Researcher examines palliative care in rural areas

[img_inline align=”right” src=”http://padnws01.mcmaster.ca/images/allison williams edited.jpg” caption=”Allison Williams is a researcher in the McMaster Institute of Environment & Health and associate professor in Geography & Earth Sciences. File photo.”]Canadians view compassionate, respectful palliative and end-of-life (P/EOL) care as a core value. The goal of palliative care is to provide high quality care to terminally-ill or dying persons and their families.

Despite these lofty ideals, there is much disparity between the demand for and capacity to provide both basic and specialized P/EOL care, with rural residents the most vulnerable to unmet needs.

A new five-year Interdisciplinary Capacity Enhancement Grant funded by CIHR (Canadian Institutes of Health Research) entitled, Timely Access & Seamless Transitions in Rural Palliative/End-of-Life Care, examines this issue.

Allison Williams, a researcher in the McMaster Institute of Environment & Health and associate professor in Geography & Earth Sciences, is the nominated principal investigator for this grant and leads, together with University of Alberta researcher, Donna Wilson, an interdisciplinary, multi-provincial team with international collaborators from New Zealand, Australia, the U.K. and the U.S. The team is comprised of 24 researchers from 11 disciplines, including geography, nursing, medicine and anthropology.

Williams, who initiated this project four years ago, believes that an interdisciplinary perspective is necessary to tackle complex problems such as, “No single discipline has the capacity to address this complex issue given the variation in health determinants across our rural geographies, within and across provincial jurisdictions.”

Timely access and seamless transitions are two essential components for high quality P/EOL care. Unless many evidentiary gaps specific to access and transitions are addressed, rural Canadians will continue to be in a highly vulnerable position.

Several barriers hinder the referral process to specialized programs, if available; these result in delays in service, or, in less predictable illness trajectories, no palliative care services whatsoever.

The list of barriers to appropriate care includes human and system characteristics such as geographic isolation, culture, socio-demographic conditions, healthcare services organization and timing of referral, differences in the dying trajectory, and legal myths.

Until the evidentiary gap between what is and what should be is filled, families, providers, and policy makers will continue to be ill-equipped to make decisions that ensure the provision of optimal P/EOL in rural Canada. The increased number of dying persons will occur despite anticipated limitations in fiscal resources for health care and the projected shortage of professionals–limitations which are accentuated in rural Canada.

The results of this research will generate knowledge for delivering quality P/EOL care services to people and family caregivers who are dying in rural communities, and build knowledge to support rural providers in delivering quality care.

The research includes 10 projects in three main areas: timely access (four studies), seamless transitions (four studies) and interventions (two studies). The interventions make up the core of the research program, spanning four of the five-year granting period and will be informed by the studies undertaken in both the timely access and seamless transitions areas. The overall goal of the research program is to improve the quality of care for rural-based terminally ill persons and their families.