Table 1.

Program assessment framework for a rural palliative supportive service (RPaSS).

Quality principles for rural palliative care from the literature	RPaSS assessment framework: strategies
Embedded within community
• Based on a community assessment. • Vision generated from community. • Involves champions in the community. • Is publicly visible. • Broad-based community support.	• Advisory committee with broad stakeholder representation. • Regular advisory meetings to report on activities and solicit feedback. • Media strategy for reporting. • Website. • Active community referrals. • Yearly environmental scan and strategic planning.
Palliative care is timely, comprehensive and continuous
• Timely designation occurs for those who may benefit from palliative care. • Designation is comprehensive and dependent on need rather than prognosis. • Palliative care is available for any life-limiting illness and in an upstream approach. • Palliative care may be provided in conjunction with life-prolonging treatments. • Patients and families have access to services 24 hours a day, 7 days a week for basic to advanced palliative care. • Case management supports continuity of care to help integrate transitions for patients and families between care settings (eg, home, hospitals, residential facilities and urban relocations).	• Referrals received for patients who have not yet received a palliative benefits designation. • Referrals received from patients with a variety of chronic life limiting conditions. • A RPaSS coordinator maintains regular contact with registrants throughout all transitions in care. • Treatments are discussed and negotiated on a regular basis with registrants. • Documentation of physical, psychosocial and spiritual needs of registrants. • Documentation of care delivered through the RPaSS. • Access 24/7 to healthcare providers with palliative expertise. • Physician orders to treat symptoms available with no undue delays.
Access to palliative care education and experts
• Continuing palliative care education is available for primary health care providers. • Primary care physicians and nurses with palliative expertise are utilized in the community and can undertake direct care of the patient if needed. • Palliative care experts are available as back-up (eg, Telehealth).	• RPaSS coordinator provides evidence of his/her continuing PC education. • RPaSS coordinator documents educational needs encountered in care and reports to advisory committee. • RPaSS coordinator documents continuing education opportunities offered within the community. • All appropriate registrants aware of provincial palliative care nurse referral line and usage of service documented. • Expert physician resource available in rural community.
Effective teamwork and communication
• Clear leadership structure. • Regular team meetings to discuss, plan and evaluate care and initiatives. • Formal communication plan. • Registry of palliative individuals. • Peer support for team members. • Builds connections in community between volunteer/paid/formal/informal healthcare providers.	• Advisory committee with terms of reference. • Care committee with terms of reference. • RPaSS care plan created, regularly updated and left in registrant home as a means of communication for other care providers. • Registrants sign a release allowing information to be shared between RPaSS coordinator and other care providers. • Comprehensive RPaSS communication plan constructed and reviewed annually. • Registration database created for RPaSS. • Registrants screened and educated regarding hospice services. • Registrants screened and educated regarding spiritual/religious care services.
Family partnerships
• An inventory of local and regional bereavement services available to health care providers and bereaved family members. • Needs and roles are negotiated and re-negotiated on an ongoing basis. • Receive anticipatory and timely teaching and guidance based upon needs. • Participates in choices around place of care. • Bereavement care available through a variety of approaches.	• Designated family registrants. • Family registrants receive resource binder. • Family registrants complete Robinson et al caregiving decision aid regarding location of care and discussion occurs regarding identified needs. • Family registrant involved in advance care planning. • Family registrant participates in care conferences. • Family registrants regularly assessed regarding satisfaction with RPaSS care and caregiver burden. • Family registrant participates in bereavement visits × 2.
Policies and services that support rural capacity and values
• Policies of agencies providing palliative care are supportive of rural values and needs. • Advance care planning occurs and is revisited when a disease is recognized that is life-limiting. • Necessary benefits and services are available and accessible in a timely manner. • Persons are aware of available benefits and services. • Desired place of death is discussed and meets the realistic expectations of the patient.	• Documentation of the effects of policies that hinder and facilitate high-quality palliative care with a feedback loop to advisory committee, ministry of health and health authority. • Registrants will be aware of My Voice, engage in conversations about advance care planning and have someone to whom they can make their wishes known. • Resource inventory for rural communities updated yearly. • Documentation of benefits and services obtained through RPaSS coordinator. • Preference for place of death recorded. • Needs assessment performed of feasibility of preferred place of death. • Family caregivers complete Robinson et al decision making tool and discussion occurs regarding identified needs.
Systematic approach to measuring and improving outcomes of care
• Accountability cycle with feedback to stakeholders. • Validated patient and family outcome measurements. • Built upon research and translation of best practice guidelines.	• Documentation of gaps in care (eg, failure to control symptoms or unavailable services). • Regular feedback loops about quality of care to care committee, advisory committee and community. • Registrants complete quality of life tools. • Family registrants complete satisfaction with care provided by RPaSS and caregiving burden tools. • Bereaved family registrants complete satisfaction with care and grief tools. • RPaSS coordinator completes healthcare utilization index. • Knowledge integration plan in place for RPaSS.