Healthcare professionals' perspectives on improving care coordination between palliative and cancer care for rural older adults: A qualitative study

Abstract

Introduction

Rural-dwelling older adults with cancer have limited access to palliative care and face barriers in coordinating palliative care with cancer care. This study aimed to identify barriers and facilitators to care coordination in the palliative care referral and care delivery process for rural-dwelling older adults with cancer from the perspectives of palliative care and oncology healthcare professionals (HCPs).

Materials and Methods

We conducted focus groups and dyadic semi-structured interviews with palliative care and oncology HCPs. Participants were recruited from clinics within large academic health systems (n = 14) and rural non-affiliated practices (n = 11) in Colorado. We analyzed interviews guided by a reflexive thematic analysis approach.

Results

Five themes emerged; within each theme specific barriers and facilitators were identified: (1) Tension of different practice styles delays palliative care referral for rural older adults; (2) Limited capacity prevents early palliative care integration for older adults in rural areas; (3) Structured communication pathways can facilitate coordinated care for older rural adults; (4) Competing influences of rural cultural context on older adults' palliative and oncologic care coordination; and (5) Telehealth has “come a long way,” offering more opportunities for rural older adults to receive effective care coordination. Participants also shared insights on intervention strategies targeting barriers to coordinating palliative care with cancer care for rural-dwelling older adults with cancer.

Discussion

The identified barriers and facilitators suggest intervention targets to improve care coordination between palliative care and cancer care for rural-dwelling older adults at the health system, provider, and patient levels.