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Palliative care improves outcomes, yet rural residents often lack adequate and equitable access. This study provides practical tips to address palliative care (PC)-related challenges in rural communities. Strategies include engaging trusted community partners, addressing cultural factors, improving pediatric care, utilizing telehealth, networking with rural teams including caregivers, and expanding roles for nurses and advanced practice providers. Despite complex barriers to access, providers can tailor PC to be patient-centered, respect local values, and bridge gaps. The "Top 10" format emphasizes the relevant issues to enable clinicians to provide optimal care for people from rural areas. [ABSTRACT FROM AUTHOR]

Background: The defining attributes of intentional learning match the needed characteristics of students in competency-based education (CBE). The Learning Orientation Questionnaire measures these characteristics and can be used to facilitate improvement in these attitudes and skills, which results in higher order thinking and lifelong learning. Method: A longitudinal study was performed with nursing students (N = 53) to determine if intentional learning scores continued to improve over time and were associated with student performance. Results: These students had significantly higher intentional learning scores at the end of the program than at the end of the second semester (p <.001). Intentional learning scores were not associated with student performance at the end of the program (p =.473). Conclusion: As nursing programs transition to CBE, intentional learning theory can be used to support students. Nursing programs are advancing these characteristics but will need to do so earlier as they implement CBE. [J Nurs Educ. 2024;63(8):552–555.] [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic created a unique opportunity to evolve an interdisciplinary palliative care seminar (IPC) into a virtual platform. This seminar provides foundational palliative and hospice concepts, introductions into palliative care disciplines, integration of teamwork, and incorporates interdisciplinary student led patient encounters. Traditionally, this experience had been in person, however during the COVID-19 pandemic, healthcare restrictions transitioned the educational delivery to a virtual platform. Methods: To assess the knowledge gained from this novel experience, the Palliative Care Knowledge Test (PCKT) was administered before and after the IPC Seminar. A 1-year follow up survey was also administered to evaluate how the IPC Seminar was applicable to the students' clinical experiences and practice. Results: The virtual didactics and virtual student led patient encounters significantly improved learners understanding of palliative and hospice care. This gain of knowledge was noted across undergraduate and graduate programs, which highlights the need for and benefit from foundational concepts. Furthermore, a 1-year follow up survey noted the IPC seminar was applicable to their practices and suggests that this experience will impact future patients. Discussion: Many of the students practice in rural areas where access to palliative care services is limited or non-existent. This experience exponentially impacts the growth of palliative and hospice care understanding and access to care across the region. Conclusion: Evolving our IPC Seminar has shown to significantly improve knowledge, foster collaboration of student led interdisciplinary teams, and increases capacity to meet the needs of more learners. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe and analyze the psychometric properties of the Learning Orientation Questionnaire (LOQ), which have not been previously published. Psychometric validation involves the accumulation of proper empirical evidence to confirm measurement of the intended construct, and to justify the intended uses of the scales. LOQ is based upon the intentional learning theory, which is a comprehensive, holistic learning theory. Through the expertise of the LOQ's developer, educational researcher, and psychometrician, this article presents evidence of LOQ's reliability and validity according to published best practices for scale development and validation. LOQ is a reliable and valid instrument determining where learners fall along the learning orientation continuum. Education researchers can use this information to support learners to move upward on the learning orientation continuum, improving their inclination to learn, high-order thinking, and life-long learning. [ABSTRACT FROM AUTHOR]

Purpose: To explore the effectiveness of education on increasing knowledge of palliative care and how to access palliative care services among community members. Design: A descriptive study using a retrospective survey was conducted after in-person educational events on palliative care. This study used the definition of rural and frontier provided by the South Dakota Department of Health which is based on the US Census Bureau population estimates (2020). Sample: Educational events occurred in 17 communities across South Dakota with 256 community members. Of which, 166 people completed the survey. Methods: Wilcoxon signed rank test was performed to evaluate for change in palliative care knowledge. Fisher's Exact Test was utilized to analyze for an association between past palliative and hospice care use, palliative care knowledge, and confidence in finding palliative care services. Findings: The majority of educational events took place in rural or frontier locations with 85% of participants and 95.2% of survey respondents attending in a rural or frontier location. Most of the survey respondents (61.5%) were a caregiver of someone with a serious health condition, while 13.3% had a serious health condition and 3% were both a caregiver and had a serious health condition. After completion of the community education program, community members demonstrated a statistically significant improvement in their knowledge of palliative care and their confidence in being able to locate palliative care services, p <.001. Having used palliative care services was significantly associated with palliative care knowledge and confidence in accessing these services, p < .001. Conclusion: Performing education individualized to each community increased knowledge regarding palliative care and how to access these services. Additional needs of community members were discovered which is critically important to address as the rural population ages and is more likely to be living with serious illness(es). [ABSTRACT FROM AUTHOR]

