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Julie Benson’s interest in palliative care began while she was providing care for people in hospice.

For Benson, MD, it became clear that people need the services she was providing long before they arrived in hospice.

“People have needs well beforehand, whether it’s symptom management or goals of care conversations,” explains Dr. Benson. “My frustration was that we were getting people late.”

Palliative care, Dr. Benson says, continues to be treated as a sequential step in the healthcare system when it should be offered further upstream, alongside other forms of treatment.

Dr. Benson serves as a Family Medicine Physician with Lakewood Health System, which operates a 25-bed critical access hospital, five primary care clinics and offers services geared toward supporting seniors.

Lakewood Health System is based in Staples, MN, a town with just fewer than 3,000 residents. Providing palliative care in rural areas can present unique challenges, Dr. Benson says, including limited awareness of palliative care and a shortage in clinicians qualified to provide it.

“Most rural doctors don’t have specific hospice and palliative care training,” says Dr. Benson.

A lack of reimbursement for palliative care services and a need to serve impoverished communities are also barriers to overcome for those delivering palliative care in this setting. These challenges influenced Dr. Benson’s decision to become more involved in the policy side of advanced care.

In 2017, Dr. Benson was one of 19 individuals appointed to the newly created Minnesota Palliative Care Advisory Council. The council was commissioned by the state legislature to assess the availability of palliative care across the state, analyze barriers that hinder access to palliative care, and provide policy recommendations and draft legislation.

For Dr. Benson, joining the council provided an opportunity to raise concerns of palliative care providers in rural areas and those receiving treatment.

“I’ve been a big advocate for rural palliative care,” says Dr. Benson, who has worked with Quality Improvement Organization Stratis Health on a number of initiatives related to the issue. “I just want to make sure they have a voice.”

In its latest legislative report, the council notes that it has directed its work group to advise lawmakers on legislation related to pain and opioid misuse. The report cites the need to balance the relationship between policies addressing addiction and policies supporting quality palliative care.

Dr. Benson notes that striking this balance will be important to ensure that opioid addiction is dealt with while still ensuring that those receiving palliative care have access to the treatment they need.

“As they narrow down opioid use, it shouldn’t be harder for us to get medication for our patients,” says Dr. Benson.

Dr. Benson’s participation in the council ensures that rural palliative care providers and those in their care are represented when policy decisions are being made.

“We have to stay vigilant about having a voice at the table,” Dr. Benson says.

Looking to the future of palliative care, Dr. Benson would like to see training and education in the discipline continue to expand beyond specialists and into medical education curricula.

“There will always be a need for specialty palliative care,” Dr. Benson says, “but we need to build up and make robust our primary palliative care.”

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