Paramedics and serious illness: communication training

Abstract

ObjectivesThe need to empower Ambulance Service staff at the point of delivery of end of life care (EoLC) is crucial. We describe the delivery, outcomes and potential impact of the Serious Illness Conversation project delivered to Welsh Ambulance Service Trust (WAST) staff. Over an 18-month period, 368 WAST staff attended face-to-face teaching, which included serious illness conversation communication skills, symptom control and ‘shared decision making’.MethodData collected from WAST staff were used to gain insight on perception of their role and challenges within the context of EoLC, understand the impact of teaching on self-confidence and identify impact on the wider service. A mixed methods approach was used for data analysis.ResultsWAST staff view themselves in several important roles, acting as ‘facilitators’ to patient-centred, seamless care, providing support, liaison between services and practical help in patient care at the end of life. The difficult questions and situations pertaining to EoLC were related to discussions on death and dying and managing expectation. The predominant barriers identified related to communication. Quantitative outcomes on the six communication domains indicate statistically significant improvement in self-assessed confidence. The overall impact to the wider ambulance service suggests a trend towards better use of resources.ConclusionThe perceived roles and challenges identified by paramedics can help in customising training objectives. The initial outcomes from the ongoing project with WAST demonstrate increased confidence in handling communication issues. Initial successive surveys suggest teaching is making a real life impact on patient care at end of life.

Paramedic experiences of providing care in Wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

“…Such disparity in guidelines have also been reported in the literature. 28 They faced rapid changes in their role in provision of EoLC, which some were not confident in, and while studies have previously reported this, [29][30][31][32][33] empowering staff at the point of delivery of EoLC has been deemed crucial and can make a real life impact. 30 The pandemic may have expedited developments in paramedic provision of EoLC and tragic decisions may have been made.…”

“…28 They faced rapid changes in their role in provision of EoLC, which some were not confident in, and while studies have previously reported this, [29][30][31][32][33] empowering staff at the point of delivery of EoLC has been deemed crucial and can make a real life impact. 30 The pandemic may have expedited developments in paramedic provision of EoLC and tragic decisions may have been made. However, powerful positive EoLC encounters were reported by paramedics which may reflect professional and organisational growth which can emerge from such crises.…”

Advance care planning re-imagined: a needed shift for COVID times and beyond

“…Articles and blogs to help those less accustomed to technology have been written in response to the crisis. 23 , 25…”

“…Articles and blogs to help those less accustomed to technology have been written in response to the crisis. 23,25 This information, again with their consent, is shared on handover and referral forms, to enable community palliative care teams to have discussions. Some of these discussions will be challenging.…”

“…In Wales, paramedics have received Serious Illness Communication skills training, so that they can feed into the ACP approach. 23 If the paramedic guidelines alerted future patients and families to the importance of ACPs, especially ACPs in fast moving circumstances, then these patients and families who have not prepared their own go-bags can be made aware of their value, and then quickly prepare one, at the point of paramedic service.…”