Background: Early advance care planningh as clear benefits for patients approaching the end of their life, yet many of those attended by UK paramedics do not have this planning in place. Aims: To explore staff stakeholder views on the role of UK paramedics in advance care planning, including the use of the Gold Standards Framework Proactive Identification Guidance for screening and referral of patients. Methods: In-depth semi-structured telephone interviews with paramedics, general practitioners, Emergency Department and community doctors and nurses in the South West of England. Results: Seventeen staff stakeholders participated. Four main themes were identified: a lack of advance care planning; variation across health conditions; a lack of joined-up care; poor-quality end of life conversations. Paramedic use of the Gold Standards Framework Proactive Identification Guidance to screen and refer patients for advance care planning was seen as feasible and acceptable, with perceived benefitssuch as identifying patients not accessing primary care, and the potential to reduce avoidable hospital admissions. Conclusions: UK paramedics are well-placed toscreen and refer patients for advance care planning. Further research is needed to explore how this type of intervention might be developed to fit into a communitycentred approach aimed at improving advance care planning.

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BackgroundPatients are approaching End of Life when they are likely to die within the next 12 months. Quality in End of Life Care is variable and identifying patients in the End of Life phase is challenging, particularly in those people with diagnoses other than cancer. Many patients accessing the ambulance service are in the last year of their lives and the role of ambulance services in recognising patients approaching the end of their lives is often overlooked. Patients who are End of Life should be offered advanced care planning.Research QuestionWhat are stakeholders’ views on a paramedic screening and referral intervention aimed at improving care planning in patients in the last year of life?MethodsA qualitative study using semi-structured telephone interviews conducted with 17 stakeholders to investigate stakeholders’ views on:the utility of a paramedic screening and referral toolthe likely impact of a paramedic screening and referral toolPreliminary ResultsAll staff groups:Increasing advanced care planning would be advantageous for patientsPatients with non-malignant conditions are not readily recognised as End of Life.Paramedics should use the Gold Standards Framework Proactive Identification Guidance to identify patients in the last year of life.The proposed intervention has the potential to reduce unnecessary hospital admissions and unnecessary resuscitation.Specific staff groups:GPs: Concerns about additional workload.GPs: The intervention is useful for patients who may ‘fall under the radar’.GPs and ED doctors: Concerns about the need for paramedics to have sensitive communication skills.Paramedics and GPs: A dedicated End of Life lead or team would be advantageous.ConclusionsThe introduction of an end of life screening and referral tool into paramedic practice is a welcome intervention and will have a positive impact on patients at the end of life. GPs expressed concern about capacity to manage referrals.