Examining the Relationship Between Rural and Urban Clinicians' Familiarity With Patients and Families and Their Comfort With Palliative and End-of-Life Care Communication.

Background: Effective healthcare clinician communication is a key component of quality palliative and end-of-life (PEOL) care. However, communication may be hampered when clinicians are not comfortable initiating these conversations with patients and their families. Clinicians working in rural areas report several barriers to providing palliative care. This study examined the relationship between rural and urban clinicians' reported familiarity with their patients and families end-of-life, their reported comfort in initiating PEOL conversations, and their PEOL care knowledge. Method: This study used a cross-sectional design to examine the relationships between rural and urban clinicians' familiarity, their comfort in PEOL communication, and their PEOL care knowledge. Results: N = 548 rural and urban clinicians participated. Rural clinicians reported greater familiarity, more PEOL knowledge, and more comfort with PEOL communication. Multiple regression analyses of PEOL knowledge showed significant associations in knowledge with older clinicians (P < 0.01) and additional palliative care training (P < 0.01); comfort in PEOL communication had significant associations with more palliative care training (P < 0.01) and opportunities to provide palliative care (P < 0.01). Conclusion: The concept of familiarity is highly complex and poorly understood in relation to PEOL care in both rural and urban settings. Future research is needed to explore how additional training in PEOL care and clinician reported familiarity positively impact patient outcomes by increasing the number of advance directives completed and followed and improved documentation of advance care planning.