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Juhrmann M, Butow P, Platts C, Boughey M, Simpson P, Clayton JM. Health professionals' and caregivers' perspectives on improving paramedics' provision of palliative care in Australian communities: a qualitative study. BMJ Open 2024; 14:e086557. [PMID: 39343451 PMCID: PMC11440190 DOI: 10.1136/bmjopen-2024-086557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/07/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES Paramedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted education and training. This study aimed to elicit paramedics', palliative care doctors' and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' attitudes and perspectives on how palliative paramedicine can be improved to better suit the needs of community-based patients, their families and carers, and the clinicians involved in delivering the care. DESIGN In this qualitative study underpinned by a social constructivist epistemology, semistructured interviews were conducted. SETTING AND PARTICIPANTS 50 participants with palliative paramedicine experience, from all jurisdictions of Australia. Participants were interviewed between November 2021 and April 2022. RESULTS All participants suggested paramedics play an important adjunct role in the provision of palliative and end-of-life care in home-based settings. Three levels of opportunities for improvement were identified: macrolevel (policy and frameworks; funding and education; accessing medical records and a widening scope); mesolevel (service-level training; interprofessional understanding and communities of practice and community expectations) and microlevel (palliative care subspecialty; debriefing and self-care and partnering with families). CONCLUSION To enhance paramedic capacity to provide palliative care support, improvements targeting systems, services, communities and individuals should be made. This calls for stronger inclusion of paramedicine in interdisciplinary palliative care and greater investment in both the generalist and specialist palliative paramedicine workforce.
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Affiliation(s)
- Madeleine Juhrmann
- The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
| | - Phyllis Butow
- The University of Sydney School of Psychology, Sydney, New South Wales, Australia
| | - Cara Platts
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Mark Boughey
- The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
- Palliative Medicine, St Vincent's Hospital (Melbourne) Limited, Fitzroy, Victoria, Australia
| | - Paul Simpson
- Western Sydney University School of Health Sciences, Penrith, New South Wales, Australia
| | - Josephine M Clayton
- The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
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College of Paramedics Research Conference 2024. Br Paramed J 2024; 9:44-72. [PMID: 39246836 PMCID: PMC11376326 DOI: 10.29045/14784726.2024.9.9.2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
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3
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Pask S, Omoruyi A, Mohamed A, Chambers RL, McFarlane PG, Johansson T, Kumar R, Woodhead A, Okamoto I, Barclay S, Higginson IJ, Sleeman KE, Murtagh FEM. Telephone advice lines for adults with advanced illness and their family carers: a qualitative analysis and novel practical framework. Palliat Med 2024; 38:555-571. [PMID: 38600058 PMCID: PMC11107135 DOI: 10.1177/02692163241242329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care. AIM To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services. DESIGN A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework. SETTING/PARTICIPANTS Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled. RESULTS Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations. CONCLUSIONS Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Allen Omoruyi
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Ahmed Mohamed
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Phillippa G McFarlane
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rashmi Kumar
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Andy Woodhead
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, 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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6
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Scott J, Thomas L, Joy T, McCrossan P. How can quality be measured within a physician-led Community Emergency Medical service? A scoping review protocol. Syst Rev 2024; 13:3. [PMID: 38167079 PMCID: PMC10759743 DOI: 10.1186/s13643-023-02424-w] [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] [Received: 07/12/2022] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Quality measurement as part of quality improvement in healthcare is integral for service delivery and development. This is particularly pertinent for health services that deliver care in ways that differ from traditional practice. Community Emergency Medicine (CEM) is a novel and evolving concept of care delivered by services in parts of the UK and Ireland. This scoping review aims to provide a broad overview of how quality may be measured within services delivering CEM. METHODS AND ANALYSIS The methodology follows both the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). It is guided by recognised work of Arksey and O'Malley and the guidelines developed by the Joanna Briggs Institute. Several databases will be searched: MEDLINE, EMbase, EMcare, CINAHL, Scopus, the Cochrane Library and grey literature. Search terms have been developed by representatives within Community Emergency Medicine services. Two reviewers will independently screen eligible studies for final study selection. Results will be collected and analysed in descriptive and tabular form to illustrate the breadth of quality indicators that may be applicable to CEM services. This scoping review protocol has been registered with the Open Science Framework platform (osf.io/e7qxg). DISCUSSION This is the first stage of a larger research study aimed at developing national quality indicators for CEM. The purpose of this scoping review is to provide a comprehensive review of quality indicators that could be used within CEM. The results will be mapped using a framework and identify gaps in the literature to help guide future-focused research.
