A national survey of ambulance paramedics on the identification of patients with end of life care needs

Abstract

<sec id="s1">Objectives: Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. </sec> <sec id="s2">Methods: Between 4 November 2019 and 5 January 2020, registered paramedics from nine English NHS ambulance service trusts were invited to complete an online questionnaire. The questionnaire initially explored current practice and awareness, employing multiple-choice questions. The Gold Standards Framework Proactive Identification Guidance (GSF PIG) was then presented as an example of EoLC assessment guidance, and further questions, permitting free-text responses, explored attitudes towards performing this role. </sec> <sec id="s3">Results: 1643 questionnaires were analysed. Most participants (79.9%; n = 1313) perceived that they attended a patient who was unrecognised as within the last year of life on at least a monthly basis. Despite 72.0% (n = 1183) of paramedics indicating that they had previously made an EoLC referral to a General Practitioner, only 30.5% (n = 501) were familiar with the GSF PIG and of those only 25.9% (n = 130) had received training in its use. Participants overwhelmingly believed that they could (94.4%; n = 1551) and should (97.0%; n = 1594) perform this role, yet current barriers were identified as the inaccessibility of a patient’s medical records, inadequate EoLC education and communication difficulties. Consequently, facilitators to performing this role were identified as the provision of training in EoLC assessment guidance and establishing accessible, responsive EoLC referral pathways. </sec> <sec id="s4">Conclusions: Provision of EoLC assessment training and dedicated EoLC referral pathways should facilitate ambulance paramedics’ roles in the timely recognition of EoLC patients, potentially addressing current inequalities in access to EoLC. </sec>

Emergency medical services and palliative care: a scoping review

“…Included studies were performed in the USA (n=16),1 6 26–39 the UK (n=9),7 14 40–46 Germany (n=10),8 47–55 Australia (n=8),2 4 11 56–60 Canada (n=4),15 61–63 France (n=1),5 Switzerland (n=1),13 New Zealand (n=2),64 65 Finland (n=2),66 67 Czech Republic (n=1),68 Brazil (n=1)69 and South Africa (n=1)16 between 2002 and 2022. The majority of studies (96%, n=54) were performed in HICs with only Brazil and South Africa representing LMICs, and most (63%, n=35) were published between 2018 and 2022.…”

“…Methodologically, most studies were quantitative (55%, n=31) while the remainder used a qualitative (27%, n=15) or mixed-methods (18%, n=10) approach. Quantitative studies comprised of surveys (n=12),1 8 30 32 38 41 43 48 49 51 56 58 retrospective cohorts (n=9),5 33 34 40 52 54 55 57 66 literature reviews (n=5),11 46 61 64 68 case series/reports (n=3),6 13 35 a pre-intervention and post-intervention study (n=1)29 and a prospective cohort (n=1) 8. Qualitative studies contained individual interviews (n=12),7 14 16 26–28 31 42 44 47 65 69 focus group interviews (n=2)2 63 and deliberative dialogues (n=1),62 while the mixed-methods studies4 15 36 37 39 45 50 59 60 67 made use of various survey and interview combinations.…”

“…35 Several studies discussed the potential decreased healthcare costs resulting from EMS and palliative integration. 41 59 61 66 The decreased costs would, theoretically, result from provision of homecare, thus avoiding expensive and unnecessary hospital admissions. 61 A Finnish study evaluating the integration of paramedics in EoL care argued that healthcare costs may be diminished through provision of homecare by paramedics in particular.…”

“…These were EMS provider education, 4 EMS and palliative system collaboration, 5 EMS palliative care guideline/protocol creation, 16 specialised out-of-hospital palliative care teams 34 and further research. 57 The following topics were highlighted as areas for EMS provider education: identifying patients with palliative needs, 41 palliative therapeutic goals, 44 legal documentation and advance care planning, ethics, 13 withholding and withdrawing treatment, 38 51 patient and family communication (including caregiver support), 47 symptom management, 54 interdisciplinary teamwork 59 and current palliative system structures. 58 Lamba et al detailed four steps for EMS and palliative care integration: (1) identify EMS 'champions', (2) review protocols and literature, (3) perform a needs assessment and ( 4) create an action plan.…”

EMS responses to hospice patients: a qualitative study

“…Understanding the phenomenon of EMS responses to patients enrolled in hospice programs could support patient-and family-centered end-of-life care, improve the working interface between EMS systems and hospice programs, and optimize utilization of EMS resources. Numerous studies using individual interviews, focus groups, and surveys have explored the recollections and perceptions of hospice staff, 12 family members, 13 and EMS providers [14][15][16][17][18][19][20][21][22][23] of the role of EMS and hospitalization in palliative care. (It should be noted that terms like "palliative care" are sometimes used loosely in the literature, and it may not be limited to patients formally enrolled in a hospice program.)…”