Access to high-quality palliative and end-of-life care remains uneven across the United States, with rural communities facing some of the most persistent disparities.
In Oregon, where 26 of 36 counties qualify as rural or frontier, geographic isolation and limited healthcare infrastructure significantly constrain access to specialized services. Patients living with serious or terminal illness often travel long distances, sometimes up to 200 miles, to consult oncologists or other specialists. These encounters sometimes represent their only opportunity to receive palliative care. In many communities, hospice and bereavement services remain scarce or entirely unavailable, leaving patients and families without essential support during some of life’s most challenging moments.
These gaps reflect broader structural challenges in healthcare delivery. While clinical care remains critical, research consistently demonstrates that up to 80% of the needs associated with serious illness and end-of-life care are psychosocial in nature. These needs, which range from emotional support and caregiver assistance to practical help with daily living, often exceed the capacity of formal healthcare systems alone. In rural settings, where professional services are limited, communities themselves play an essential role.
The Peaceful Presence Project (PPP) addresses this challenge through an innovative model grounded in the Compassionate Communities framework. This approach recognizes that effective care extends beyond clinical settings and mobilizes local networks. It utilizes neighbors, faith groups, and trained community members to provide holistic support during illness, dying, and bereavement. By strengthening community capacity, the model improves preparedness for serious illness while reinforcing the social bonds that sustain rural communities.
In 2024, Peaceful Presence received a $50,000 award through AVDF’s philanthropic partnership with the Rita & Alex Hillman Foundation as part of the Hillman Emergent Innovation: Serious Illness and End of Life program. This initiative supports nurse-led, early-stage innovations designed to improve care for underserved populations. With this funding, Peaceful Presence began collecting qualitative and quantitative data across three rural pilot communities in Oregon, working in collaboration with public health departments and the Oregon Coalition of Local Health Officials. These efforts aim to identify community-specific needs, refine messaging strategies, and develop a replicable framework for community-based palliative care.
Building on this foundation, AVDF provided additional direct support in 2026 to expand the organization’s statewide efforts. Central to this work is the development of the Oregon Network for Community-Based Serious Illness Support, which trains and mobilizes Community Health Workers (CHWs) and End-of-Life Doulas to deliver nonmedical palliative care. Through this initiative, Peaceful Presence will provide continuing education, research-based assessment, and ongoing support to 150 rural practitioners, strengthening the workforce available to serve patients and families.
This network-based approach integrates community-based care with formal healthcare systems. By connecting trained CHWs and doulas with clinicians and local organizations, Peaceful Presence creates a coordinated model that enhances continuity of care. The initiative also prioritizes accessibility by developing a user-friendly online platform optimized for low-bandwidth environments, ensuring that rural residents can access resources regardless of technological limitations.
Importantly, the program emphasizes equity and affordability. AVDF-supported funding helps subsidize services for low-income families, removing financial barriers that often prevent individuals from seeking care. Additional resources support workforce development, including covering costs associated with training, certification, and professional participation. Membership to the Center to Advance Palliative Care further strengthens the initiative by connecting participants to national expertise and evidence-based tools.
As the program scales, Peaceful Presence anticipates reaching nearly 200,000 rural Oregonians, significantly expanding access to community-based palliative care. At the same time, insights from the pilot communities will inform the development of a replicable toolkit that can guide similar efforts in other states. The dual focus of local impact and national applicability positions the initiative as a model for addressing rural healthcare disparities more broadly.
The broader significance of this work lies in its redefinition of care delivery. By integrating clinical expertise with community-based support, the Peaceful Presence Project demonstrates how healthcare systems can extend their reach through partnerships with the communities they serve. This approach not only improves quality of life for individuals facing serious illness but also strengthens the social infrastructure that underpins resilient, compassionate communities.
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