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

Abstract

Background: Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. Aim: To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. Design: A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. Setting/Participants: The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. Results: Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. Conclusions: Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients’ and families’ views on the paramedics’ participation in end-of-life care should be evaluated in the future.

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.…”

“…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.…”

“…64 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. Open access EMS' palliative care role Numerous studies (66%, n=37) 1 2 6 8 11 14-16 26-28 31 34 35 37 41-46 48 51 53-55 57 59-61 [63][64][65][66][67][68][69] discussed the potential role of EMS in palliative care. Most EMS providers viewed palliative care positively, regarding it as important to their role as demonstrated in studies performed in the UK, 43 Australia, 59 Canada 15 and South Africa.…”

Prehospital emergency medicine for children receiving palliative home care in Germany—a cross-sectional, exploratory study of EMS providers

“…In recent years, publications have indicated a growing awareness of EMS providers regarding patients with life limiting conditions ( 31 – 33 ). In this study >90% of providers could recall an EMS call involving adults with LLCs, which was expected.…”

‘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

“…8,[14][15][16] Previous studies have qualitatively explored the importance, feasibility and challenges of palliative paramedicine in one country 14 ; bereaved family members' experiences of ambulance care at end-of-life 17,18 ; the alignment of paramedics' identity with providing palliative care at home 19 ; and the educational needs of paramedics providing this type of care. 20 However, a gap remains in understanding multidisciplinary stakeholders' perspectives of the current impediments and facilitators of palliative paramedicine practice; the findings of which could have resonance for ambulance and palliative care services worldwide. Thus, the aims of this study are 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 homebased settings.…”