Evaluating the barriers in accessing palliative care at an NCI-designated Cancer Center with a rural catchment area: Implications for public health

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.  Rural cancer patients are at increased risk for unmet palliative care needs.

Objective:  The aim of this study was to identify existing barriers in accessing PC services for cancer patients at an 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.  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, (4) insufficient or inadequate education for patients and oncology providers. 

 

Conclusion:  This study highlights aspects of integration of PC that can be enhanced from a process, education, and systems perspective with a particular focus on care coordination of a rural cancer population.  High quality palliative care delivery for underserved populations should remain a public health priority.