title: Barriers to quality care for dying patients in rural communities.
abstract: BACKGROUND
  Barriers to providing optimal palliative care in rural communities are not well understood.
  
  
  OBJECTIVE
  To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care.
  
  
  METHODS
  An anonymous self-administered survey was sent to health care personnel throughout 2 rural practice-based research networks. Targeted personnel included clinicians, nurses, medical assistants, chaplains, social workers, administrators, and ancillary staff, who worked at hospice organizations, hospitals, ambulatory clinics, public health agencies, home health agencies, and nursing homes.
  
  
  RESULTS
  Results from 363 completed surveys indicated that most health care personnel were satisfied with the palliative care being provided in their health care facilities (84%) and that most were comfortable helping dying patients transition from a curative to a palliative focus of care (87%). Yet, many reported that the palliative care provided could be improved and many reported that family members' avoidance of issues around dying (60%) was a barrier to providing optimal care in rural health care facilities.
  
  
  CONCLUSIONS
  Findings suggest that health care personnel perceive they are effective at providing palliative care in their rural health care facilities, yet face barriers to providing optimal end-of-life care. Results of this study suggest that differences in training and experience may influence health care personnel's perceptions of the existing barriers. It may be important in rural areas to customize interventions to both the professional role and the site of care.
authors.affiliation: Foundation for Healthy Living, Latham, NY 12110, USA. vanvorst.rebecca@healthnow.org
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Van Vorst
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Phoebe Lindsey
authors.initials: PL
authors.lastname: Barton
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.forename: K James
authors.initials: KJ
authors.lastname: Kallail
authors.forename: John M
authors.initials: JM
authors.lastname: Westfall
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003120:Colorado; D005260:Female; D058016:Health Facility Administration; D006297:Health Services Accessibility; D006801:Humans; D007615:Kansas; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration*