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Gage CH, Gwyther L, Stassen W. South African palliative care provider perspectives on emergency medical services in palliative situations. Afr J Emerg Med 2024; 14:231-239. [PMID: 39291135 PMCID: PMC11402548 DOI: 10.1016/j.afjem.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Due to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations. Methods A qualitative design employing individual semi-structured interviews was implemented. Ten interviews with experienced doctors and nurses holding post-graduate palliative medicine qualifications were conducted. Verbatim transcriptions of interviews were subjected to content analysis with an inductive-dominant approach to develop codes and categories. Results Four categories were developed: (1) Disposition towards EMS, (2) Perceived EMS challenges, (3) Positive EMS impact across patients' palliative care journeys and (4) Methods of EMS and palliative care system integration. Participants maintained an overall positive view of EMS and palliative care integration, noting the beneficial impact of EMS and suggesting various methods of integration, while also highlighting challenges and concerns. Conclusion EMS and palliative care integration would be mutually beneficial to both systems while benefiting patient well-being and the broader healthcare system. Potentially low-cost, high-impact interventions suggested by participants, such as palliative care cards for patients and enhancing EMS and palliative care system communication, represent efficacious and judicious use of limited resources within the SA context. Pilot studies investigating these suggestions should be conducted.
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Affiliation(s)
- Caleb Hanson Gage
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Liz Gwyther
- Division of Interdisciplinary Palliative Care and Medicine, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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2
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Juhrmann ML, Butow PN, Simpson P, Boughey M, Makeham M, Clayton JM. Development of a palliative paramedicine framework to standardise best practice: A Delphi study. Palliat Med 2024; 38:853-873. [PMID: 38483052 DOI: 10.1177/02692163241234004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
BACKGROUND Growing global demand for palliative care services has prompted generalist clinicians to provide adjunct support to specialist teams. Paramedics are uniquely placed to respond to these patients in the community. However, embedding palliative care principles into their core business will require multifactorial interventions at structural, healthcare service and individual clinician and consumer levels. AIM To develop a palliative paramedicine framework suitable for national implementation, to standardise best practice in Australia. DESIGN Delphi study utilising questionnaire completion; each round informed the need for, and content of, the next round. Free text comments were also sought in Round 1. Two rounds of Delphi were undertaken. SETTING/PARTICIPANTS Sixty-eight participants took part in Round 1, representing six countries, and 66 in Round 2. Participants included paramedics, palliative care doctors and nurses, general practitioners, researchers and carers with lived experience and expertise in palliative paramedicine. RESULTS Seventeen of the original 24 components gained consensus; 6 components were modified; and 9 new components arose from Round 1. All modified and new components gained consensus in Round 2. Only one original component did not gain consensus across both rounds and was excluded from the final 32-component framework. CONCLUSION This study has developed a comprehensive national framework addressing the macro-, meso- and micro-level interventions required to standardise palliative paramedicine across Australia. Future research ought to engage a multidisciplinary team to create an implementation strategy, addressing any perceived barriers, facilitators and challenges for applying the framework into policy and practice.
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Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, Australia
- The Palliative Centre, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
| | - Phyllis N Butow
- Chris O'Brien Lifehouse, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Paul Simpson
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- New South Wales Ambulance, Rozelle, NSW, Australia
| | - Mark Boughey
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Meredith Makeham
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Josephine M Clayton
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, Australia
- The Palliative Centre, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
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Wan J, Vaughan A, Shepherd E, Coombs S, Trethewie S, Jaaniste T. Evaluation of paediatric palliative care ambulance plans: A retrospective study. J Child Health Care 2024:13674935231225714. [PMID: 38262591 DOI: 10.1177/13674935231225714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Paediatric Palliative Care Ambulance Plans ('Plans') are used by New South Wales Ambulance (Australia) to support the care needs of children with life-limiting conditions. We aimed to describe the population of children with Plans and provide details regarding Plan completion, paramedic responses during ambulance callouts, and correspondence between Plan recommendations and paramedic responses. Plans lodged in January 2017-December 2019 were retrospectively coded for demographic information, completeness and care preferences. Associated paramedic callout notes (January 2018-December 2019) were coded for paramedic responses. Of 141 Plans retrieved, 38 (41.3% of those providing suggested medications) suggested medication use outside general paramedic scope of practice. Of 199 associated ambulance callouts, reasons for callout included symptom management, planned transfer, death notification and end-of-life care. Over two-thirds of callouts (n = 135, 67.8%) occurred after-hours. Most paramedic callouts (n = 124, 62.3%), excluding planned transfers, resulted in children being transported. Paramedic interventions corresponded with interventions suggested in Plans. However, only 24 (25.3%) of paramedic callout notes documented Plans being sighted. This study provided detailed information about children with palliative care needs for whom Plans were being used, the nature of these Plans and associated paramedic callouts. However, it is not known how paramedics were influenced by Plans.
