{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:09:53Z","timestamp":1777882193058,"version":"3.51.4"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100008213","name":"South Dakota State University","doi-asserted-by":"publisher","award":["Research, Scholarship, and Creative Activity Chall"],"award-info":[{"award-number":["Research, Scholarship, and Creative Activity Chall"]}],"id":[{"id":"10.13039\/100008213","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001073","name":"Arthur Vining Davis Foundations","doi-asserted-by":"publisher","award":["Hillman Emergent Innovation: Serious Illness and E"],"award-info":[{"award-number":["Hillman Emergent Innovation: Serious Illness and E"]}],"id":[{"id":"10.13039\/100001073","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017234","name":"Rita and Alex Hillman Foundation","doi-asserted-by":"publisher","award":["Hillman Emergent Innovation: Serious Illness and E"],"award-info":[{"award-number":["Hillman Emergent Innovation: Serious Illness and E"]}],"id":[{"id":"10.13039\/100017234","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat&amp;#65533;Care"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>American Indian (AI) persons with advanced cancer (PwAC) in South Dakota have seen increased rates of cancer incidence and mortality compared to national rates. These inequities are driven by social determinants of health. Providing early palliative care is highly important for rural PwAC but is sparsely available in rural South Dakota.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To explore cancer care experiences and patient symptoms and caregiver burden among AI and rural PwAC, and their family caregivers (FCGs), to understand the barriers and opportunities for adapting an early palliative care intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Descriptive study design reporting on the qualitative and quantitative data collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      PwAC and FCG participants were recruited from a rural healthcare facility delivering cancer care and serving AI tribal and rural\/frontier populations. Quantitative data were collected using online surveys to discover symptoms and caregiving burden among PwAC (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200918) and FCGs (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200912), respectively. These participants were invited to semi-structured interviews to elicit perspectives of rural cancer care delivery (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200911 PwAC and 8 FCGs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>PwAC experience moderate symptom burden with 83.3% lacking energy, 77.8% feeling drowsy, and 72.2% feeling pain. FCGs experience high caregiver burden across all three subscales of the caregiving scale. Qualitative analysis found an overarching category of \u201cHealthcare Fragmentation Amplified by Living in a Rural\/Frontier Location\u201d with three underlying codes: \u201cBeing Seen and Heard: Value-Based Connection to Distant Resources,\u201d \u201cFacilitating Decision Making from Afar,\u201d and \u201cProblem Solving Skills and Solutions.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study demonstrates that rural cancer care is challenged by multiple factors, including fragmented healthcare, lack of healthcare infrastructure, and vast travel distances. This greatly impacts PwAC and FCG\u2019s ability to feel seen and heard, make decisions, and problem-solve. Supportive programs designed for the local rural context are imperative to improve the quality of life for rural PwAC and their FCGs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26323524261438152","type":"journal-article","created":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T16:17:28Z","timestamp":1775405848000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A descriptive study of cancer care experiences and burden of rural South Dakotans"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3432-660X","authenticated-orcid":false,"given":"Sarah","family":"Mollman","sequence":"first","affiliation":[{"name":"South Dakota State University College of Nursing, Rapid City, SD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3340-2382","authenticated-orcid":false,"given":"Teddi","family":"Dowling","sequence":"additional","affiliation":[{"name":"Avera Health, Sioux Falls, SD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0754-3405","authenticated-orcid":false,"given":"Patricia","family":"Woolridge","sequence":"additional","affiliation":[{"name":"Avera Health, Sioux Falls, SD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0979-8243","authenticated-orcid":false,"given":"Jamie","family":"Hillmer","sequence":"additional","affiliation":[{"name":"Avera Health, Sioux Falls, SD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6764-0254","authenticated-orcid":false,"given":"James","family":"Odom","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham School of Nursing \u2013 Center for Palliative and Supportive Care, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2913-2053","authenticated-orcid":false,"given":"Marie","family":"Bakitas","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham School of Nursing \u2013 Center for Palliative and Supportive Care, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3449-4953","authenticated-orcid":false,"given":"Hossein","family":"Moradi Rekabdarkolaee","sequence":"additional","affiliation":[{"name":"Department of Applied Statistics and Operations Research, Bowling Green State University, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9426-5453","authenticated-orcid":false,"given":"Brandon M.","family":"Varilek","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center College of Nursing, Omaha, NE, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"National Cancer Institute. 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