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Affiliation(s)
- Jamie Scott
- Physician Response Unit, Barts Health NHS Trust, London, UK.
| | - Libby Thomas
- Kings College Hospital NHS Foundation Trust, London, England
| | - Tony Joy
- Physician Response Unit, Barts Health NHS Trust, London, UK
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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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Simpson J, Remawi BN, Potts K, Blackmore T, French M, Haydock K, Peters R, Hill M, Tidball OJ, Parker G, Waddington M, Preston N. Improving paramedic responses for patients dying at home: a theory of change-based approach. BMC Emerg Med 2023; 23:81. [PMID: 37532997 PMCID: PMC10394789 DOI: 10.1186/s12873-023-00848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Paramedics are increasingly being called to attend patients dying from advanced incurable conditions. However, confidence to deal with such calls varies, with many feeling relatively unskilled in this aspect of their role. A number of interventions have been piloted to improve their skills in end-of-life care (EoLC) but without a fully specified theoretical model. Theory of Change models can provide theoretical and testable links from intervention activities to proposed long-term outcomes and indicate the areas for assessment of effectiveness. This study aimed to develop an intervention for improving paramedic EoLC for patients in the community. METHODS A Theory of Change approach was used as the overarching theoretical framework for developing an intervention to improve paramedic end-of-life skills. Nine stakeholders - including specialist community paramedics, ambulance call handlers and palliative care specialists - were recruited to five consecutive online workshops, ranging between 60 and 90 min. Each workshop had 2-3 facilitators. Over multiple workshops, stakeholders decided on the desired impact, short- and long-term outcomes, and possible interventions. During and between these workshops a Theory of Change model was created, with the components shared with stakeholders. RESULTS The stakeholders agreed the desired impact was to provide consistent, holistic, patient-centred, and effective EoLC. Four potential long-term outcomes were suggested: (1) increased use of anticipatory and regular end-of-life medications; (2) reduced end-of-life clinical and medication errors; (3) reduced unnecessary hospitalisations; (4) increased concordance between patient preferred and actual place of death. Key interventions focused on providing immediate information on what to do in such situations including: appraising the situation, developing an algorithm for a treatment plan (including whether or not to convey to hospital) and how to identify ongoing support in the community. CONCLUSIONS A Theory of Change approach was effective at identifying impact, outcomes, and the important features of an end-of-life intervention for paramedics. This study identified the need for paramedics to have immediate access to information and resources to support EoLC, which the workshop stakeholders are now seeking to develop as an intervention.
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Affiliation(s)
- Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK.
| | - Bader Nael Remawi
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YT, UK
| | - Kieran Potts
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Tania Blackmore
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Maddy French
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Karen Haydock
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Richard Peters
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Michael Hill
- Heart of Kent Hospice, Preston Hall, Aylesford, Kent, ME20 7PU, UK
| | | | - Georgina Parker
- Heart of Kent Hospice, Preston Hall, Aylesford, Kent, ME20 7PU, UK
| | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
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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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Anderson NE, Robinson J, Goodwin H, Gott M. 'Mum, I think we might ring the ambulance, okay?' A qualitative exploration of bereaved family members' experiences of emergency ambulance care at the end of life. Palliat Med 2022; 36:1389-1395. [PMID: 36154525 DOI: 10.1177/02692163221118204] [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: 11/17/2022]
Abstract
BACKGROUND In the context of a sudden or unexpected event, people with a life-limiting illness and their family caregivers may be dependent on emergency ambulance services. AIM To explore bereaved family members' experiences of emergency ambulance care at the end of life. DESIGN A qualitative study using reflexive thematic analysis of data collected from semi-structured phone interviews. SETTING/PARTICIPANTS A purposive sample of 38 family caregivers identified from a database of deaths in Aotearoa, New Zealand. RESULTS Emergency ambulance personnel assist, inform and reassure patients and family caregivers managing distressing symptoms, falls, infections, unexpected events and death itself. Family members and patients are aware of the pressure on emergency services and sometimes hesitate to call an ambulance. Associating ambulances with unwanted transport to hospital is also a source of reluctance. CONCLUSIONS The generalist palliative care provided by emergency ambulance personnel is a vital service for patients in the last year of life, and their caregivers. This must be acknowledged in palliative care policy and supported with training, specialist consultation and adequate resources.
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Affiliation(s)
- Natalie Elizabeth Anderson
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.,Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Jackie Robinson
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.,Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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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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