Purpose: To explore the palliative care perceptions of rural dwelling providers, nurses, and adults and, to explore the relationship between the knowledge and perceptions of palliative care held by rural providers and nurses, using a convergent parallel design.
Sample: Qualitative (n = 25), Quantitative (n = 51)
Methods: The setting was a geographically defined rural area of 8,500 square miles. Following institutional review board approval, providers (n = 5), nurses (n = 7), and adults (n = 13), completed a demographic survey and audio-recorded, face-to-face, semi-structured interviews. Qualitative data were analyzed using thematic analysis following a loosely grounded theory approach that was comprised of multiple rounds of coding assisted by qualitative analysis software. Survey packets were delivered to 19 healthcare organizations in the same geographic study area; 51 participants (providers, n = 7; nurses, n = 44) completed a demographic survey and the 20-item Palliative Care Knowledge Test (PCKT). Both qualitative and quantitative data were analyzed separately before merging and comparing the results in a final analysis.
Results: Six themes were identified: Palliative care offers comfort for the dying or end-of-life care; Palliative care? Never heard of it; Uncertainty about the differences between palliative care and hospice; Conflicts between theory and practice; Timing is everything; and Experience is a strong teacher. PCKT total scores for the sample of providers and nurses (n = 51) was 10.73 (SD 2.93) which suggested poor palliative care knowledge. After merging the results, the final analysis indicated convergence. Two constructs, Maturity and Rural Investment, were identified.
Conclusion: Providers and nurses in rural areas are experienced, having lived and practiced in rural areas for a considerable time; supporting the constructs of Maturity and Rural Investment. Misperceptions and poor knowledge related to palliative care likely prevent the broader application of palliative care in rural areas.
Keywords: palliative care, rural, providers, nurses, perceptions, convergent parallel design
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