title: Palliating inside the lines: The effects of borders and boundaries on palliative care in rural Canada.
abstract: We draw lines to divide our world into specific places, territories, and categories. Although borders and boundaries are dynamic and socially constructed, their existence creates many broad impacts on our lives by geographically distinguishing between groups (e.g., us/them; here/there; inside/outside) at various scales from the national down to the personal spaces of the individual. Particularly, borders and boundaries can be used to define a variety of differing spaces such as the familial, social, economic, political, as well as issues of access - including access to health services. Despite the implicit connection between borders, boundaries, and health, little research has investigated this connection from a health geography perspective. As such, this secondary thematic analysis contributes to addressing this notable gap by examining how borders and boundaries are experienced and perceived to impact access to palliative care in rural Canada from the perspectives of the formal and informal providers of such care. Drawing upon data from qualitative interviews (n = 40) with formal and informal palliative caregivers residing in four different rural Canadian communities, five forms of borders and boundaries were found to directly impact care delivery/receipt: political; jurisdictional; geographical; professional; and cultural. Implicitly and explicitly, participants discussed these borders and boundaries while sharing their experiences of providing palliative care in rural Canada. We conclude by discussing the implications of our findings for palliative care in rural Canada, while also emphasizing the need for more health geography, and related social science, researchers to recognize the significance of borders and boundaries in relation to health and healthcare delivery. Lastly, we emphasize the transferability of these findings to other health sectors, geographical settings, and disciplines.
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada; School of Geography & Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada. Electronic address: mgiesbre@sfu.ca.
authors.forename: Melissa
authors.initials: M
authors.lastname: Giesbrecht
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.affiliation: Department of Geography and Planning, Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Castleden
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.affiliation: Department of Geography, Trent University, 1600 West Bank Drive, Peterborough, Ontario, K9J 7B8, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Skinner
authors.affiliation: School of Geography & Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
mesh_terms: D002170:Canada; D005260:Female; D005843:Geography / Q000639:trends*; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data
keywords: Access to care; Borders; Boundaries; Canada; Caregiving; Palliative care; Rural