Palliative Care in Rural Areas
Audrey Landry, MSN-NE, RN; Nancy Claus, DNP, CRNP, FNP-BC, CNE; Laura Steadman, Ed. D, CRNP, MSN, RN
Introduction
Palliative care is a specialty healthcare that aims to improve the quality of life for individuals with serious, chronic, or life-limiting illnesses through symptom management, psychosocial support, and care coordination. Despite growth in palliative services, significant disparities persist in rural areas, where patients encounter limited access to specialty care, workforce shortages, and geographic barriers. Rural populations also tend to be older, have a higher burden of chronic illness, and experience greater overall health disparities compared to urban populations, highlighting the critical need for more accessible and equitable palliative care services (Rural Health Information Hub, 2025.).
Barriers to rural palliative care include limited availability of trained providers, transportation issues, and reduced access to interdisciplinary teams. Rural healthcare systems often lack the infrastructure and financial resources needed to support comprehensive palliative programs. Despite challenges, integrating palliative care into primary care and leveraging community-based resources has shown promise in improving outcomes (World Health Organization, 2020).
Improving Access to Rural Palliative Care
Expanding palliative care into rural areas is crucial for reducing disparities in symptom management, advanced care planning, and end-of-life care. Nurses and advanced practice providers play a critical role, often serving as primary points of contact for patients and families.
Rural nurses can:
• Integrate palliative care into primary care and community health settings to improve access for rural populations through workforce, infrastructure, and policy-focused strategies (Bakitas et al., 2025).
• Expand tele-palliative care services to address geographic barriers and provider shortages by leveraging virtual consultations for symptom management and advance care planning (Bakitas et al., 2025).
• Increase educational opportunities in palliative care for rural healthcare providers to strengthen workforce capacity (Centers for Medicare & Medicaid Services, 2022).
• Strengthen rural palliative care delivery through partnerships with community organizations, hospice services, faith-based groups, and academic institutions to expand resources, support workforce development, and promote interdisciplinary collaboration (Rural Health Information Hub, 2025).
• Implement nurse-led care coordination and navigation services to improve continuity of care for rural palliative patients transitioning between home, hospital, and community settings, while strengthening communication among providers, patients, and families (Bakitas et al., 2020).
• Implement mobile health units and home-based palliative care programs to reduce transportation barriers and improve continuity of care (Centers for Medicare & Medicaid Services, 2022).
• Advocate for reimbursement reform, rural practice incentives, and healthcare infrastructure investment to sustain rural palliative care programs and improve outcomes (Rural Health Information Hub, 2025).
References
Bakitas, M., Allen Watts, K., Malone, E., Dionne-Odom, J. N., McCammon, S., Taylor, R., Tucker, R., & Ruth Elk (2020). Forging a new frontier: Providing palliative care to people with cancer in rural and remote areas. Journal of Clinical Oncology, 38(9), 963–973. https://doi.org/10.1200/JCO.18.02432
Bakitas, M. A., Gazaway, S., Underwood, F., Ekelem, C., Heard, V. T., Kennedy, R., Azuero, A., Tucker, R., McCammon, S., Hauser, J. M., McElwain, L., & Ronit, E. (2025). Palliative video consultation and symptom distress among rural inpatients: A randomized clinical trial. JAMA Network Open, 8(7), e2519426. https://doi.org/10.1001/jamanetworkopen.2025.19426
Centers for Medicare & Medicaid Services. (2022). Telehealth services. https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth
Rural Health Information Hub. (2025). Rural hospice and palliative care [online]. Rural Health Information Hub. https://www.ruralhealthinfo.org/topics/hospice-and-palliative-care World Health Organization. (2020, August 5). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care
