Visioning For Secondary Palliative Care Service Hubs in Rural Communities: A Qualitative Case Study from British Columbia's Interior

Background: As the populations of many developed nations continue to age at rapid rates it is becomingincreasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areasface a number of challenges in doing this, and thus dedicated attention must be given to determining how to bestenhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are todetermine the vision for establishing secondary palliative care service hubs (SPCH) in rural communities throughundertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs.Methods: A rural region of British Columbia, Canada was selected for primary data collection, which took placeover a five-month period in 2008. Formal and informal palliative care providers (n = 31) were interviewed. Apurposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews wereconducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim.Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation tostrengthen interpretation.Results: Four themes emerged from the dataset: (1) main SPCH features; (2) determining a location; (3) valueaddedoutcomes; and (4) key considerations. It was found that participants generally supported implementing aSPCH in the rural region of focus. Several consistent messages emerged, including that: (1) SPCHs must createopportunities for two-way information exchange between specialists and generalists and communities; (2) SPCHsshould diffuse information and ideas throughout the region, thus serving as a locus for education and a means ofenhancing training opportunities; and (3) hubs need not be physical sites in the community (e.g., an office in ahospice or hospital), but may be virtual or take other forms based upon local needs.Conclusion: Visioning innovation in the provision of palliative care service in rural communities can be enhancedby consultation with local providers. Interviews are a means of determining local concerns and priorities. Therewas widespread support for SPCH coupled with some uncertainty about means of implementation.