Challenges UK paramedics currently face in providing fully effective end-of-life care

Brady, Mike

doi:10.12968/ijpn.2014.20.1.37

Cited by 25 publications

(20 citation statements)

References 20 publications

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“…It is difficult to establish the percentage of emergency ambulance calls relating to end-of-life conditions, and published data are scarce 1. End-of-life care emergency calls are complex and conveyance to the ED is often viewed as the best decision.…”

Section: Introductionmentioning

confidence: 99%

Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors

Murphy-Jones

Timmons

2016

Emerg Med J

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A range of factors influence paramedics' decisions to transport nursing home residents to EDs in end-of-life care situations. Decision making became a process of negotiation when the patient's perceived best interests conflicted with that of others, resulting in contrasting approaches by paramedics. This paper considers how paramedics might be better trained and supported in dealing with these situations, with the aim of providing dignified and appropriate care to patients as they reach the end of their lives.

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Section: Introductionmentioning

confidence: 99%

Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors

Murphy-Jones

Timmons

2016

Emerg Med J

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“…Increasingly, palliative care is being recognised as an important skill for emergency care providers more broadly (2)(3)(4)(5)(6), and the perspectives of Australian emergency department (ED) staff in providing palliative care have recently been explored (7)(8). Research focused on pre-hospital emergency care providers is limited and mostly deals with end-of-life issues (9)(10)(11) including moral and legal issues related to withholding resuscitation (12)(13) and advance or present directives (14)(15). One study, using a focus group methodology, explored Australian paramedics' knowledge and attitudes related to the care of patients requiring palliative care (15).…”

Section: Introductionmentioning

confidence: 99%

Paramedics’ Perceptions and Educational Needs with Respect to Palliative Care

Rogers

Shearer

Rogers

et al. 2015

Australasian Journal of Paramedicine

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IntroductionTo identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes of death.MethodsAll St John Ambulance Western Australia paramedics were invited to complete a mixed methods qualitative and quantitative survey using a tool previously validated in studies involving other emergency care providers. Quantitative results are reported using descriptive statistics, while Likert-type scales were converted to ordinal variables and expressed as means +/- SD. Qualitative data was analysed using content analysis techniques and reported as themes. ResultsCompleted surveys were returned by 29 paramedics. They considered palliative care to be strongly focussed on end-of-life care, symptom control and holistic care. The dominant educational needs identified were ethical issues, end-of-life communication and the use of structured patient care pathways. Cancer diagnoses were overrepresented as conditions considered most suitable for palliative care, compared with their frequency as a cause of death. Conditions often experienced in ambulance practice, such as heart failure, trauma and cardiac arrhythmias were overestimated in their frequency as causes of death. ConclusionsParamedics have a sound grasp of some important aspects of palliative care including symptom control and the holistic nature of the palliative approach. They did however tend to equate palliative care with that occurring in the terminal phase and saw it as being particularly applied to cancer diagnoses. Paramedic palliative care educational efforts should focus on ethical issues and end-of-life communication, as well as increasing understanding of the common causes of death and those where a palliative approach might be beneficial.

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“…Ambulance staff would like to enable people to receive effective treatment even if this is achieved by enabling a good death at home. They need to be sure that patients would not benefit from treatment available only in hospital2 and to be confident that they receive the care that is in their best interests by staying at home.…”

Section: Discussionmentioning

confidence: 99%

Hospice advice and rapid response service for ambulance clinicians

Dent

Tipping

Anderson

et al. 2020

BMJ Support Palliat Care

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ObjectivePatients in the last year of life experience medical emergencies which may lead to an emergency attendance by ambulance clinicians and some patients having a transfer to hospital even when this is unwanted by patients, carers or professionals. Here we report the patient characteristics and outcomes of a 24-hour hospice nursing telephone advice service to support an ambulance service.MethodAn evaluation of the outcomes of ambulance calls to a nursing telephone advice service for people living in northwest London, UK, attended at home during a 6-month period by the London Ambulance Service, whose clinicians then sought advice from the hospice’s 24 hours’ telephone line.ResultsForty-five attendances of 44 acutely ill people with palliative care needs resulted in a telephone call. Thirteen patients (30%) were male and the median age was over 80 years. Thirty-two attendances (71%) were managed without a transfer to hospital, with telephone advice from the hospice and in some cases arrangements for another clinician to visit. Seven attendances (16%) resulted in a transfer to hospital, of which at least five led to an admission. Six attendances (13%) resulted in a notification of the patient’s death.ConclusionsThis preliminary study shows the feasibility, outcomes and acceptability of telephone advice to support ambulance clinicians attending patients with palliative care needs. The service was associated with low rates of subsequent transfer to hospital. Further controlled research is needed to assess the clinical and cost-effectiveness of the service.

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Challenges UK paramedics currently face in providing fully effective end-of-life care

Cited by 25 publications

References 20 publications

Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors

Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors

Paramedics’ Perceptions and Educational Needs with Respect to Palliative Care

Hospice advice and rapid response service for ambulance clinicians

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