Integration of Community Health Workers Into Palliative Care Teams: Challenges, Barriers, Facilitators, and Implementation Strategies.

In rural communities, primary care providers and other nonspecialists provide palliative care services when specialty care is not available. Recognizing the need to improve palliative care knowledge of providers across the care spectrum, groups across South Dakota have initiated programs to expand palliative care education. South Dakota also has a growing community health worker (CHW) infrastructure, and integrating CHWs into palliative care teams may be a way to further expand the reach of palliative care services. This mixed-methods study examines challenges, barriers, and facilitators of integrating CHWs into palliative care teams from the perspective of palliative care providers and advocates. Organizational culture and implementation climate are included as potential barriers and facilitators, and the results of the mixed-methods inquiry are used to select implementation strategies for integrating CHWs into palliative care teams in the South Dakota context from the Expert Recommendations for Implementation Change project.