Developing Successful Palliative Care Teams in Rural Communities: A Facilitated Process.

Developing palliative care (PC) programs in rural settings is challenging due to limitations on training, staff, resources, and reimbursement. Employing established frameworks and processes can assist rural communities in developing quality PC programs. We sought to employ a facilitated community-centric planning process to guide several rural community teams across three states in the United States to support PC program development. This is a prospective, observational, quality improvement initiative implemented over 18-24 months. A total of 17 community teams volunteered to participate in the process and completed initial assessments that identified gaps in clinical PC skills in several aspects of PC, including bereavement care, care continuity, pain and symptom management, and communication with family. Teams also identified barriers to optimizing PC for patient and families, including limited community awareness, poor reimbursement mechanisms, lack of resources and experience with PC, and inadequate care coordination. All 17 community teams developed and worked on implementation of a community-specific action plan to develop PC services. However, due to staff capacity limitations imposed by COVID-19, only eight communities completed a follow-up assessment in late 2020. These teams showed some improvement in knowledge of multiple PC domains as a result of the process and provided qualitative feedback indicating that the process was helpful in building capacity to offer needed services and developing the skills and workflows necessary to support delivery of PC. This unique development process can help rural communities organize, develop, and sustain PC programs and overcome common barriers to providing PC.