Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Susan Harrington

Third Advisor

Rachel Curaca


Advances in healthcare have led to many individuals with cancer to live longer, however the quality of life of these individuals has decreased. Palliative care is a medical sub-specialty that can assist to care for individuals with a life-limiting illness such as cancer. However, the access to palliative care services in rural communities is limited. According to the Institute of Medicine (IOM) report Dying in America, increasing access to palliative care will not only enhance the quality of life for patients with a life-limiting illness, but also contribute to a more sustainable healthcare system. The key stakeholders within a Midwest hospice and palliative care organization identified the need to expand palliative care services to a rural healthcare setting through telemedicine. However, the organization was lacking an evaluation plan for outpatient telemedicine delivery of palliative care. This quality improvement project focused on collaboration with a Midwest hospice and palliative care to develop an evidence-based toolkit to evaluate outpatient telemedicine delivery of palliative care. The Donabedian model and The Plan Do Study Act (PDSA) Cycle were used to guide toolkit development for evaluation and implementation of telemedicine delivery. The evidence-based toolkit includes telemedicine equipment and staffing needs, a formalized care flow process, referral recommendations, patient and organizational data collection, a cost-savings analysis, and a sustainability plan. To ensure standardized care is delivered, the evidence-based toolkit can be adapted to varied populations in different settings to expand palliative care services. The overall focus of the project and sustained goal was to address the quadruple aim of healthcare: to improve patient outcomes and experiences, reduce costs of care, and increase staff satisfaction (Bodenheimer & Sinsky, 2014).

Additional Files

A. Dwyer Powerpoint.pdf (3513 kB)