Providing palliative care at home aligns with the professional identity of paramedics: a qualitative study of paramedics and palliative health care providers

Abstract

Background An innovative program, 'Paramedics Providing Palliative Care at Home,' was implemented in Nova Scotia, Canada in 2015. Roles like this are part of an evolving professional identity; role discordance or lack of clarity not only hinders professionalization but may impair the wellbeing, and career longevity of paramedics. This study explored the alignment of providing palliative support at home with paramedic professional identity. Methods Qualitative description was employed, with thematic analysis of focus groups with paramedics and palliative health care providers. Recruitment posters were sent through the professional college (paramedics) and program managers (health care providers). Focus groups followed a semi-structured guide, discussing understanding of and experiences with the role and its alignment with professional identity. Challenges to paramedic palliative support and fit with professional identify were explored. Thematic content analysis was ongoing while focus groups were being conducted, until no new codes were found. Codes were combined, sorted into categories, and ultimately, agreed-upon themes. Saturation of themes was reached. Results Eleven paramedics and twenty palliative health care providers participated. Four themes reflected paramedic's expanded role: (1) patient centeredness and job satisfaction with provision of palliative support, (2) a bridging role, (3) paramedic as advocate and educator, (4) provision of psychosocial support. Four themes reflected paramedic's professional identity: (1) evolution of paramedicine as a skilled clinical profession, (2) helping people and communities, (3) paramedic skill set aligns with work in palliative care, and (4) changing paramedic mindset. Conclusion Paramedics and palliative health care providers highlighted the provision of palliative care as part of a positive growth of paramedicine as a health profession, and a good fit with professional identity. Novel roles like this are important in the evolution of our health care system faced with increasing pressures to get the right care with the right provider at the right time.

‘The palliative care ambulance’: A qualitative study of patient and caregiver perspectives of an ambulance service

“…23 Our data also support recent findings from Canada whereby service providers felt paramedics' new palliative care role contributed significantly to family caregivers' security and confidence in providing care at home. 20 Our findings support those of a recent Canadian programme in which paramedic training resulted in high patient and carer satisfaction, as well as increased confidence in paramedics. 33 Despite the imperative to deliver equitable, safe and high-quality palliative care to people at home, care systems around the world face significant workforce challenges.…”

“…Paramedics valued being able to provide care that was patient centred and meant transport to hospital was not always necessary. 20 Thus, the aim of this study was to explore patient and family caregiver perspectives of an ambulance service including extended care paramedics who had education and experience in palliative care.…”

Emergency medical services and palliative care: a scoping review

“…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.…”

‘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

“…38 Moreover, paramedicine has traditionally prided itself as a discipline of independence and autonomy, perhaps reinforcing hierarchies and siloes of care, and hindering opportunities for establishing communities of palliative care practice. 19,39…”

“…However, paramedics reportedly still lack the skills, confidence and clinical support to provide palliative and end-of-life care in the community. 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.…”