Paramedics providing palliative care at home: A mixed-methods exploration of patient and family satisfaction and paramedic comfort and confidence

Abstract

ObjectiveParamedics Providing Palliative Care at Home was launched in two provinces, including a new clinical practice guideline, database, and paramedic training. The aim of this study was to evaluate patient/family satisfaction and paramedic comfort and confidence.MethodsIn Part A, we gathered perspectives of patients/families via surveys mailed at enrolment and telephone interviews after an encounter. Responses were reported descriptively and by thematic analysis. In Part B, we surveyed paramedics online pre- and 18 months post-launch. Comfort and confidence were scored on a 4-point Likert scale, and attitudes on a 7-point Likert scale, reported as the median (interquartile range [IQR]); analysis with Wilcoxon ranked sum/thematic analysis of free text.ResultsIn Part A, 67/255 (30%) enrolment surveys were returned. Three themes emerged: fulfilling wishes, peace of mind, and feeling prepared for emergencies. In 18 post-encounter interviews, four themes emerged: 24/7 availability, paramedic professionalism and compassion, symptom relief, and a plea for program continuation. Thematic saturation was reached with little divergence. In Part B, 235/1255 (18.9%) pre- and 267 (21.3%) post-surveys were completed. Comfort with providing palliative care without transport improved post launch (p = < 0.001) as did confidence in palliative care without transport (p = < 0.001). Respondents strongly agreed that all paramedics should be able to provide basic palliative care.ConclusionsAfter implementation of the multifaceted Paramedics Providing Palliative Care at Home Program, paramedics describe palliative care as important and rewarding. The program resulted in high patient/family satisfaction; simply registering provides peace of mind. After an encounter, families particularly noted the compassion and professionalism of the paramedics.

Pallium Canada's Curriculum Development Model: A Framework to Support Large-Scale Courseware Development and Deployment

“…The LEAP Paramedics course, which targets ambulance first responders, illustrates this. 26 A decision was made in 2015 to prioritize the development of that consider. The team is also given access to existing LEAP courses to facilitate the process and to increase efficiencies, as well as to ensure common messaging and design across the courses.…”

Paramedic delivery of community-based palliative care: An overlooked resource?

“…Ambulance services globally are progressively embracing new paradigms of care, including palliative care, with the view of improved holistic support for patients at home. 12,13 In Australia for instance, NSW Ambulance has engaged collaboratively with other health services to develop palliative care plans that inform the attending paramedic of resuscitation plans, treatment for specific symptoms (including outof-paramedic scope), guidance for where the patient may be admitted, if required, and contact details of other services involved in the patient's care. 14 Additionally, paramedics are already well placed as a mobile healthcare workforce to respond to patients requiring unscheduled care.…”

“…In Canada, for example, despite the high proportions of patients expressing a preference to die at home, over half of patients requiring palliative care who contacted an ambulance were transported to an emergency department, hospital or hospice facility. 12 More recently, higher transport rates have been reported in Australia with approximately three-quarters of the 4348 palliative care patients who contacted a state ambulance service in a 12 month period were transported. 16 Caring for patients receiving palliative care may seem contrary to the traditional life-saving focus of paramedic practice, although paramedics appear to have a sound understanding of important aspects of palliative care with respect to symptom control and holistic care.…”

“…17 The core of the issue may lie in a lack of confidence and competence in managing palliative patients due to a perceived aperture in paramedic education. 12 Despite the ongoing perceptual challenges across health systems in understanding what paramedics 'do', it is curious to note that paramedics and ambulance services are not referenced at state 18 and national-level 19 peak palliative care review and policy documents in Australia. This omission is despite paramedicine recently becoming the 15th registered health profession in Australia, after their UK counterparts first registered some two decades ago.…”

“…However, paramedics have been delivering palliative care in numerous jurisdictions globally for some time with promising outcomes. 12,20 Yet despite recognition of the need for collaborative engagement across multiple service providers to achieve high-quality patient-centred palliative care, ambulance paramedics have notably been missing from the table.…”