Palliative care challenges-access to anticipatory medications in rural and remote settings.

Abstract

Introduction Anticipatory medications (AM) have beenwidely used in various settings across many countries in people approaching end of life. Access to palliative care in rural and remote areas of Australia is lacking as are other medical services when compared with the metropolitan setting. Our aim is to identify challenges with the administration and access toAMin rural and remote communities with outcomes to guide improved delivery of care. Methods An online survey administered using Qualtrics, a secure survey platform was distributed to a total of 18 managers from 18 rural and remote organisations across the South East of Victoria in Australia. Results A total of 29 nurses completed the survey (response rate 28%). Almost a third of all nurses surveyed did not have specific guidance regarding the use of AM for their patients. Opioids (55%) were by far the most commonly used AM followed by anti-emetics (45%). The most common decisions taken by nurses to administer AM were cited as patient deterioration or in their terminal phase with a fluctuating level of anxiety and patients' agitation. Access to AM and lack of staff education were major challenges in rural and remote areas. Conclusions Provision of timely AM has the potential to improve the quality of life of patients and their caregivers. Key barriers to access AMcan be overcome with community-level planning and nurses' education. Advanced nurses' roles have the opportunity to provide specialised care where access to specialist physicians is challenging.