“If I have any problems, I just want to see my [primary care] doctor”: perspectives on a proposed collaborative RUral PALliative care intervention (RuPal)

BACKGROUND: People living with advanced heart failure in rural areas have poorer quality of care as their disease progresses, which may be due to lack of access to specialty palliative care. A collaborative care model, connecting specialty palliative care clinicians to embedded complex care teams in primary care practices, may increase access to palliative care in this population. Research objectives To explore perspectives on a proposed collaborative palliative care intervention and whether this intervention would be appropriate for people living with heart failure in rural areas. METHODS: We conducted a qualitative study (n=26), including patients with heart failure (n=7), caregivers (n=2), complex care team members working in primary care practices (n=5), primary care providers (n=5), interdisciplinary specialty palliative care clinicians (n=4), and cardiologists (n=3) all living and/or practicing in a rural community in Maine. Interviews were audio recorded and professionally transcribed. We used Max-QDA, line-by-line coding, and grounded theory analysis. RESULTS: We found people living and working in rural areas wanted palliative care integrated into primary care. Participants voiced suspicion about care "from outsiders" and that introduction of a specialty palliative care team into their medical care might not be well received. As one primary care provider noted "rural [people] are less influenced by … seeing the latest specialist," so describing palliative care as a specialty may not be appealing. However, participants felt that patients would be open to receiving palliative care delivered by their primary care teams. Palliative care specialists and primary care clinical staff were enthusiastic about a collaborative care model to navigate patients' desire to avoid a new team while increasing access to specialty palliative care expertise. CONCLUSION: A collaborative palliative care model may be welcomed by patients, caregivers, and clinicians in rural areas.