Cathy L. Campbell

Factors That Influence the Presence of a Hospice in a Rural Community

PURPOSE The purpose of this study was to identify socioeconomic, physician-related, and rural-urban factors that may influence the presence of a Medicare-certified hospice in three rural-urban areas. DESIGN This was secondary analysis of selected socioeconomic, physician-related, and rural-urban data from 3,140 counties using the 2005 Area Resource File, a county-level database. The county was the unit of analysis. METHODS Descriptive statistics were calculated for selected socioeconomic, physician, and rural-urban variables for the data set of 3,140 counties. Logistic regression was used to identify variables that influenced the presence of a Medicare-certified hospice across three rural-urban areas. FINDINGS As the rural-urban classification progressed from metropolitan (least rural) to rural-nonadjacent (most rural), the physician rate, racial-ethnic diversity, and number of counties with at least one Medicare-certified hospice decreased. However, in all three rural-urban areas only the physician rate was consistently significantly associated with the presence of a Medicare-certified hospice. CONCLUSIONS Given the increasing numbers of patients and families who will be facing end-of-life care issues across the globe, access to hospice care is a significant end-of-life outcome. The most rural communities are least likely to have a Medicare-certified hospice. The higher the physician rate, the more likely a county is to have a Medicare-certified hospice. The Medicare Hospice Benefits regulations requiring a physicians certification of terminal illness may be creating a barrier to hospice care, especially in rural communities. In this study, racial-ethnic diversity decreased as the rural-urban classification progressed from metropolitan (least rural) to rural-adjacent to metro to rural-nonadjacent (the most rural). The availability of Medicare-certified hospices in the metro and rural nonadjacent counties was influenced by the minority composition of the county. More research is needed on how the interaction of rurality, race-ethnicity, and physician access may affect access to hospice in rural communities. CLINICAL RELEVANCE Increasing numbers of patients and their families across the globe will be facing end-of-life care. One of the most common barriers to end-of-life care in rural communities all over the world is physician availability. People living in rural communities with few physicians may experience less access to the comprehensive services of hospice than people living in metropolitan communities and therefore not realize important end-of-life outcomes such as symptom management, improved quality of life, financial support, and bereavement support.

A systematic review of cognitive behavioral interventions in advanced cancer

OBJECTIVE To systematically review cognitive behavioral interventions for people with advanced cancer. METHODS A literature search was conducted using Medline©, CINAHL©, and Psych-info©. INCLUSION CRITERIA studies were included in the review if they met the following criteria: (1) the design was a randomized clinical trial, (2) the study tested a cognitive behavioral therapy, including psycho-educational, alternative and complementary therapies (i.e. acupuncture, relaxation), expressive, support and skill building interventions, (3) participants were adults (18 years of age or older) with advanced cancer and the (4) outcomes were directly related to the patient with advanced cancer. RESULTS 11 studies met the inclusion criteria. Of the studies in the review: treatment effects were not statistically significant in most studies, methods were not consistently described, and samples had limited racial/ethnic diversity. CONCLUSION The interpretation of the effectiveness of the CBIs was limited by major challenges to the internal validity of the studies included in the review. The lack of data about the efficacy of CBIs to support people with advanced cancer is a gap in the current knowledge base. PRACTICE IMPLICATIONS Given the needs of people living with advanced cancer well-designed studies are needed to test interventions that will improve outcomes for people living with advanced cancer.

A team approach to recruitment in hospice research: engaging patients, close people and health professionals

Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care. A successful recruitment plan includes three key strategies: identifying key members of the MDRT early in the research process; having a clear and constant communication stream; and creating an environment where all team members have a shared commitment to the research, all voices are heard and valued, and everyone contributes to the research aims. An MDRT approach will be helpful to guide the development of successful recruitment plans for academic-community research partnerships in the hospice setting.

Racial/Ethnic Perspectives on the Quality of Hospice Care

Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).

