Paramedics experiences and expectations concerning advance directives: A prospective, questionnaire-based, bi-centre study

Taghavi, Mahmoud; Simon, Alfred; Kappus, Stefan; Meyer, Nicole; Lassen, C.L.; Klier, Tobias; Ruppert, D; Graf, Bernhard M.; Hanekop, G. G.; Wiese, C.H.R.

doi:10.1177/0269216311419885

Cited by 40 publications

(73 citation statements)

References 23 publications

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“…Surveys of EMS staff may elicit important information and perspectives, which can then be addressed as part of an improvement effort. 32,39,57,58 …”

Section: Needs Assessment Part 1-define the Problemmentioning

confidence: 99%

Integrating Palliative Care in the Out-of-Hospital Setting: Four Things to Jump-Start an EMS-Palliative Care Initiative

Lamba

Schmidt

Chan

et al. 2013

Prehospital Emergency Care

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Emergency medical service (EMS) is frequently called to care for a seriously ill patient with a life-threatening or life-limiting illness. The seriously ill include both the acutely injured patients (for example in mass casualty events) and those who suffer from advanced stages of a chronic disease (for example severe malignant pain). EMS therefore plays an important role in delivering realistic, appropriate, and timely care that is consistent with the patient's wishes and in treating distressing symptoms in those who are seriously ill. The purpose of this article is to; 1) review four case scenarios that relate to palliative care and may be commonly encountered in the out-of-hospital setting and 2) provide a road map by suggesting four things to do to start an EMS-palliative care initiative in order to optimize out-of-hospital care of the seriously ill and increase preparedness of EMS providers in these difficult situations.

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“…Surveys of EMS staff may elicit important information and perspectives, which can then be addressed as part of an improvement effort. 32,39,57,58 …”

Section: Needs Assessment Part 1-define the Problemmentioning

confidence: 99%

Integrating Palliative Care in the Out-of-Hospital Setting: Four Things to Jump-Start an EMS-Palliative Care Initiative

Lamba

Schmidt

Chan

et al. 2013

Prehospital Emergency Care

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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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“…The participants listed several reasons for considering stopping resuscitation such as when it is not likely to be useful to the patient's outcome, prolonged duration of resuscitation when the patient or the legal guardians' preference is against it and in case of advanced terminal illness. Other investigators[ 6 7 ] have highlighted advanced directives as a key factor in resuscitation decisions. In Lebanon, advanced directives are not commonly practiced, partly because they may be at odds with religious beliefs, and partly since the Lebanese society is collectivist, with major life and death decisions made by the family rather than the individual.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the West suggested that prehospital providers prefer withholding resuscitation in cases of futile situations, end-of-life situations, or in the presence of advance directives. [ 6 7 ] Yet deciding to stop resuscitation is challenging to prehospital providers, as this may be beyond their scope of practice. [ 8 ] Online medical control or having prehospital providers consult with an emergency physician for cases where they believe resuscitation to be futile can be helpful.…”

Section: Introductionmentioning

confidence: 99%

Resuscitation of out-of-hospital cardiac arrest victims in Lebanon: The experience and views of prehospital providers

Haidar¹,

Noureddine

Osman

et al. 2018

J Emerg Trauma Shock

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Paramedics experiences and expectations concerning advance directives: A prospective, questionnaire-based, bi-centre study

Cited by 40 publications

References 23 publications

Integrating Palliative Care in the Out-of-Hospital Setting: Four Things to Jump-Start an EMS-Palliative Care Initiative

Integrating Palliative Care in the Out-of-Hospital Setting: Four Things to Jump-Start an EMS-Palliative Care Initiative

Paramedics’ Perceptions and Educational Needs with Respect to Palliative Care

Resuscitation of out-of-hospital cardiac arrest victims in Lebanon: The experience and views of prehospital providers

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