Building Bridges to Hospice and Rural Appalachia

Palliative care, and specifically the management of pain issues, is an important and understudied issue in areas such as rural Appalachian Kentucky. Despite attempts to increase awareness on this issue, pain continues to be undertreated for chronic pain patients, including those with advanced disease and at the endof- life. This will only worsen as fears grow concerning prescription medication abuse and diversion. The application is designed to create a fully functioning research partnership between the University of Kentucky (UK) and Hospice of the Bluegrass (HOB), one of the largest hospice organizations among rural states. One major outcome of this relationship is to conduct a formal needs-based assessment of frontline care workers (ie, physicians, nurses, CNAs, social workers) who have to manage pain issues in a rural population noted for issues with prescription drug abuse and diversion. Data will be used for the purpose of identifying barriers to effective treatment and to gather initial data for a future interventional study. The needs assessment will be conducted through focus groups, key informant interviews, and assessment of frontline care workers at HOB. Specific attention will be paid to deficits in the knowledge base of providers regarding the appropriate use of opioid analgesics. To meet this end, assessment instruments will include worker demographics, a survey of their knowledge base and attitudes about pain management, a job satisfaction survey, and a measure of general self-efficacy. An additional survey on opioid knowledge and fear of use, along with a case vignette, will be developed to further round out the assessment package. As a final step, the study will conclude the needsbased assessment by conducting an agency wide survey at HOB to target future areas for applied research that address the application of clinical research needs pertinent to HOB and their patient population.