Exploring the Barriers and Suggestions for Improvement to Delivering Palliative Health Care Services in Four Underserved Rural Canadian Settings
Bibliographic record
Abstract
As the size of Canada’s elderly population continues to grow, so will the demand for palliative (or end-of-life) health care services, which strive to improve the quality of life of those suffering with life-threatening illness. Unfortunately, access to palliative care is inconsistent across Canada, especially among those residing in rural settings who, unlike urban residents, encounter additional geographical and financial barriers to care. Access to culturally-sensitive palliative care, particularly for Indigenous peoples, can also be challenging in these settings. Therefore, the goal of my thesis is to understand health care providers’ (HCP) perspectives on barriers to palliative care delivery in rural Canadian settings and to identify their suggestions for delivery improvement in these regions. To achieve this goal, I analysed forty semi-structured interviews capturing the perspectives of formal and informal HCPs from four rural and/or remote communities with limited palliative care resources. Barriers to palliative care delivery were initially coded using Penchansky and Thomas’ five dimensions of access (i.e. availability, affordability, acceptability, physical accessibility, and accommodation), however a recently added sixth dimension of access (i.e. awareness) became the primary focus of this analysis. Next, barriers to Indigenous palliative care were identified according to three palliative care environments (i.e. community, hospital, and home). A supplemental quantitative analysis was also conducted exploring the association between Indigenous identity and short- and long-term healthcare service use, as well as reasons for unmet health care needs, using three cycles (2012-2014) of the Canadian Community Health Survey. Findings indicate that barriers to palliative care delivery, via palliative care awareness, stem from limited palliative care knowledge/education, communication, and coordination among HCPs, and suggest that inadequate palliative care awareness may jeopardize initiatives striving to address barriers to the original five dimensions of access. The barriers to palliative care delivery among Indigenous peoples were also shown to differ between palliative care environments, and suggested that improving cultural sensitivity among HCPs could address these barriers. To improve rural palliative care delivery HCPs suggested implementing community-led and community-specific initiatives that enhance HCP knowledge, communication, and coordination of culturally-sensitive palliative care within different environments to ultimately encourage equitable access for all Canadians. Access to health care, palliative care, awareness
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.038 | 0.010 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.004 | 0.007 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".