Rural patients with life-limiting illness are at very high risk of not receiving appropriate care due to a lack of
health professionals, long distances to treatment centers, and limited palliative care (PC) clinical expertise.
Although culture strongly influences people's response to diagnosis, illness and treatment preferences,
culturally-based care models are not currently available for most seriously-ill rural patients and their family
caregivers. Public health consequences of these problems are: 1) Access-Rural patients have sub-optimal or
no access to PC and 2) Acceptability-Even when palliative and hospice services are available, African
Americans (AA), compared to Whites (W) are more likely to receive poor quality care due to a culturally-
insensitive health care system and mistrust of health care providers. As a result, rural patients, especially from
minority groups, experience significant suffering from uncontrolled symptoms that PC expertise could alleviate.
Our R21 Tele-consult pilot studyand our other telehealth RCTs have systematically incorporated diverse
community stakeholder input on how to best design and deliver culturally-based palliative care for rural communities. Our
Tele-consult Intervention was developed by and for rural, Deep South AA and W patients and providers, and uses state-of-
the-art telehealth methods, to provide PC consultation to hospitalized seriously-ill patients and family. Using National
Consensus Project guidelines that have been adapted through a culturally-based, community-developed CBPR process,
we developed a PC Tele-consult intervention whereby a remote PC expert conducts a comprehensive PC patient
assessment, in collaboration with local providers, and following interdisciplinary PC team review, makes recommendations.
Two additional structured follow up contacts of PC expert with patient and local provider ensure care coordination and
smooth transitions, allowing patients to receive guideline-concurrent PC care in their communities.
We propose a three-site, randomized controlled trial to test the efficacy of a community-developed, culturally-based
PC Tele-consult program for 352 hospitalized AA and W older adults with life-limiting illnesses. We have partnered with 3
rural, Deep South community hospitals, located in South Carolina, Alabama, and Mississippi that lack PC resources and
recognize the potential benefits that PC expertise via Tele-consult can provide. Prior to study launch, we will assemble a
local Community Advisory Group at each site to provide further input and assist in communicating study goals to patients.
Study aims are to compare a robust, culturally-based PC Tele-consult program to usual hospital care to determine
whether a culturally-based PC Tele-consult program leads to: 1. Lower symptom burden in hospitalized AA and W older
adults with a life-limiting illness (primary aim) and 2. Higher patient and caregiver quality of life, care satisfaction, and lower
caregiver burden at Day 7 post-consultation, and lower resource use 30-days post-discharge (secondary aim.)
Impact: Ours is one of the first culturally-based palliative care Tele-consult programs developed by and for the rural
southern AA and W populations it serves. This study will move the field forward by testing a promising culturally-based
Tele-consult intervention that is scalable, and serves as a model for future culturally-based PC programs.
