Hospice and palliative care: an educational intervention for healthcare professionals in a rural community

The purpose of the study was to increase the awareness and availability of hospice care in rural communities. In Taos, New Mexico, a community of about 30,000 people, we developed an educational intervention that introduced the topic of end-of-life care and hospice to their healthcare professionals. We targeted nurses, physicians, and other related healthcare professionals. The nurses and allied health professionals received a half-day seminar. The physicians attended a grand round about hospice and palliative care lead by the local hospice medical director. This individual was an important member of the local medical staff and was certified in hospice and palliative medicine. After the intervention, we were able to demonstrate an increase in the hospice annual census by 85 percent (p < 0.001). Average length of stay was not altered (27.3 percent enrolled for six days or less preintervention, 29.5 percent enrolled for six days or less postintervention; p = 0.97). Similarly, the number of patients admitted with a non-cancer diagnosis was not affected (54.6 percent preintervention, 44.3 percent postintervention; p = 0.34). We concluded that the educational intervention significantly increased the number of patients referred for hospice care. However, it did not affect the length of stay or increase enrollment for people with a non-cancer diagnosis. The educational intervention was inexpensive, locally run, and very effective as demonstrated by the increase in hospice referrals. Exporting the model to other rural sites appears to be feasible.