Hi everyone, my name is Selma. I'm a fourth-year medical student at the University of New England College of Osteopathic Medicine. I'm so excited to be presenting at OMED 24 and to share my research about navigating chronic pain in rural New Hampshire. This is a study on palliative care access and challenges. A bit of context around this study is that access to palliative care in rural areas can often present significant challenges due to social determinants of health and reliance on local community physicians for complex medical conditions. Palliative care providers may serve as crucial resources for individuals dealing with chronic pain in rural New Hampshire where access to specialized medical care can be limited. This study explores the experience of patients with chronic pain to understand how palliative care impacts their lives, examining both positive outcomes and challenges. For the methods for this study, all of the questions were asked via phone surveys. Individuals had to be enrolled in the palliative care program at the Small Rural Community Hospital in New Hampshire and they had to fulfill the following criteria. They needed to have a diagnosis of chronic pain, have appointments between March 1st, 2024 and July 1st, 2024, and currently under the care of a palliative care physician. The reason why this time frame was chosen was to ensure a feasible sample size and also consider the fact that many palliative care patients transition to hospice or other outcomes. Out of the 40 potential palliative care patients, 16 fulfilled our selection criteria that I mentioned above and eight of them responded. We collected data that included demographics, transportation accessibility, all the way to qualitative insights on their palliative care experiences. Moving on to the second column under background and data, we can see a bit of demographics of the patients. So out of the eight patients that we surveyed, they ranged in age from 60 years of age to 92 years of age. For the etiology of their chronic pain, 87.2% of the participants had metastatic cancer as the etiology of their chronic pain and 12.8% had polymyalgia rheumatica as the etiology of their chronic pain. In terms of distance range and proximity to palliative care physicians, five of our patients lived less than 10 miles away from their palliative care physician and three lived 10 to 20 miles away. For responses, we can see the first one is the challenges in accessing care. So we had many patients say that travel to tertiary care centers and primary care access difficulties were among the greatest challenges that they faced in terms of accessing care in rural areas. In the middle here, we can see on a more positive note, all of the patients reported their pain as well-managed and to kind of break that down a little bit more, 75% reported that their pain was very well-managed and 25% reported that their pain was somewhat well-managed. And then the graph next to that, we can see a hundred percent positive responses. So all eight participants noted that they were all able to schedule an appointment with their palliative care provider within a week. All of them felt community support and none of them faced transportation issues. So moving on to the results here in this third column, so all participants reported their pain as well-managed through seeing a palliative care provider. All participants were able to schedule an appointment with their palliative care provider within a week. None reported missing their appointments due to transportation difficulties and many of them cited being prepared for rural conditions as a reason why. So they knew that if there was a big snowstorm coming or if there was, if it was mud season and they were getting tons of rain, they knew how to prepare for that in advance to make sure that they weren't missing the appointment with their physician. Emotional and social support were seen as beneficial in addressing and dealing with problems related to their illness. Participants all felt well supported by their communities and managing their chronic pain. And participants appreciated the coordinated care that their palliative care provider was able to give them when it came to talking with their oncologist and getting updates from other specialized medical providers that they've seen to kind of summarize the treatment plan and make sure that these patients were being advocated for in the best possible way. And the palliative care provider was really able to do that for them and kind of make their lives a little bit more easy when dealing with so many illnesses and dealing with chronic pain. So as a conclusion, palliative care in rural New Hampshire is a crucial resource in assisting patients in managing their chronic pain. All participants reported their pain as well-managed through seeing a palliative care provider for medical management and emotional and social support. Key challenges as we discussed included the access of tertiary care centers which can sometimes be hours away and also contacting their primary care physicians. Recommendations for further studies would be to administer surveys in person to improve response rates and conduct similar studies with similar questions in urban areas to see how these responses may differ. Finally, continued education on palliative care is essential to reduce stigma and enhance palliative care utilization. A little bit about me, I'm a fourth-year medical student at the University of New England College of Osteopathic Medicine. During my third year of medical school, I was assigned to complete my rotations at a small rural community hospital in New Hampshire and here I saw the opportunity to learn more about rural populations and explore the social determinants of health that may impact this unique population. I placed my references down below and also my contact information. If you have any questions about this study or you'd like to chat further, my contact is shotzik at une.edu. Thank you so much for listening. It was a pleasure to present this for you all and I hope to hear from you soon in terms of any questions or further discussions that you'd like to have on this topic. Thank you.

chronic pain management

palliative care

rural healthcare

New Hampshire

healthcare access