‘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

Abstract

Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: 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 community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.

What are the triggers for palliative care referral in burn intensive care units? Results from a qualitative study based on healthcare professionals’ views, clinical experiences and practices

“…Meanings were built and interpreted based on participants’ views, experiences and practices. 25 – 30 The knowledge generated was the result of a constructive process, focussing on the analysis of processes or functions of person-situation-interaction, in which we sought to obtain comprehensive detail to be confident that we were representing differing and complementary views. 27 , 31 …”

“…28 , 29 , 32 – 34 It is a valuable approach in healthcare research to gain deeper insight into professionals’ experiences, practices and sense-making around them. 27 , 30 , 33 – 35 The Standards for Reporting Qualitative Research (SRQR) was used as reporting guideline. 36 …”

“…Acknowledging the research team’s experiences and beliefs influencing the interpretive analysis of the data, we remained mindful of this and invited all participant perspectives to be captured. 27 , 42 , 45 The operationalisation of the six phases of reflexive thematic analysis is presented in Table 1 . Th-roughout these six phases, ongoing discussions were held within the research team that embraced a critical dialogue until reaching interpretative depth and reflexive practice.…”