title: Improving pain relief in a rural cancer center.
abstract: OBJECTIVE
  The purpose of this article is to describe barriers to cancer pain management and strategies for making improvements in an academic rural cancer center.
  
  
  BACKGROUND
  Rural communities pose unique challenges to cancer pain management because of their unique strengths and burdens. Successful strategies used by a comprehensive cancer center to improve pain management in rural New England are summarized.
  
  
  CONCLUSIONS
  Improving cancer pain management in a rural setting required a recognition of the contrasting characteristics between a sophisticated academic medical center and a rural community. The successful implementation of quality improvement strategies required a combination of leadership support, internal and external funding, and professional and federal recognition of the problem. Using a quality improvement approach rather than a traditional didactic approach, and fostering communication, trust, and collegiality at our outreach sites were pivotal to our success.
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
authors.forename: Tammy E
authors.initials: TE
authors.lastname: Baltic
authors.forename: Marie Bakitas
authors.initials: MB
authors.lastname: Whedon
authors.forename: Tim A
authors.initials: TA
authors.lastname: Ahles
authors.forename: Gilbert
authors.initials: G
authors.lastname: Fanciullo
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards*; D006801:Humans; D059408:Pain Management; D019035:Rural Health Services / Q000592:standards*