Advanced Prostate Cancer Survivors: Implications for Palliative Care

Introduction: Men with long term advanced cancer of the prostate can be considered transitional cancer survivors because many have complex physical, emotional, and psychosocial needs that extend beyond the active treatment period. Methods: Health care providers completed a survey identifying the needs most common to men with advancedprostate cancer. Descriptive statistics were used to describe the sample and analyze the survey data, including means for continuous variables and frequencies for categorical variables. Qualitative content analysis was used to analyze the cancer-related topics suggested by the respondents that were not included in the questionnaire. Results: Thirty providers completed the survey. Mean age of respondent was 46.8 years. The majority of participants reported that their race was White, indicated that they were physicians, and reported that they practiced in outpatient or ambulatory care settings. The respondent’s mean years in the current clinical role, current clinical setting and experience with people with advanced cancer was 17.8 years, 11.0, and 17.3, respectively. The needs identified by the respondents as important (listed from highest to lowest frequency) were help with decisions (92%), help with hands-on care (88%), and referral to community resources (88%), financial assistance (85%), help with anxiety or depression (85%), help with grieving (77%), and help with an advanced directive (73%). The needs that least likely to be addressed by the health care providers in their clinical settings were financial assistance (95%), spiritual care (84%), and help with grieving (58%). Discussion: While community-based physician practices are able to address the direct physical needs, they may have limited ability to provide emotional, spiritual or financial support that are needed by families. Given the large and growing number of long-term survivors, the time has come to develop comprehensive plans of care that integrate palliative care principles throughout all phases of the cancer journey.

Palliative care in Thailand

In Thailand, several barriers exist that prevent people with life-limiting illnesses from accessing good-quality palliative care, namely: lack of palliative care providers; lack of training and education for the palliative care workforce; and issues with availability and distribution of opioids. Without palliative care, people suffer needlessly during the last months of their life. This paper gives an analysis of these issues and provides recommendations for clinical practice, research and health policy that may help to alleviate these issues.

Pain Management Topics of Interest for Nurses in Rural Appalachia

BACKGROUND Continuing education for registered nurses is a component of safe, effective pain management in every clinical setting. METHODS Two hundred ninety-one registered nurses from seven counties in rural southwestern Virginia completed a 22-item survey that assessed their interest in pain management topics. RESULTS The mean interest score for all respondents was 4.04 (range = 1 to 5). Mean interest scores did not differ significantly between younger and older respondents (t = 1.034, p = .302) or between clinical settings (t = 0.479, p = .632). The mean interest scores for nurses with an associates degree in nursing/diploma and those with a bachelor of science in nursing or higher were 4.19 and 3.88, respectively, and the difference was statistically significant (t = 3.535, p < .001). CONCLUSION Nearly 300 registered nurses from communities in the southwestern Virginia area of Appalachia indicated interest in a wide variety of pain management topics. Nurses with at most an associates degree in nursing/diploma were significantly more interested in pain management education than those with a bachelor of science in nursing or higher degree. The overall interest scores were high, indicating that the respondents found the topics salient to their clinical practice.

Community Health Workers' Palliative Care Learning Needs and Training: Results from a Partnership between a US University and a Rural Community Organization in Mpumalanga Province, South Africa.

Abstract:The lack of palliative care knowledge among health care providers is a major barrier to adequate care in the rural provinces of South Africa (SA). Three aims: (1) to identify palliative care learning needs of community health workers (CHWs) working in a non-governmental organization (NGO) in Mpumalanga province SA, (2) to develop a training session based on the needs identified by the CHWs, and (3) to describe CHWs’ perceptions of the usefulness of the training content. Data were collected from 29 CHWs in focus group interviews. Content analysis identified eight palliative care learning needs: HIV/AIDS, palliative care, TB, sexually-transmitted illnesses, debriefing, care of bedridden patients, other chronic diseases. Based on three of the most salient learning needs, a training session was planned and delivered. Future program development should consider interventions to provide emotional support for CHWs and how to evaluate the quality and impact of care provided on the community.

Quality of hospice care: comparison between rural and urban residents.

Discrepancies between needed and received hospice care exist, especially in rural areas. Hospice care quality ratings for 743 rural and urban patients and their families were compared. Rural participants reported higher overall satisfaction and with pain/symptom management. Regardless of geographic location, satisfaction was higher when patients were informed and emotionally supported. Patients and family ratings did not differ. Findings support prior reports using retrospective rather than our studys point-of-care surveys.