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Affiliation(s)
- Julianna Wan
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Elizabeth Shepherd
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Sandra Coombs
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Susan Trethewie
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tiina Jaaniste
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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Juhrmann ML, Butow PN, Platts CM, Simpson P, Boughey M, Clayton JM. 'It breaks a narrative of paramedics, that we're lifesavers': A qualitative study of health professionals', bereaved family members' and carers' perceptions and experiences of palliative paramedicine. Palliat Med 2023; 37:1266-1279. [PMID: 37452564 PMCID: PMC10503236 DOI: 10.1177/02692163231186451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. AIM To elicit paramedics', palliative care doctors and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. DESIGN A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. SETTING/PARTICIPANTS A purposive sample of 50 stakeholders from all Australian jurisdictions participated. RESULTS Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). CONCLUSION Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.
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Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- The Palliative Centre, HammondCare, Greenwich Hospital, New South Wales, Australia
| | - Phyllis N Butow
- Chris O’Brien Lifehouse, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - Cara M Platts
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Paul Simpson
- School of Paramedicine, Faculty of Health Sciences, Western Sydney University, New South Wales, Australia
| | - Mark Boughey
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
- St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Josephine M Clayton
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- The Palliative Centre, HammondCare, Greenwich Hospital, New South Wales, Australia
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Gage CH, Stander C, Gwyther L, Stassen W. Emergency medical services and palliative care: a scoping review. BMJ Open 2023; 13:e071116. [PMID: 36927584 PMCID: PMC10030966 DOI: 10.1136/bmjopen-2022-071116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The sub-questions regarding this literature were, (1) what types of literature exist?, (2) what are the key findings? and (3) what knowledge gaps are present? DESIGN A scoping review of literature was performed with an a priori search strategy. DATA SOURCES MEDLINE via Pubmed, Web of Science, CINAHL, Embase via Scopus, PsycINFO, the University of Cape Town Thesis Repository and Google Scholar were searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened titles, abstracts and full texts for inclusion. Extracted data underwent descriptive content analysis and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. RESULTS In total, 10 725 articles were identified. Following title and abstract screening, 10 634 studies were excluded. A further 35 studies were excluded on full-text screening. The remaining 56 articles were included for review. Four predominant domains arose from included studies: (1) EMS' palliative care role, (2) challenges faced by EMS in palliative situations, (3) EMS and palliative care integration benefits and (4) proposed recommendations for EMS and palliative care integration. CONCLUSION EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. EMS provider education, collaboration between EMS and palliative systems, creation of EMS palliative care guidelines/protocols, creation of specialised out-of-hospital palliative care teams and further research have been recommended as solutions. Future research should focus on the prioritisation, implementation and effectiveness of these solutions in various contexts.
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Affiliation(s)
- Caleb Hanson Gage
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Charnelle Stander
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Liz Gwyther
- Division of Interdisciplinary Palliative Care and Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
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Juhrmann ML, Grindrod AE, Gage CH. Emergency medical services: the next linking asset for public health approaches to palliative care? Palliat Care Soc Pract 2023; 17:26323524231163195. [PMID: 37063113 PMCID: PMC10102939 DOI: 10.1177/26323524231163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
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Affiliation(s)
| | - Andrea E. Grindrod
- Public Health Palliative Care Unit, School of
Psychology and Public Health, La Trobe University, Melbourne, VIC,
Australia
| | - Caleb H. Gage
- Division of Emergency Medicine, University of
Cape Town, Cape Town, South Africa
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Juhrmann ML, Anderson NE, Boughey M, McConnell DS, Bailey P, Parker LE, Noble A, Hultink AH, Butow PN, Clayton JM. Palliative paramedicine: Comparing clinical practice through guideline quality appraisal and qualitative content analysis. Palliat Med 2022; 36:1228-1241. [PMID: 35941755 DOI: 10.1177/02692163221110419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current ambulance services' approach to palliative and end-of-life care. AIM To examine the quality and content of existing Australian palliative paramedicine guidelines with a sample of guidelines from comparable Anglo-American ambulance services. DESIGN We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines. DATA SOURCES Eight palliative care ambulance service clinical practice guidelines (five Australian; one New Zealand; one Canadian; one United Kingdom). RESULTS None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled individual domain percentage scores varied across the guidelines: scope and purpose (8%-92%), stakeholder involvement (14%-53%), rigour of development (0%-20%), clarity of presentation (39%-92%), applicability (2%-38%) and editorial independence (0%-38%). Six themes were developed from the content analysis: (1) audience and approach; (2) communication is key; (3) assessing and managing symptoms; (4) looking beyond pharmaceuticals; (5) seeking support; and (6) care after death. CONCLUSIONS It is important that ambulance services' palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.
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Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, The University of Sydney, St Leonards, NSW, Australia.,The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
| | - Natalie E Anderson
- School of Nursing, The University of Auckland, Auckland, New Zealand.,Auckland Emergency Department, Auckland District Health Board, Auckland, New Zealand
| | - Mark Boughey
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Paul Bailey
- St John Western Australia, Perth, WA, Australia
| | | | - Andrew Noble
- South Australian Ambulance Service, Adelaide, SA, Australia
| | | | - Phyllis N Butow
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Josephine M Clayton
- Northern Clinical School, The University of Sydney, St Leonards, NSW, Australia.,The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
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