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Exploring the barriers and suggestions for improvement to delivering palliative health care services in four underserved rural Canadian settings

TitleExploring the barriers and suggestions for improvement to delivering palliative health care services in four underserved rural Canadian settings
Year of Publication2017
AuthorsPugh, A.
UniversityQueen's University
CityKingston, ON

As the size of Canada's elderly population continues to grow, so will the demand for palliative (or end-of-life) health care services, which strive to improve the quality of life of those suffering with life-threatening illness. Unfortunately, access to palliative care is inconsistent across Canada, especially among those residing in rural settings who, unlike urban residents, encounter additional geographical and financial barriers to care. Access to culturally-sensitive palliative care, particularly for Indigenous peoples, can also be challenging in these settings. Therefore, the goal of my thesis is to understand health care providers' (HCP) perspectives on barriers to palliative care delivery in rural Canadian settings and to identify their suggestions for delivery improvement in these regions. To achieve this goal, I analysed forty semi-structured interviews capturing the perspectives of formal and informal HCPs from four rural and/or remote communities with limited palliative care resources. Barriers to palliative care delivery were initially coded using Penchansky and Thomas' five dimensions of access (i.e. availability, affordability, acceptability, physical accessibility, and accommodation), however a recently added sixth dimension of access (i.e. awareness) became the primary focus of this analysis. Next, barriers to Indigenous palliative care were identified according to three palliative care environments (i.e. community, hospital, and home). A supplemental quantitative analysis was also conducted exploring the association between Indigenous identity and short- and long-term healthcare service use, as well as reasons for unmet health care needs, using three cycles (2012-2014) of the Canadian Community Health Survey. Findings indicate that barriers to palliative care delivery, via palliative care awareness, stem from limited palliative care knowledge/education, communication, and coordination among HCPs, and suggest that inadequate palliative care awareness may jeopardize initiatives striving to address barriers to the original five dimensions of access. The barriers to palliative care delivery among Indigenous peoples were also shown to differ between palliative care environments, and suggested that improving cultural sensitivity among HCPs could address these barriers. To improve rural palliative care delivery HCPs suggested implementing community-led and community-specific initiatives that enhance HCP knowledge, communication, and coordination of culturally-sensitive palliative care within different environments to ultimately encourage equitable access for all Canadians. Access to health care, palliative care, awareness.

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