title: Evaluating Stakeholder-Identified Barriers in Accessing Palliative Care at an NCI-Designated Cancer Center with a Rural Catchment Area.
abstract: BACKGROUND
  The new Commission on Cancer (CoC) accreditation standards encompass palliative care (PC) and a patient-centered approach, including specific quality measurements and outcomes. However, cancer centers differ in their interpretation of the CoC standards for PC in level of integration in the care trajectory and services provided.
  
  
  OBJECTIVE
  The aim of this study was to identify existing barriers in accessing PC services for cancer patients at a National Cancer Institute (NCI)-designated academic cancer center with a rural catchment area, using the CoC guidelines as a point of reference.
  
  
  METHODS
  This study utilized a cross-sectional qualitative design and conventional content analysis. Subjects were faculty/staff from the cancer center or from community affiliates located outside the main campus. Measurement was by semistructured qualitative interviews. Forty-two interviews were included in the final sample: clinicians, administrative support staff, and service support personnel.
  
  
  RESULTS
  Four themes were developed from the analysis focusing on barriers to PC integration: (1) fragmentation of services, (2) unclear pathways and triggers for referral, (3) demand exceeds available practitioners, and (4) insufficient or inadequate education for patients and oncology providers.
  
  
  CONCLUSIONS
  This study highlights aspects of integration of PC that can be enhanced from a process, education, and systems perspective with a particular focus on the care coordination of a rural cancer population.
authors.affiliation: 1 School of Nursing, Division of Palliative Care, University of Virginia , Charlottesville, Virginia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Keim-Malpass
authors.affiliation: 1 School of Nursing, Division of Palliative Care, University of Virginia , Charlottesville, Virginia.
authors.forename: Emma M
authors.initials: EM
authors.lastname: Mitchell
authors.affiliation: 2 School of Medicine, Division of Palliative Care, University of Virginia, Charlottesville , Virginia.
authors.forename: Leslie
authors.initials: L
authors.lastname: Blackhall
authors.affiliation: 1 School of Nursing, Division of Palliative Care, University of Virginia , Charlottesville, Virginia.
authors.forename: Pam B
authors.initials: PB
authors.lastname: DeGuzman
mesh_terms: D002173:Cancer Care Facilities; D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D054547:National Cancer Institute (U.S.); D010166:Palliative Care; D036301:Qualitative Research; D019035:Rural Health Services; D014481:United States; D014768:Virginia