| This three-manuscript dissertation reports the mixed methods dissertation research conducted to explore the palliative care perceptions of rural dwelling providers, nurses, adults, and veterans using a convergent parallel design. The secondary research aim was to explore the relationship between knowledge and perceptions of palliative care held by rural providers and nurses. The results are reported in three manuscripts; an integrative literature review, a report of the full mixed methods study, and a qualitative account of the rural veteran participants. Following institutional review board approval, 25 rural participants (providers, n = 5; nurses, n = 7; adults, n = 7; and veterans, n = 6) from a geographically defined area of over 8,500 square miles completed audio-recorded, face-to-face, semi-structured interviews; and 51 participants
(providers, n = 7; nurses, n = 41) from 19 organizations within the study area completed the 20-item Palliative Care Knowledge Test (PCKT). Both samples answered 13 demographic questions. Veterans answered an additional seven questions related to their service. Qualitative data was analyzed using thematic analysis. Quantitative analysis was performed using SPSS, Version 23. Qualitative and quantitative data were analyzed separately before merging and comparing in the final analysis. Six themes were identified: Palliative care is comfort for the dying or end-of-life care; Palliative care? Never heard of it; Uncertainties about the differences between palliative care and hospice; Conflicts between theory and practice; Timing is everything; and Experience is a strong teacher. In contrast to the other groups, none of the rural veterans associated palliative care with hospice care, and none of the rural veterans were able to define palliative care. PCKT total scores for the sample of providers and nurses (n = 51) was 10.73 (SD 2.93) suggesting relatively poor palliative care knowledge. Two constructs, Maturity and Rural Investment, were identified. Providers and nurses in rural areas are experienced, have lived and practiced in rural areas for considerable time supporting the constructs of Maturity and Rural Investment. Broad-based palliative care education is needed for rural adults and veterans and the providers and nurses who provide care in rural areas. Keywords: Rural, palliative care, hospice care, veterans, perceptions |