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2021 Annual Meeting Poster: Barriers and Facilitators to Palliative care among rural communities of Indiana: Healthcare Providers' Perspectives

Posted almost 2 years ago

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ISNA 2021 Poster (1000 KB)


Dr Nasreen Lalani, ISNA Member

Dr Nasreen Lalani: Barriers and Facilitators to Palliative care among rural communities of Indiana: Healthcare Providers' Perspectives

Dr Lalani is a nurse clinician and  researcher for the last 25 years and currently working as a Assistant Professor at Purdue University School of Nursing. Her research program aims to develop psychosocial and spiritual interventions for caregivers in palliative care settings in vulnerable and underrepresented communities.  She has also developed resilience building interventions in the post disaster recovery and pandemic situations. Find more information on Dr Dr Lalani's next study, Identifying Perceived Barriers and Facilitators in Access to Palliative Care in Rural Indiana, within the attachments.


  • The Purpose of the Study

This study aims to identify common barriers and facilitators to access palliative care services in rural areas of Indiana from the perspectives of healthcare providers including clinicians, educators, and community stakeholders. 

  • Background and Significance 

In Indiana, 6.3 million people are living with at least one chronic disease, 1.6 million with 2 or more chronic diseases, most common being heart disease (22%) followed by cancer (20.5%) chronic obstructive pulmonary disease (18%), and diabetes (18%)1. A large proportion of them reside in rural regions represent agricultural workforce, consequently, suffer huge socio-economic and caregiving burden2. Barriers to access palliative care services may result in unmet goals of care, lack of autonomy and decision making, increased healthcare costs, caregiving burden, and distress among rural patients and families3.

  • Method/Procedures 

Using a community-based participatory approach, an exploratory descriptive study was designed. A purposive sample of palliative care providers (n=15) working in small towns and rural areas of Indiana was obtained.  Penchansky and Thomas (1981) theoretical framework of access was used to guide the study4. A semi-structured individual in-depth interview guide was used to collect the data. All the interviews were conducted online, audio-recorded, and transcribed. Thematic analysis of the data was carried out. Ethical approval for the study was obtained from Institutional Review Board at Purdue University.

  • Major Outcomes

Major barriers to PC included misconceptions about palliative care as an underrecognized specialty; lack of trained palliative care providers; late involvement of inpatient palliative care and community hospice services; inadequate palliative care education and training; financial barriers, attitudes and beliefs around PC; and geographical barriers. Facilitators to palliative care included financial gains supporting palliative care growth, enhanced nurses’ role in identifying patients with palliative care needs and creating awareness and informing the community about PC.

  • Conclusions and Implications 

Lack of PC access can be a major factor affecting the healthcare conditions in rural and underserved communities, overall influencing rural growth and wellbeing. Further emphasis and efforts are needed at both practice and policy levels to enhance the awareness, importance, and availability of PC services in rural communities. Strengthening advanced practice nurses’roles and increasing healthcare funding and resources can create and lead new pathways for ensuring accessible PC services among rural communities of Indiana.

Indiana State Department of Health (2018). Division of Chronic Disease, Primary Care and Rural Health. Retrieved from

Donlon R, Purington K, Williams N. Advancing palliative care for adults with serious illness: A National review of state palliative care policies and programs. 2019.

Maeda I, Miyashita M, Yamagishi A, et al. Changes in Relatives’ Perspectives on Quality of Death, Quality of Care, Pain Relief, and Caregiving Burden Before and After a Region- Based Palliative Care Intervention. J Pain Symptom Manage. 2016;52(5):637–645.

Penchansky R, Thomas JW. The concept of access: definition and relationship to con- sumer satisfaction. Med Care. 1981;19(2):127–140.