Infusing the palliative into paramedicine: Inter-professional collaboration to improve the end of life care response of UK ambulance services

Murphy-Jones, Georgina; Laverty, Diane; Stonehouse, Joanne

doi:10.1080/09699260.2021.1879348

Cited by 10 publications

(10 citation statements)

References 10 publications

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“…Multidisciplinary approaches to palliative care were praised by participants and supported by literature. 34,35 The Australian and New Zealand Society of Palliative Medicine has previously called for a greater focus on expanding the practice of specialist palliative care teams to better support primary palliative care providers through consultative or consortium arrangements. 36 Despite these assertions, paramedicine is still lacking from palliative care policies, 16,37 and remains an under recognised palliative care asset within international frameworks.…”

Section: Discussionmentioning

confidence: 99%

‘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

Juhrmann,

Butow,

Platts

et al. 2023

Palliat Med

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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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Section: Discussionmentioning

confidence: 99%

‘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

Juhrmann,

Butow,

Platts

et al. 2023

Palliat Med

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“…5 It has also been found that the paramedics convey dying patients to hospital despite patients having advance care plans or being known to community palliative care teams and previously expressing a wish to avoid an acute hospital admission. 6 Another hurdle for paramedics is that the patient documentation available in the home is often out of date, inconsistent and limited which can lead to lack of confidence when caring for dying patients in expected deaths. This lack of confidence may lead paramedics to a defensive clinical practice culture rather than a patient centered culture, resulting in the dying patient’s conveyance to hospital.…”

Section: Paramedics Providing Palliative and End Of Life Carementioning

confidence: 99%

What is the role of paramedics in palliative and end of life care?

Blackmore

2022

Palliat Med

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“…1 This shifting practice of EMS is apparent across both high-income countries (HIC) and low-and middle-income countries (LMIC). [7][8][9][10][11][12] Public health provides a useful framework to conceptualise palliative and EoLC in communitybased settings, [13][14][15] recognising that health is determined by a range of social and structural factors impacting on equity of access to palliative care, 16,17 while highlighting the intersecting role of health services and citizens in delivering holistic EoLC, and recognising everyone has a role to play in EoLC. 18 Palliative care networks have made significant progress to integrate multidisciplinary teams into their provision of care, including emergency departments (EDs).…”

Section: Introductionmentioning

confidence: 99%

Emergency medical services: the next linking asset for public health approaches to palliative care?

2023

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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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Infusing the palliative into paramedicine: Inter-professional collaboration to improve the end of life care response of UK ambulance services

Cited by 10 publications

References 10 publications

‘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

‘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

What is the role of paramedics in palliative and end of life care?

Emergency medical services: the next linking asset for public health approaches to palliative care?

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