Palliative care aims to provide relief of pain and other patient symptoms, such as fatigue, dyspnea, constipation, anxiety, and depression, in order to improve quality of life. Patients in isolated rural settings often lack easy access to palliative care and other 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 symptom-management program for 288 cancer 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 symptom-management intervention, or to control groups. Our primary aim is to compare patient self-reports of symptoms 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 symptoms and perceived competence in treating symptoms.
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 symptom management and palliative care among underserved rural populations.

Public Health Relevance

Rural patients face many health disparities, including challenges in obtaining palliative care for relief of pain and other distressing symptoms. This study will evaluate the effectiveness of a telehealth-enhanced palliative care symptom-management intervention for rural cancer patients and their health care providers. The findings of this study will be instrumental in enhancing symptom management and palliative care, which will have applicability to delivery of other specialist care among underserved rural populations.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
Project #
Application #
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Mccloskey, Donna J
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
Other Health Professions
Schools of Nursing
United States
Zip Code
Eaton, Linda H; Gordon, Debra B; Wyant, Sheryl et al. (2014) Development and implementation of a telehealth-enhanced intervention for pain and symptom management. Contemp Clin Trials 38:213-20
Gordon, Debra B; Loeser, John D; Tauben, David et al. (2014) Development of the KnowPain-12 pain management knowledge survey. Clin J Pain 30:521-7
Kundu, Anjana; Lin, Yuting; Oron, Assaf P et al. (2014) Reiki therapy for postoperative oral pain in pediatric patients: pilot data from a double-blind, randomized clinical trial. Complement Ther Clin Pract 20:21-5
Tauben, David J; Loeser, John D (2013) Pain education at the University of Washington School of Medicine. J Pain 14:431-7
Doorenbos, Ardith Z; Gordon, Deborah B; Tauben, David et al. (2013) A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain 14:1533-8
Bensink, Mark E; Eaton, Linda H; Morrison, Megan L et al. (2013) Cost effectiveness analysis for nursing research. Nurs Res 62:279-85
Kundu, Anjana; Dolan-Oves, Rebecca; Dimmers, Martha A et al. (2013) Reiki training for caregivers of hospitalized pediatric patients: a pilot program. Complement Ther Clin Pract 19:50-4
Murphy, Alana; Siebert, Kathryn; Owens, Darrell et al. (2013) Healthcare Utilization by Patients Whose Care is Managed by a Primary Palliative Care Clinic. J Hosp Palliat Nurs 15: