The aim of this systematic review was to determine the impact of specialist palliative care (SPC) consultations in outpatient settings on pain control in adults suffering from cancer.

METHODS

Systematic Review. Databases CINAHL, Medline, PsychInfo, and Embase were searched in February 2021. Relevant studies were also hand-searched and gray literature was searched in February 2021. The PICO mnemonic (Population, Intervention, Comparison, and Outcome) was used to form the review question. Of 1053 potential studies identified, 10 met the inclusion criteria. Quality appraisal of included studies was conducted using the evidence-based librarian (EBL) critical appraisal checklist.

RESULTS

Outcome data from 56% (n = 5/9) studies indicated a non-statistically significant reduction in pain. Narrative analysis of the remaining studies indicated a statistically significant reduction in pain in 50% (n = 2/4) of the studies, one study showed mixed results, and one study found no statistically significant improvement in pain control. In relation to secondary outcomes, results from 33% (3/9) of studies indicated statistically significant improvement in symptom control. Data from 22% (n = 2/9) of studies indicated no statistically significant improvement in the symptoms measured. Narrative analysis of the remaining four studies indicated generally mixed results. EBL scores of included studies ranged between 50% and 95.23%.

CONCLUSION

Outpatient SPC consultations may have a positive impact on the control of pain and other distressing symptoms for cancer patients, however, results show mixed effects. Given that it is unclear what it is about outpatient SPC that impacts positively or otherwise on pain and symptom control.