Canadian rural-urban differences in end-of-life care setting transitions.

Few studies have focused on the care setting transitions that occur in the last year of life. People living in rural areas may have more difficult care setting transitions and also more moves in the last year of life as health changes occur. A mixed-methods study was conducted to gain an understanding of the number and implications or impact of care setting transitions in the last year of life for rural Canadians. Rural Albertans had significantly more healthcare setting transitions than urbanites in the last year of life (M=4.2 vs 3.3). Online family respondents reported 8 moves on average occurred in the last year of life. These moves were most often identified (65%) on a likert-type scale as "very difficult," with the free text information revealing these trips were often emotionally painful for themselves and physically painful for the decedent. Eleven informants were then interviewed until data saturation, with constant-comparative data analysis conducted. Moving from place to place for needed care in the last year of life was identified as common and concerning for rural people and their families, with three data themes developing: (a) needed care in the last year of life is scattered across many places, (b) traveling is very difficult for terminally-ill persons and their caregivers, and (c) local rural services are minimal. These findings indicate planning is needed to avoid unnecessary end-of-life care setting transitions and to make needed moves for essential services in the last year of life less costly, stressful, and socially disruptive for rural people and their families.