Rural and Remote Populations

Rural and Remote Populations

In Australia, approximately one third of the population live in rural areas. Another half a million people live in remote regions of the country. There can be practical and geographic specific issues to be considered in advance care planning and palliative care delivery. The following resources may be useful.

Key Resources

Support for older Australians living in rural and remote areas (My Aged Care)

Rural and remote (CareSearch Review Collection)

Practice Issues

Australian College of Rural and Remote Medicine (ACRRM). Clinical guidelines for mobile devices. Current (freely accessible website)
The Clinical guidelines for mobile devices provide rural doctors with a handheld decision support tool, accessible within two minutes at point of contact with the patient, to guide immediate clinical management. These are available for download to all mobile device operating systems (with touch screens) as well as computers, laptops, tablets and iPads by using the iSiloTM software. Includes the ACRRM Primary Curriculum - Fourth Edition and ACRRM Advanced Specialised Training Curricula.

Mitchell G, Zhang J, Burridge L, Senior H, Miller E, Young S, et al. Case conferences between general practitioners and specialist teams to plan end-of-life care of people with end stage heart failure and lung disease: An exploratory pilot study. BMC Palliat Care. 2014 May 5;13:24. (free full text journal article)
We report a pilot study of case conferences between the patient's GP and specialist staff to facilitate care planning for people with end stage heart failure or non-malignant lung disease in a regional health service in Queensland Australia. This pilot study is the initial step in the development and testing of a complex intervention based on a model of integrated care. A single case conference involving the patient's heart or lung failure team is associated with significant reductions in service utilization, apparently by improving case coordination, enhancing symptom management and assessing and managing carer needs.

Ray RA, Fried O, Lindsay D. Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations. BMC Health Serv Res. 2014 Jun 19;14:272. (free full text journal article)
A program of multidisciplinary palliative care video conferences was presented to health practitioners across part of northern Australia in an effort to address the disadvantages of people living in rural and remote locations accessing palliative care. The provision of professional education about palliative care issues via multidisciplinary video conferencing increased confidence among rural health practitioners, by meeting their identified need for topic and context specific education. This technology also enhanced the networking opportunities between practitioners, providing an avenue of ongoing professional support necessary for maintaining the health workforce in rural and remote areas.

Policy and management considerations

Blackford J, Street A. Is an advance care planning model feasible in community palliative care? A multi-site action research approach. J Adv Nurs. 2012 Sep;68(9):2021-33. 
This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure.

Hatton I, McDonald K, Nancarrow L, Fletcher K. The Griffith area palliative care service: A pilot project. Aust Health Rev. 2003;26(2):11-8. 
The new National Framework stressed an important set of values to guide models of palliative care delivery. It notes that the challenge is to secure the place of palliative care as an integral part of health care across Australia, routinely available within local communities to those people who need it. The Griffith Area Palliative Care Service (GAPS) is a two-year pilot project delivering a palliative care service through a truly integrated approach to care for patients, their carers and families within the Griffith Local Government Area and Carrathool Shire areas. This paper describes how GAPS is successfully meeting the challenges of service provision to rural and remote areas.

Phillips JL, Davidson PM, Jackson D, Kristjanson L, Bennett ML, Daly J. Enhancing palliative care delivery in a regional community in Australia. Aust Health Rev. 2006 Aug;30(3):370-9. 
This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalized integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.

WA Cancer and Palliative Care Network (Department of Health, Western Australia) Rural palliative care model of care (408kb pdf). 2008. (freely accessible)
This Rural Palliative Care Model in Western Australia has the purpose of addressing the specific palliative care needs in rural and remote Western Australia and supplements the Palliative Care Model of Care. 

Associated materials

CareSearch. Information for Nurses - Rural and Remote. Current (freely accessible website)
Overview of issues in relation to palliative care for rural and remote populations. Includes links to further information, consumer resources and one-click topic searching of evidence through to PubMed database.

Program of Experience in the Palliative Approach (PEPA). PEPA - Online learning modules. Current (freely accessible online resource)
These online learning modules have been designed for participants undertaking a PEPA supervised clinical placement. The modules help users prepare for and maximise their learning during a PEPA placement. Areas include key topics in palliative care, provide activities to consolidate learning and direct users to other sources of information that should enable them to further develop their knowledge and skills in palliative care.

Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: A scoping review. BMC Palliat Care. 2019 Feb 14;18(1):21. doi: 10.1186/s12904-019-0404-y
Based on rural Indigenous peoples in Canada, United States, New Zealand and Australia, this review examined strategies that have potential to strengthen approaches to culturally safe palliative care. Thematic analysis and mapping revealed two categories of strategies to provide culturally competent palliative care; culturally competent practices and culturally safe approaches. The authors provide important insights and make recommendations based on these categories.

Page updated on 04 July 2019