A national collaborative to spread and scale paramedics providing palliative care in Canada: Breaking down silos is essential to success

Carter, Alix; Arab, M; Cameron, Cheryl; Harrison, Michelle; Pooler, Charlotte; McEwan, Ian; Austin, Michael; Helmer, Jennie; Özel, Gürkan; Heathcote, Jessica; Reardon, Natalie; Anderson, Elizabeth; Carey, Megan E; Moxam, Raquel Shaw; Crick, Shelly

doi:10.1080/09699260.2020.1871173

Cited by 15 publications

(18 citation statements)

References 12 publications

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“…Given some of the similarities between intentional concerns and the desired outcomes identi ed in this study, the ToC speci ed in this study may have clinical utility outside the UK. Where this study differs somewhat is that it identi ed the importance of immediate access to online and other resources, rather than a focus on higher system-level interventions described elsewhere (15,22). The involvement of staff, including 'frontline' paramedics, has likely shaped the immediate and practical -rather than systemic -focus of the interventions.…”

Section: Discussionmentioning

confidence: 99%

“…A number of interventions aimed at improving paramedic knowledge around end-of-life care and reducing unnecessary hospital admissions have been piloted. These include a specialist palliative care telehealth service for paramedics on call-outs (20), the development of a speci c protocol (8) and pathway (21), and a package including a palliative care clinical practice guideline, speci c training, and mechanism for sharing of goals of care (22). Additionally Murphy Jones (23) reports on two case studies where comprehensive packages were introduced which targeted a number of areas; while the two interventions developed differed, key similarities were specialist education for the paramedic workforce and the need for consistency in response.…”

Section: Introductionmentioning

confidence: 99%

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Improving paramedic responses for patients dying at home: a theory of change-based approach

Simpson

Remawi

Potts

et al. 2023

Preprint

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Background Paramedics are increasingly being called to attend patients dying from advanced incurable conditions. However, confidence to deal with such calls varies, with many feeling relatively unskilled in this aspect of their role. A number of interventions have been piloted to improve their skills in end-of-life care but without a fully specified theoretical model. Theory of change models can provide theoretical and testable links from intervention activities to proposed long-term outcomes and indicate the areas for assessment of effectiveness. This study aimed to develop an intervention for improving paramedic end-of-life care for patients in the community. Methods A theory of change approach was used as the overarching theoretical framework for developing an intervention to improve paramedic end-of-life skills. Relevant stakeholders - including specialist community paramedics, ambulance call handlers and palliative care specialists - were recruited to five consecutive online workshops. Over multiple workshops, stakeholders decided on the desired impact, short- and long-term outcomes, and possible interventions. During and between these workshops a theory of change model was created, with the components shared with stakeholders. Results The stakeholders agreed the desired impact was to provide consistent, holistic, patient-centred, and effective end-of-life care. Four potential long-term outcomes were suggested: 1) increased use of anticipatory and regular end-of-life medications; 2) reduced end-of-life clinical and medication errors; 3) reduced unnecessary hospitalisations; 4) increased concordance between patient preferred and actual place of death. Key interventions focused on providing immediate information on what to do in such situations including: appraising the situation, developing an algorithm for a treatment plan (including whether or not to convey to hospital) and how to identify ongoing support in the community. Conclusions A theory of change approach was effective at identifying impact, outcomes, and the important features of an end of life intervention for paramedics. This study identified the need for paramedics to have immediate access to information and resources to support end-of-life care, which the workshop stakeholders are now seeking to develop as an intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving paramedic responses for patients dying at home: a theory of change-based approach

Simpson

Remawi

Potts

et al. 2023

Preprint

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“…One Canadian service was selected to reflect contemporary best practice derived from the findings of a recently implemented palliative paramedicine quality improvement programme. 15 However, variation in palliative paramedicine practice is apparent across Canada and it was acknowledged amongst the team this one service may not reflect all.…”

Section: Methodsmentioning

confidence: 99%

“…12,13 Globally, ambulance services have developed specialised roles capable of delivering palliative and end-of-life care, such as Extended Care Paramedics, 14 to mirror the pioneering success of Canada's community paramedicine model. 15 However, these roles will not suffice the growing demand for palliative paramedicine alone and, instead, the broader paramedic community requires the skills to take a palliative approach to care for patients with end-of-life needs. 16 A recent systematic review identified end-of-life care Clinical Practice Guidelines (guidelines) as a key enabler to standardising palliative care practice for paramedics.…”

Section: Introductionmentioning

confidence: 99%

Palliative paramedicine: Comparing clinical practice through guideline quality appraisal and qualitative content analysis

et al. 2022

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Background: Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current ambulance services’ approach to palliative and end-of-life care. Aim: To examine the quality and content of existing Australian palliative paramedicine guidelines with a sample of guidelines from comparable Anglo-American ambulance services. Design: We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines. Data sources: Eight palliative care ambulance service clinical practice guidelines (five Australian; one New Zealand; one Canadian; one United Kingdom). Results: None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled individual domain percentage scores varied across the guidelines: scope and purpose (8%–92%), stakeholder involvement (14%–53%), rigour of development (0%–20%), clarity of presentation (39%–92%), applicability (2%–38%) and editorial independence (0%–38%). Six themes were developed from the content analysis: (1) audience and approach; (2) communication is key; (3) assessing and managing symptoms; (4) looking beyond pharmaceuticals; (5) seeking support; and (6) care after death. Conclusions: It is important that ambulance services’ palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.

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“…Paramedicine in Canada has experienced significant changes in recent years, and this has resulted in a misalignment between existing conceptualizations of the profession and emerging practice (1). For instance, in contrast to more 'traditional' responsibilities (e.g., responding to emergencies and providing transport to emergency departments), paramedics have played a role in delivering primary care in under-serviced rural areas, have been integrated into long-term care settings, and support palliative and family health teams (1)(2)(3)(4). Increasingly, paramedicine is becoming recognized as a profession whose unique point of contact with broad patient groups can be leveraged to better serve health care needs and meet new policy goals (5,6) What paramedicine is, how it should be organized, and what newer roles and conceptualizations mean, are challenging well-established boundaries and guiding frameworks are lacking(7-9).…”

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confidence: 99%

Principles to Guide the Future of Paramedicine in Canada

Tavares¹,

Allana²,

Beaune³

et al. 2021

Prehospital Emergency Care

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A national collaborative to spread and scale paramedics providing palliative care in Canada: Breaking down silos is essential to success

Cited by 15 publications

References 12 publications

Improving paramedic responses for patients dying at home: a theory of change-based approach

Improving paramedic responses for patients dying at home: a theory of change-based approach

Palliative paramedicine: Comparing clinical practice through guideline quality appraisal and qualitative content analysis

Principles to Guide the Future of Paramedicine in Canada

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