Date of Project Completion

Fall 12-7-2020

Document Type

Project Paper

Degree Name

Doctor of Nursing Practice



First Advisor

Jenny Prochnow

Second Advisor

Julie Ponto


Background: Rural areas have higher percentages of older adults with multiple chronic illnesses yet disparities exist with access to palliative care (PC) in rural areas. Palliative care can improve quality measures that positively impact care and health outcomes.

Objective: The evidence-based project’s (EBP) objective was to implement a community-based PC program in a rural primary care clinic in rural Minnesota, US and evaluate quality metrics to further support program sustainability.

Design: The project developed and implemented a community-based PC program in rural Minnesota. A tool kit was created for use for the site’s care providers and leaders.

Setting/Subjects: The project included older adults in three long-term care (LTC) and three assisted living facilities in a rural community in Minnesota in the United States and included 15 participants.

Methods: Quality of life (QOL), symptom assessment, and hospital utilization were measured to evaluate effectiveness and efficacy of a new rural community-based PC program. Data collection was completed on QOL using The McGill Quality of Life-Revised (MQOL-R) survey was used to collect data on QOL. Chart review was used to obtain clinical assessment of symptoms. A retrospective analysis was used to analyze hospital utilization.

Results: Participants had higher psychological well-being but perceived their life as having less meaning. Analyzing the influence of number of participant illnesses on the MQOL-R physical subscale demonstrated marginal significance (p = 0.073) with a higher number of illnesses decreasing QOL.

Conclusion: PC programs in rural communities can play an important role in support older adults in their experience with chronic diseases and decrease hospital utilization. Quality measurements related to symptom assessment are feasible to collect in rural PC programs. Hospital utilization rates may positively impact with PC.

Key words: Palliative care, quality of life, symptom assessment, symptom management, hospital utilization, rural healthcare.

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