Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis

Abstract

Background: There is a growing demand for community palliative care and home-based deaths worldwide. However, gaps remain in this service provision, particularly after-hours. Paramedicine may help to bridge that gap and avoid unwanted hospital admissions, but a systematic overview of paramedics’ potential role in palliative and end-of-life care is lacking. Aim: To review and synthesise the empirical evidence regarding paramedics delivering palliative and end-of-life care in community-based settings. Design: A systematic integrative review with a thematic synthesis was undertaken in accordance with Whittemore and Knafl’s methodology. Prospero: CRD4202119851. Data sources: MEDLINE, CINAHL, PsycINFO and Scopus databases were searched in August 2020 for primary research articles published in English, with no date limits applied. Articles were screened and reviewed independently by two researchers, and quality appraisal was conducted following the Mixed-Methods Appraisal Tool (2018). Results: The search retrieved 5985 articles; 23 articles satisfied eligibility criteria, consisting of mixed-methods ( n = 5), qualitative ( n = 7), quantitative descriptive ( n = 8) and quantitative non-randomised studies ( n = 3). Through data analysis, three key themes were identified: (1) Broadening the traditional role, (2) Understanding patient wishes and (3) Supporting families. Conclusions: Paramedics are a highly skilled workforce capable of helping to deliver palliative and end-of-life care to people in their homes and reducing avoidable hospital admissions, particularly for palliative emergencies. Future research should focus on investigating the efficacy of palliative care clinical practice guideline implementation for paramedics, understanding other healthcare professionals’ perspectives, and undertaking health economic evaluations of targeted interventions.

Paramedics’ experiences and educational needs when participating end-of-life care at home: A mixed method study

“…In this, and some previous studies 8,17,19,22,23,32,40 paramedics expressed a need for regular training in end-of-life care. Improving their skills in end-of-life care might reduce feelings of stress.…”

“…Paramedics have an important role in caring for patients in end-of-life care, although this potential task has only recently been recognized and still unfrequently organized. 6,7,9,13,16,17,19,22,23 Previous studies 11,19,23,24,27,32,40 have shown the urgent need for integration of palliative care into the healthcare system, development of palliative care pathways and finally, guidelines for paramedics to treat end-of-life patients. The end-of-life care by paramedics’ needs a shift from a life-saving approach to a relief of suffering 17 and expanding their role from an ambulance transferer to a nurse of end-of-life-patient.…”

“…14 Only little is known of paramedics’ own perceptions of challenging situations in end-of-life care at home and their educational needs. 22…”

“…6,9,16,20,21 However, the care of palliative care patients has not traditionally perceived as the main task of paramedics and only small proportion of all emergencies are related to palliative care. 6,9,11,14,22 The traditional role of paramedic has been in lifesaving. They have faced the patients in end-of-life care without a knowledge of their medical history or care plans.…”

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

“…CP can deliver time-sensitive therapies such as rehydration and nausea control and even lab services [84]. They may provide a bridge to other health professionals, via telehealth or other forms of communication [77,[85][86][87][88][89]. For example, patients under hospice care, for example, may receive pain medication via MIH or CP programs while waiting for the arrival of a hospice nurse.…”