BROOKINGS — Madison Fitch, a senior at South Dakota State University, will show state legislators the need for palliative care services for Native Americans in rural communities when she heads to the Capitol next month.

Fitch, a Rapid City native majoring in nursing, is one of two SDSU undergraduates who will showcase their research in front of South Dakota lawmakers. Fitch and Jay Holm will travel to Pierre on Feb. 7 for the 2023 South Dakota Student Research Poster Session.

Student researchers from Black Hills State University, University of South Dakota, Dakota State University, South Dakota Mines and Northern State University will also present their work.

Need for palliative care

Not to be confused with hospice, palliative care is a specialized type of medical care provided to those with serious or chronic disease. While hospice care is provided to patients with less than six months to live, palliative care can begin at any time during the disease process and can include symptom management, medications and treatments, which differs from hospice care.

“That’s a big distinction,” Fitch said.

For the past three years, Fitch had been working at Monument Hospital in Rapid City in the oncology unit. She also volunteered there for four years during high school.

“I became very exposed to oncology and palliative care,” Fitch said. “All of my grandparents went through those types of care, and so I knew that was something I wanted to research and something I wanted to go into once I graduated.”

Last spring, Fitch was looking for a research opportunity and noticed that Sarah Mollman, associate dean for research for the College of Nursing, had just received a grant to explore ways to increase the knowledge of palliative care among Native American communities. Fitch emailed her adviser asking how she could get involved with this project.

After connecting with Mollman, Fitch began working alongside the research team. Her project, titled “Identifying the Need for a Nurse-Driven Palliative Care Intervention for Rural Native American Caregivers,” explores the literature surrounding palliative care in comparison to health care interviews conducted by the research team.

“The nursing profession leads the advancement of palliative care and should deliver care in a culturally appropriate manner,” Fitch explained. “Rural Native Americans with cancer and their caregivers face many barriers to receiving a culturally appropriate delivery of palliative care.”

One of the biggest barriers to palliative care services for Native Americans is access. For patients who live in very rural communities, the closest access point for these services may be a three-hour drive, and travel may not feasible, Fitch explained.

During the pandemic, telemedicine and telehealth services became increasingly popular and provided those living in isolated areas accessible services. The issue here, Fitch said, is that some who need the services may not have reliable internet or telephone access.

“Sometimes in rural America, it can be difficult to get internet access,” Fitch said. “Often it’s not available or it can be very expensive.”

Fitch’s study aims to look at other barriers, develop key cultural competencies and identify areas of necessity for nurse-driven palliative care interventions for rural Native American caregivers with patients diagnosed with cancer.

“I went through the literature and found themes related to the cultural responsiveness of palliative care,” Fitch explained. “Now, I’m going through some interviews that were conducted with Native Americans and pulling themes from them as well. I will then be comparing my literature review to the actual findings.”

Findings

Fitch’s study found that culturally appropriate palliative care education and nursing interventions are needed as health care evolves to meet the needs of those it serves. Further, considerations for rural Native American culture should include risk factors for palliative care, values and societal impact.

“There is a necessity for improved access, support services and awareness of palliative care,” Fitch said. “Additionally, rural Native American caregivers exhibit the need for improved palliative care access, awareness, education and communication methods. Historically, Native Americans have endured discriminatory delivery of culturally appropriate health care. Increased access to quality palliative care is essential to improve outcomes for rural Native Americans with serious health-related suffering and their caregivers.”

The results of Fitch’s study align with the American Academy of Nursing’s call for nurses to recognize their obligation to protect human rights, which includes quality palliative care services and delivery.

Fitch is currently in the process of analyzing and comparing the health care interviews to the findings in her literature review.

“Palliative care is such a big need, especially in South Dakota,” Fitch said. “Access, awareness and education are especially important.”

Next steps

Outside of classes, Fitch has interned at the Sanford USD Medical Center in Sioux Falls and has been involved in various clinical rotations. In her free time, Fitch enjoys hiking, skiing, fly-fishing and spending time with her friends and family.

After graduating from SDSU this spring, she will begin work as a critical care RN at the Sanford USD Medical Center.

“I like everything, and I can’t wait to get more experience,” Fitch said. “There are really wonderful people at Sanford, and it’s a great unit.”

Earning a doctorate in nursing to specialize in palliative care is a long-term goal of Fitch’s that she hopes to pursue at some point in the future.