Is it possible to devise a method of delivering effective ongoing palliative care to cancer patients living in rural communities? Yes, and its success relies on nurses, according to a recent study conducted in the Canadian province of British Columbia.1
RURAL HEALTH CARE CHALLENGES
People in the many rural areas of British Columbia are older and, according to the researchers, are aging proportionately faster than their urban counterparts. Cancer and chronic illness rates are higher among this population.1 A number of barriers, however, impact access to medical care for this population. A shortage of providers results in limited health care services of any kind, and the further away from an urban core people live, the more the availability of medical care deteriorates. Severe weather conditions lead to difficult travel conditions, and patients and family caregivers frequently cannot get the support and information they need.
Thirty percent of patients with cancer living in rural areas experience multiple admissions to acute care facilities during their last month of life, compared with 20% of their counterparts living in urban areas. Patients in rural areas also utilize emergency departments, family physicians, and pharmacists more often. Compared with people who live in an urban setting, patients in rural areas undergo more medical procedures in the year before they die. This is a sad irony, because these are people who would prefer to die at home.1
With these facts in mind, Barbara Pesut, PhD, RN, associate professor, School of Nursing, and Canada Research Chair, at University of British Columbia, Okanagan, and colleagues undertook a pilot study to test the feasibility of establishing a palliative supportive service for older patients with cancer and other life-limiting illnesses who live in rural areas. They concentrated on two communities with a population of 10,000 people each. The towns are located 30 minutes from each other; each is a difficult 4-hour drive from a facility that offers palliative care, making the communities an ideal location for a rural service. In the part of British Columbia where the research was conducted, an estimated more than 600,000 people must drive long distances over difficult terrain, often in inhospitable weather, just to reach a health care facility of any type.
The rural palliative supportive service functions independently, with no links to urban specialists. It is designed to expand the network of primary care in the rural community, and functions under the aegis of the family physician in that community. At the program’s core is the nurse coordinator who functions as an oncology nurse navigator. The nurse coordinator ensures and facilitates continuity of care, and promotes palliative care that is centered on the patient and family. An important facet of the nurse coordinator’s role is to help the patient navigate through the health care services the community offers. The nurse coordinator receives support from a community-based clinical team of a nurse practitioner and a general practitioner, both of whom are trained in palliative care.