1. Identify two techniques to increase providers' comfort in addressing spiritual needs. 2. Analyze a tool developed to measure interprofessional students' comfort level and barriers to addressing spirituality with patients. Comfort addressing spirituality may affect engagement with patients and families seeking meaning and connection. We created a palliative care spirituality curriculum. Using pre/post assessments, we measured significant changes in interprofessional students' comfort with spiritual care. These students will mostly practice in the rural Midwest with limited educational and spiritual resources. Spiritual needs are commonly addressed by chaplains, yet patients and families often incorporate faith in communicating with interdisciplinary team members throughout their encounters. Providers' comfort in addressing spirituality may affect how they engage as patients and families seek meaning and connection. Providing a spirituality curriculum focused on supporting the seriously ill and using pre/post assessments, we measured changes in interprofessional students' attitudes and comfort with spiritual care. To develop a tool to evaluate participants' comfort level and barriers to addressing spirituality with patients and evaluate participants' change in comfort level with spirituality after participating in the IPC Seminar. Interdisciplinary palliative care seminar was provided including a lecture and a patient encounter focused on spiritual care. Over 250 students across 7 disciplines and undergraduate through post-graduate programs participated. Students completed pre-post assessments using a Likert scale to evaluate participants' comfort exploring their own and patients' spirituality, and potential factors affecting their comfort. Analysis of the data using a 2-sample t-test assuming equal variances was used to evaluate the results. Half of the questions showed a statistically significant (p < 0.05) impact on comfort exploring spirituality and its role in healthcare. Participants (pre n = 248, post n=173) increased their comfort in exploring patient's spirituality and had less conflict when spirituality was introduced in medical settings. The remaining questions showed a measurable, though less significant, impact. Introducing spirituality education to interdisciplinary students showed significant improvement in comfort with learning more about other people's spirituality and how it impacts their health decisions. Most of the students in this study will practice in the rural upper Midwest where there are limited educational and spiritual resources available. Thus, creating a spirituality curriculum that empowers students to learn more about patient needs will hopefully translate into whole person care. Existential / Humanities / Spirituality / Religion; Quality Improvement [ABSTRACT FROM AUTHOR]

1. Participants will describe salient strategies of how to deliver an interdisciplinary palliative care seminar to students using diverse pedagogy and across rural settings. 2. Participants will describe the impact an interdisciplinary palliative care seminar has on students' perceptions of collaborative practice measured with the Interprofessional Socialization and Valuing 9-item parallel equivalent forms. A national interdisciplinary palliative care team has successfully developed a seminar to deliver uniform education that prepares interprofessional students for collaborative practice as measured by the Interprofessional Socialization and Valuing Scale (ISVS). This pedagogy has evolved to be distance mediated to overcome geographical barriers in a primarily rural area. A gold standard of palliative and hospice care is interdisciplinary teams delivering quality patient and family-centered care; thus, educating interprofessional students for collaborative practice is essential. Diverse pedagogy is utilized by providing in-person patient encounters alongside live and virtual interactive sessions to over 250 students across 400 miles annually. The Interdisciplinary Palliative Care (IPC) Seminar provides evidence-based, uniform education to 7 disciplines, ranging from undergraduate through post-graduate students. While a previous in-person IPC Seminar showed that it positively influenced participants' perceptions of interprofessional socialization and valuing1, hybrid delivery had not been studied. 1) evaluate the participants' change in perceptions of interprofessional teamwork and collaboration after participating in the IPC Seminar to determine collaborative practice readiness and 2) analyze the hybrid delivery of the IPC Seminar. Participants completed an online survey of the Interprofessional Socialization and Valuing Scale (ISVS)2 pre-post IPC Seminar. Data was analyzed using a 2-sample t-test assuming equal variances. The hybrid IPC Seminar demonstrated significant impact (p <.0001) on interprofessional socialization and valuing scores with participants (pre n = 248; post n = 173) valuing interprofessional aspects of collaborative practice more after completing the seminar. This is consistent with previous finding when the IPC Seminar was delivered in-person1. The hybrid delivery model mediates distance by utilizing diverse pedagogies. Given these outcomes, this delivery model may be reproducible for other areas with barriers to educational access, such as limited resources (time, expertise, financial). The IPC seminar is an effective educational strategy to transform interdisciplinary students' beliefs, behaviors, and attitudes toward interprofessional collaborative practice and can make an impact as these students transition into their professional roles providing care in the rural Midwest. Interdisciplinary Teamwork / Professionalism / Quality Improvement [ABSTRACT FROM AUTHOR]

1. Participants will be able to describe the necessity to adapt, implement, and evaluate a nurse-driven palliative care model appropriate for Native American and rural family caregivers. 2. Participants will be able to identify the role a nurse plays in advocating for a palliative care model for Native American and rural culture. A thematic analysis of eighteen multidisciplinary healthcare professionals delivering cancer care in the Great Plains region revealed the fundamental role nurses have in successfully developing and integrating a culturally responsive wraparound palliative care model respecting Native American and rural culture for family caregivers of those impacted by cancer. Native American and rural patients with cancer and their caregivers (FCGs) face many barriers to receiving culturally responsive palliative care (PC). Understanding their unique strengths and needs will be imperative to adapting and implementing a comprehensive PC model to overcome these barriers. The study purpose was to compare a literature review on Native American and rural FCGs with the findings of a qualitative study among healthcare professionals who deliver cancer care to a Native American and rural population. A literature review of articles retrieved from PubMed, CINAHL, and EBSCOhost was conducted with the following inclusion criteria: published after 2020, English, peer-reviewed, and includes the key terms Native American, cancer, caregiver, nursing, palliative care. A thematic analysis of eighteen multidisciplinary healthcare professionals delivering cancer care at a rural cancer institute in the Great Plains region was conducted. Three themes and ten sub-themes were revealed through qualitative analysis and were compared to the thematic findings of the literature review. Priority themes described by the healthcare professionals and the literature included: access, support, and awareness. Consideration of these core themes, coupled with the individual cultural circumstance, is critical in addressing disparities faced by many Native American and rural FCGs. The successful development and integration of a culturally responsive wraparound PC model respecting Native American and rural culture is critical to advancing health equity for those impacted by cancer. Assimilation of the needs and circumstances of FCGs is evident and should influence the desired outcomes of the model and to make a positive, meaningful impact in promoting human health and well-being of FCGs. Diversity, Equity, Inclusion, Belonging, Justice / Models of Palliative Care Delivery [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. Methods: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. Results: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents. [ABSTRACT FROM AUTHOR]

Objective: This descriptive qualitative study sought to understand the barriers affecting cancer care delivery from the perspective of healthcare professionals (HCPs) serving American Indian (AI), rural, and frontier populations., Methods: One-on-one, semi-structured interviews with multidisciplinary HCPs ( N  = 18) who provide cancer care to AI, rural, and frontier populations were conducted between January and April 2022. Interviews were conducted via Zoom. Data were analyzed following thematic content analysis methodologies., Results: Thematic content analysis revealed three major themes: (a) Access, (b) Time, and (c) Isolation. The themes represent the HCP perspectives of the needs and barriers of persons with cancer to whom they provide cancer care. Furthermore, these themes also reflect the barriers HCPs experience while providing cancer care to AI, rural and frontier populations., Conclusions: This study provides preliminary evidence for the need and strong multidisciplinary support for an early palliative care intervention in rural and frontier South Dakota (SD). This intervention could support the needs of persons with advanced cancer as well as the HCPs delivering cancer care in rural settings., Innovation: This study is the initial step to develop the first culturally responsive, nurse-led, early palliative care intervention for AI, rural, and frontier persons with advanced cancer in SD., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sarah Mollman reports financial support was provided by The Rita & Alex Hillman Foundation. Sarah Mollman reports financial support was provided by Arthur Vining Davis Foundations. Sarah Mollman reports financial support was provided by South Dakota State University Research, Scholarship, and Creative Activity Challenge Fund. Brandon Varilek reports financial support was provided by The Rita & Alex Hillman Foundation. Brandon Varilek reports financial support was provided by Arthur Vining Davis Foundations. Brandon Varilek reports financial support was provided by South Dakota State University Research, Scholarship, and Creative Activity Challenge Fund., (© 2023 The Authors. Published by Elsevier B.V.)