Community-Generated Palliative Care Telemedicine for Rural African American Elders

Palliative care programs and consultations have both been shown to reduce symptoms, alleviate suffering, improve family satisfaction, enhance effectiveness of care, and are associated with hospital cost savings. There are areas in the US where palliative care is not available, especially in rural areas of the Southern United States. Telemedicine is increasingly used to deliver health care for a variety of illnesses, but there has been only one randomized clinical trial of a telemedicine palliative care program in the US. Seventy five percent of South Carolina (SC) is rural, and 33% of its residents reside in rural areas where poverty and unemployment rates are high, and per capita income is low. African Americans comprise 28% of those who live in rural SC. Rural residents experience disparities in health outcomes and health care access. Previous studies of urban patients indicate that race, ethnicity and culture strongly influence end of life-sustaining measures. Significantly more African Americans choose life-sustaining therapies including resuscitation regardless of prognosis, have strong spiritual beliefs that fate is in God’s hands, and choose to include family members and religious leaders in the decision-making process. Culturally appropriate models of palliative care that take into consideration cultural preferences of terminally ill rural patients and their family caregivers are not currently available in the US. The proposed study will be the first to use Community Based Participatory Research (CBPR) to design and test the feasibility, acceptability and short-term effectiveness of a palliative care program for Black and White rural elders and their families.