Pain and Symptom Management in Rural Communities

Patients in isolated rural settings often lack easy access to pain care and specialist
services. Yet rural residents are more likely than their urban counterparts to be older; be
in poorer overall health; suffer from more chronic or serious illnesses and disabilities; be
uninsured or underinsured; and live in poverty. Telehealth is an emerging method of health
care delivery that has been found useful and effective in many clinical settings and
specialties. Telehealth technologies can bridge geographic distance and increase access to
specialist care in rural settings. We propose a cluster randomized clinical trial design to
test the effects of a telehealth-enhanced palliative care pain-management program for 288
patients and 96 providers in rural health care settings. The proposed program will provide
services to both patients and providers: Patients will conduct self-assessments and report
pain and other symptoms via telehealth. Health care providers will receive
telehealth-delivered case consultations that will include case management, evidence-based
practice resources, and peer support. Providers and their patients will be randomly assigned
to intervention groups, which receive the telehealth-enhanced palliative care
pain-management intervention, or to control groups. Our primary aim is to compare patient
self-reports of pain and quality of life in the intervention and control groups over 2
months. Aim 2 is to examine, in the intervention and control groups over 2 months,
providers' knowledge and attitudes regarding pain and perceived competence in treating pain.
Aim 3 is to evaluate the cost-effectiveness of the telehealth intervention. We will use
mixed effects models with patients nested within providers to evaluate the effect of the
intervention on study outcomes. Findings from this study will be instrumental in advancing
telehealth and improving pain management and palliative care among underserved rural
populations.