title: Systematic Review of Palliative Care in the Rural Setting.
abstract: BACKGROUND
  Many of the world's population live in rural areas. However, access and dissemination of the advances taking place in the field of palliative care to patients living in rural areas have been limited.
  
  
  METHODS
  We searched 2 large databases of the medical literature and found 248 relevant articles; we also identified another 59 articles through networking and a hand search of reference lists. Of those 307 articles, 39 met the inclusion criteria and were grouped into the following subcategories: intervention (n = 4), needs assessment (n = 2), program planning (n = 3), program evaluation (n = 4), education (n = 7), financial (n = 8), and comprehensive/systematic literature reviews (n = 11).
  
  
  RESULTS
  We synthesized the current state of rural palliative care research and practice to identify important gaps for future research. Studies were conducted in the United States, Australia, Canada, Africa, Sweden, and India. Two randomized control trials were identified, both of which used telehealth approaches and had positive survival outcomes. One study demonstrated positive patient quality of life and depression outcomes.
  
  
  CONCLUSIONS
  Research to guide rural palliative care practice is sparse. Approaches to telehealth, community- academic partnerships, and training rural health care professionals show promise, but more research is needed to determine best practices for providing palliative care to patients living in rural settings.
authors.affiliation: School of Nursing, Center for Palliative and Supportive Care, University of Alabama at Birmingham, AL. mbakitas@uab.edu.
authors.forename: Marie A
authors.initials: MA
authors.lastname: Bakitas
authors.forename: Ronit
authors.initials: R
authors.lastname: Elk
authors.forename: Meka
authors.initials: M
authors.lastname: Astin
authors.forename: Lyn
authors.initials: L
authors.lastname: Ceronsky
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Clifford
authors.forename: J Nicholas
authors.initials: JN
authors.lastname: Dionne-Odom
authors.forename: Linda L
authors.initials: LL
authors.lastname: Emanuel
authors.forename: Regina M
authors.initials: RM
authors.lastname: Fink
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kvale
authors.forename: Sue
authors.initials: S
authors.lastname: Levkoff
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Thomas
authors.initials: T
authors.lastname: Smith
mesh_terms: D006801:Humans; D010166:Palliative Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012424:Rural Population