Palliative care teams on the prairie: composition, perceived challenges & opportunities

Abstract

Introduction: LifeCircle South Dakota: Partners Improving End-of-Life Care is an interdisciplinary group committed to quality end-of-life care for residents of the state. Strengthening local coalitions and building a collaborative network among palliative care providers were goals of recent educational efforts. This article presents a profile of South Dakota palliative care teams.

Methods: South Dakota health care facilities and key professionals in palliative and hospice care (n=786) were invited to attend a palliative care conference in the summer of 2006. Forty-nine teams of two or more persons registered for the conference, and 40 teams completed surveys. The questionnaires asked how palliative care is delivered in a rural state, where teams go for help and consultation, and what teams perceive as the challenges and opportunities facing interdisciplinary teams. Both qualitative and quantitative data from the purposive sample of 40 South Dakota palliative care teams were analyzed.

Results: Thirty-five teams (88%) indicated nursing was included on their teams while only six (15%) included physicians. Twenty-five teams (62%) desired to add chaplaincy to their teams, followed by pharmacy (25/60%) and medicine (22/55%). On average, 42% of the primary team member's time was devoted to palliative care. Pain management, other symptom management, spiritual issues, advance directives, and family support were identified as critically important to practice. Teams consulted physicians for pain and non-pain symptom management, but sought hospices and team colleagues for consultation on advance directive, family, and spiritual issues. The top challenge teams identified in delivering end-of-life care was short length of hospice stay (lateness or lack of referral to hospice).

Conclusions: Survey data generated a profile of palliative care teams in the state-their composition, self-reported levels of palliative care expertise, resources utilized for consultation, and perceived challenges and opportunities facing them in providing end-of-life care. Having this understanding, along with knowing the perceived challenges and opportunities these teams face, will strengthen our ability to further enhance end-of-life care for South Dakotans.