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Which Way from Here? Navigation Competencies for the Care of Older Rural Adults at the End of Life

Researchers: Wendy Duggleby, PhD, RN, AOCN, Faculty of Nursing, University of Alberta; Jennifer Anderson, MN, RN; Sharon Baxter, MSW; Patricia H. Berry, PhD, APRN, ACHPN, FAAN; Dan Cooper, MDiV; Robin L. Fainsinger, MB, ChB, LMCC, CCFP; Konrad Fassbender, PhD Kimberly Fraser, PhD, RN; Karen Gayman, RN; Sunita Ghosh, PhD, P.Stat.; Donna Goodridge, PhD, RN; Lars Hallstrom, PhD; Sharon Kaasalainen, PhD, RN; Sandra Kary; Norah Keating, PhD; Kathy Kenmore, LPN; Rob MacLeod, PhD, FAChPM; Anna Mann; Cheryl Nekolaichuk, PhD; Barbara Pesut, PhD, RN; Michelle Peterson Fraser, RN; Carole Robinson, PhD, RN; Anna Santos Salas, PhD, RN; Signe Swanson, MSW; Jennifer Swindle, PhD; Sharon Watanabe, MD, FRCPC; Linda Watson, PhD, RN; Kyle Whitfield, PhD; Allison Williams, PhD; Terri Woytkiw, RN, MN, CHPCN(c).

Purpose: This final report describes the development of health care provider navigation competencies when caring for older persons with advanced disease and their families living in rural communities. Aligned with the palliative approach put forth by the Canadian Hospice Palliative Care Association (CHPCA), the competencies are cross-disciplinary and for generalist health care providers. They are necessary to help rural seniors and their family caregivers find the services and resources they need while remaining in their own communities. The development of these navigation competencies thus seeks to contribute to the peace and comfort of palliative patients at the end of life.

Procedures: This research entailed a scientific literature review and Delphi study in the development and navigation of competencies, and a final competencies and skills profile for health care navigators for older adults at the end of life in rural communities.

Findings: The themes of quality of life, independence, and social connections were prevalent throughout the literature on rural aging and rural palliative care. In recognition of the diversity of older adults and their communities, the theme of negotiating the “best fit” for older adults and their communities was also found to be important. However, the research on patient navigation clearly demonstrates that a definition reflecting these themes is lacking. Based on the literature review, a proposed definition of navigation for older rural persons and their families at the end of life was developed; it entails working in collaboration with patients, families, and communities to: a) negotiate the “best fit” between the needs of older rural persons, their families and communities and resources; b) improve access to needed services and resources at the end of life (including death) and bereavement; and, c) to promote quality of life, foster independence, and facilitate community connections utilizing a culturally safe, palliative approach. A skills profile and general area competencies for general practitioners performing patient navigation to rural older adults at end of life was developed.

Acknowledgements: Funding for this initiative was provided by a Canadian Institutes of Health Research Planning Grant.


Final Report: Which Way from Here? Navigation Competencies for the Care of Older Rural Adults at the End of Life. January 7, 2014.

Canadian Institutes of Health Research