Nearly 90 million Americans are living with serious illnesses and that number is predicted to double in the next 25 years. Seven of every 10 deaths are caused by chronic conditions.
A palliative health care team can improve quality of life and significantly reduce health care costs for patients dealing with chronic, life-threatening illnesses, according to the American Cancer Society. This specialized team of doctors, nurses, social workers and other professionals can guide patients and their families through any stage of a serious illness including choosing curative treatments.
However, delivery of these services in rural America, where the elderly population is growing faster than the national rate, can be challenging.
Associate professor Mary Minton, who teaches at the SDSU College of Nursing West River Site in Rapid City, and a team of researchers examined the palliative and end-of-life services offered among South Dakota health care facilities. By 2025, nearly one-fourth of the South Dakota population will be over the age of 65, according to projections made in 2009 as part of the state's 2010-2013 plan on aging.
Surveying health care facilities
The SDSU researchers gathered information from 455 of the state's 668 health care facilities through a phone survey. These included clinics, assisted living centers, specialty clinics, hospice and home-health providers, hospitals and nursing homes.
Geographically, the facilities were 30 percent urban, 46 percent large rural and 24 percent small rural. The research was supported by the South Dakota Department of Health Comprehensive Cancer Control Program.
More than half of the facilities surveyed had no specific person as a point of contact for advanced care directives and planning, two crucial pieces of palliative and end-of-life care, according to Minton. These directives delineate the life-prolonging procedures that patients want and, more importantly, those they do not want, once they are unable to speak for themselves.
"Often these key decisions come close to the time of death when there's a lot of stress," said Minton. "Intentional palliative and end-of-life care help alleviate some of the stress associated with urgent decision making."
Among the institutions surveyed, 75 percent had a process in place for addressing advance directives and 53 percent had one for advance care planning. The staff at 80 percent of the facilities surveyed had no palliative care training and those at 73 percent of the health care institutions had no training in end-of-life care.
Decreasing health care costs
Hospital administrators are beginning to see the benefits of palliative care for the family, patient and the health care facility, according to Dr. Theresa Campbell, a family practitioner who leads a palliative care team at Avera Queen of Peace Hospital in Mitchell.
Other than hospice, South Dakota and the Northern Plains area, in general, have been relatively slow at offering palliative care to patients, explained Campbell, noting that part of her work involves educating other physicians about palliative care.
The Mitchell palliative care team is hospital-based, but some facilities in the state provide outpatient care instead, Campbell added.
Palliative and end-of-life care services are offered for both adults and children through Avera in Sioux Falls, Aberdeen and Yankton and at Sanford Health in Sioux Falls. Rapid City Regional Hospital has formed a palliative care team.
In addition, small communities such as Parkston and Freeman are also starting palliative care programs, according to Campbell. "With our aging population, palliative care services need to grow."
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