title: A palliative care needs assessment of rural hospitals.
abstract: BACKGROUND
  Palliative care services are lacking in rural hospitals. Implementing palliative care services in rural and remote areas requires knowledge of available resources, specific barriers, and a commitment from the hospital and community.
  
  
  OBJECTIVE
  The purpose of the study was to determine awareness, knowledge, barriers, and resources regarding palliative care services in rural hospitals.
  
  
  METHODS
  A descriptive survey design used an investigator-developed needs assessment to survey 374 (40% response rate) health care providers (chief executive officers, chiefs of medical staff, chief nursing officers, and social worker directors) at 236 rural hospitals (<100 beds) in seven Rocky Mountain states.
  
  
  RESULTS
  Significant barriers to integrating palliative care exist: lack of administrative support, mentorship, and access to palliative care resources; inadequate basic knowledge about palliative care strategies; and limited training/skills in palliative care. Having contractual relationships with local hospices is a key facilitator. Respondents (56%) want to learn more about palliative care, specifically focusing on pain management, communication techniques, and end-of-life care issues. Webinar and online courses were suggested as strategies to promote long distance learning.
  
  
  CONCLUSIONS
  It is imperative for quality of care that rural hospitals have practitioners who are up to date on current evidence and practice within a palliative care framework. Unique challenges exist to implementing palliative care services in rural hospitals. Opportunities for informing rural areas focus around utilizing existing hospice resources and relationships, and favoring Web-based classes and online courses. The development of a multifaceted intervention to facilitate education about palliative care and cultivate palliative care services in rural settings is indicated.
authors.affiliation: Department of Professional Resources, University of Colorado Hospital and College of Nursing, University of Colorado, Aurora, Colorado, USA. regina.fink@uch.edu
authors.forename: Regina M
authors.initials: RM
authors.lastname: Fink
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Oman
authors.forename: Jeanie
authors.initials: J
authors.lastname: Youngwerth
authors.forename: Lucinda L
authors.initials: LL
authors.lastname: Bryant
mesh_terms: D003120:Colorado; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006780:Hospitals, Rural; D006801:Humans; D007318:Inservice Training; D007615:Kansas; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D009009:Montana; D020380:Needs Assessment; D009516:New Mexico; D010166:Palliative Care; D014589:Utah; D014959:Wyoming