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Nurse-researchers seek to expand palliative care in South Dakota

Mari Perrenoud, Charlene Berke and Sarah Mollman
Mari Perrenoud, network director of the South Dakota Palliative Care Network; left, Charlene Berke, co-project director, and Sarah Mollman, co-project director and assistant professor at South Dakota State University’s College of Nursing in Rapid City, lead efforts to expand and improve palliative care in South Dakota. The three-year project is funded through a U.S. Health Resources and Services Administration Rural Health Network Development Grant.

A palliative care team provides supportive care to patients diagnosed with serious illnesses throughout the disease trajectory and to their caregivers, according to Sarah Mollman, an assistant professor at the South Dakota State University College of Nursing's Rapid City site. She is part of a team of nurse-researchers working to improve and expand palliative care in South Dakota.

A serious illness is “any health condition that carries a high risk of mortality and negatively impacts a person’s daily function and quality of life,” Mollman explained. The most common illnesses are cancer, chronic obstructive pulmonary disease, congestive heart failure and end-stage renal disease, as well as pediatric diseases, such as cystic fibrosis.

“Palliative care is associated with increased quality of life, better communication with health care providers, increased satisfaction and increased survival,” she continued. “It’s the big picture of patient care and seeing that their wishes are being met—and doing so early in the disease trajectory.”

Because patients and their caregivers have support to manage their diseases, access to palliative care services decreases health care costs by reducing the need for emergency room and urgent care visits.

For her work, Mollman was recognized as the outstanding researcher for the College of Nursing at SDSU’s Celebration of Faculty Excellence. “This is an honor, particularly when you know the incredible people working at the university,” said Mollman, who received her bachelor’s and master’s degrees in nursing from SDSU. She began teaching at SDSU in 2015. By 2018, she had also earned her doctorate in nursing from the University of Nevada-Las Vegas—and became an assistant professor.

“SDSU has been great about mentoring and building relationships and teams,” Mollman said. “I am here because of the people who helped me along the way.” It also helps to say yes to new opportunities, she added.

As part of a project team, Mollman conducted focus groups for a one-year project for Avera Sacred Heart Hospital to evaluate and assess services for the South Dakota Palliative Care Network. The research was funded by a U.S. Health Resources and Services Administration grant.

That led to Mollman becoming co-director, along with Charlene Berke of Avera Sacred Heart Hospital, of a three-year, $900,000 HRSA project to improve the availability of palliative care services in the state by advocating for community-based resources and greater awareness. About one-third of the research funding goes to SDSU. The project, which began in July 2020, also involves Presentation College and Mount Marty University.

Assessing palliative care availability

The state’s three large health care systems—Avera Health, Sanford Health and Monument Health—are “doing pretty well at specialty palliative care and are trying to branch out,” Mollman said. However, access to palliative care in the smaller, more remote areas of the state remains limited to nonexistent.

Through focus groups conducted in Sioux Falls, Brookings, Pierre, Rapid City and Spearfish, the researchers identified a need for greater understanding and awareness of palliative care among health care providers as well as patients and their families.

“A lot of times, palliative care is seen as hospice or end-of-life care—we need to redefine that,” Mollman said. That is why palliative care professionals refer to what they do as supportive care, which can be provided along with curative treatments.

“What we are trying to do with this second grant is to increase primary palliative care,” Mollman explained. That means educating health care professionals to understand the interdisciplinary team approach to palliative care as well as making those services more widely available, particularly in smaller towns throughout the state where gaps in palliative care access have been identified.

The interdisciplinary palliative care team provides medical, emotional, spiritual and practical support that even extends to access to transportation and financial assistance. Consequently, the team can include mental health professionals, nutritionists, physical and occupational therapists, as well as social workers and chaplains, depending on the patients’ needs.

“The primary palliative care team cares for people where they are at and when they need more help, then they can consult the specialty palliative care providers, if needed,” she explained.

Expanding palliative care

To educate practicing health care professionals, the team began promoting web-based continuing education modules from the Center to Advance Palliative Care in fall 2019. Next year, the team will integrate primary palliative care into the nursing curriculums at SDSU, Presentation College and Mount Marty University. The research team also hopes to expand its educational programming to other universities, colleges, and health care disciplines.

Last spring, the researchers began developing educational materials for patients and their families. “Our goal is to improve access to quality palliative care by advocating for community-based resources and greater awareness,” Mollman explained.

During the COVID-19 pandemic, one of the palliative care physicians started a coalition through which the teams shared resources and supported one another, Mollman said. “We were a hot spot, and this is how we came together.” These resources will help the palliative care teams across the state address some of the challenges providers face in offering palliative care services.