title: Delivering palliative care to patients and caregivers in inner-city communities: challenges and opportunities.
abstract: OBJECTIVE
  Social and economic barriers can hinder access to quality palliative and end-of-life care for patients living in inner-city communities. Using a community-based participatory research (CBPR) approach, we investigated the stresses associated with living with a chronic disease and barriers to access and utilization of palliative care resources experienced by low-income patients and caregivers in five inner-city communities.
  
  
  METHODS
  Four focus groups (N = 33) were conducted with community stakeholders, including healthcare professionals (social workers and nurses), persons living with chronic illnesses (e.g., HIV/AIDS, cardiovascular disease, and cancer), and caregivers. Focus group responses were analyzed using thematic analyses.
  
  
  RESULTS
  Patients' and caregivers' stresses centered around five themes: lack of family support, communication barriers with healthcare professionals, minority stress, caregiver burden, and lack of spiritual support. The community stakeholders identified resources and services to improve access to care and the quality of life of underserved, low-income populations living with chronic illnesses.
  
  
  CONCLUSIONS
  A CBPR approach enabled us to develop an interdisciplinary and culturally sensitive intervention to begin addressing the palliative and end-of-life needs of the patients and caregivers of the inner-city community.
authors.affiliation: Graduate School of Social Work,Boston College,Boston,Massachusetts.
authors.forename: Karen
authors.initials: K
authors.lastname: Kayser
authors.affiliation: Connell School of Nursing,Boston College,Boston,Massachusetts.
authors.forename: Rosanna F
authors.initials: RF
authors.lastname: DeMarco
authors.affiliation: Graduate School of Social Work,Boston College,Boston,Massachusetts.
authors.forename: Charu
authors.initials: C
authors.lastname: Stokes
authors.affiliation: Connell School of Nursing,Boston College,Boston,Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: DeSanto-Madeya
authors.affiliation: Graduate School of Social Work,Boston College,Boston,Massachusetts.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Higgins
mesh_terms: D017028:Caregivers / Q000191:economics / Q000523:psychology*; D002908:Chronic Disease / Q000191:economics / Q000523:psychology*; D055812:Community-Based Participatory Research; D017144:Focus Groups; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000191:economics / Q000592:standards*; D011204:Poverty Areas; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D013315:Stress, Psychological / Q000191:economics / Q000209:etiology; D019037:Urban Health Services / Q000191:economics / Q000592:standards