Preparation for Frontline End-of-Life Care: Exploring the Perspectives of Paramedics and Emergency Medical Technicians

Waldrop, Deborah P.; Clemency, Brian M.; Maguin, Eugene; Lindstrom, Heather A.

doi:10.1089/jpm.2013.0442

Cited by 24 publications

(42 citation statements)

References 12 publications

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“…Several factors influence the conveyance decision: their experience and confidence (where experience was reported as more important than training),58 61 62 64 69 72 73, previous negative experiences,52 63 gender56 and the health status of the EMS staff 62. One study that examined the influence of EMS staff gender on non-conveyance due to patient refusal found that all-male teams were 4.75 times more likely to be confronted with a refusal of medical aid and subsequent conveyance to the ED than all-female and mixed-gender teams 56…”

Section: Resultsmentioning

confidence: 99%

Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review

et al. 2018

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BackgroundThe decision over whether to convey after emergency ambulance attendance plays a vital role in preventing avoidable admissions to a hospital’s emergency department (ED). This is especially important with the elderly, for whom the likelihood and frequency of adverse events are greatest.ObjectiveTo provide a structured overview of factors influencing the conveyance decision of elderly people to the ED after emergency ambulance attendance, and the outcomes of these decisions.Data sourcesA mixed studies review of empirical studies was performed based on systematic searches, without date restrictions, in PubMed, CINAHL and Embase (April 2018). Twenty-nine studies were included.Study eligibility criteriaOnly studies with evidence gathered after an emergency medical service (EMS) response in a prehospital setting that focused on factors that influence the decision whether to convey an elderly patient were included.SettingPrehospital, EMS setting; participants to include EMS staff and/or elderly patients after emergency ambulance attendance.Study appraisal and synthesis methodsThe Mixed Methods Appraisal Tool was used in appraising the included articles. Data were assessed using a ‘best fit’ framework synthesis approach.ResultsED referral by EMS staff is determined by many factors, and not only the acuteness of the medical emergency. Factors that increase the likelihood of non-conveyance are: non-conveyance guidelines, use of feedback loop, the experience, confidence, educational background and composition (male–female) of the EMS staff attending and consulting a physician, EMS colleague or other healthcare provider. Factors that boost the likelihood of conveyance are: being held liable, a lack of organisational support, of confidence and/or of baseline health information, and situational circumstances. Findings are presented in an overarching framework that includes the impact of these factors on the decision’s outcomes.ConclusionMany non-medical factors influence the ED conveyance decision after emergency ambulance attendance, and this makes it a complex issue to manage.

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Section: Resultsmentioning

confidence: 99%

Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review

et al. 2018

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“…Although only a minority of participants in each study reports these concerns, there are similarities in the kinds of challenges identified. These problems include difficulty understanding and explaining the form, 19,[24][25][26] challenges obtaining a clinician signature on forms that other members of the healthcare team prepare, 19,25,27 discomfort with problems that the form raises, 19 problems when transferring POLST across settings, 19,23,[25][26][27] family disagreements about the content, 25,27 problems with using POLST to guide treatment, 25 and inadequate education about the form for providers. 19,25 The time required to complete a POLST can also represent a barrier to use in some settings.…”

Section: Healthcare Provider Attitudes Toward and Experiences With Polstmentioning

confidence: 99%

“…[13][14][15][16]19 Code status is not predictive of a patient's preferences for other kinds of treatments, 14,16,19 highlighting the limitations of relying on code status alone to guide treatment decisions. 36 Healthcare providers largely hold positive views of POLST and find it useful in guiding discussions and decisions about treatments, but there are numerous challenges associated with use of the tool, ranging from challenges understanding and explaining the form 19,[24][25][26] to logistical challenges such as problems transferring the form across settings. 19,23,[25][26][27] Although only a minority of respondents identified these problems, the concerns raised suggest the need for systems-focused quality improvement efforts.…”

Section: Summary Of Polst Researchmentioning

confidence: 99%

Use of the Physician Orders for Life‐Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the Literature

Hickman

Keevern

Hammes

2015

J American Geriatrics Society

160

156

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The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.

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“…NYS recognizes advance directives (NYS Health Care Proxy Form and NYS Living Will) and medical orders (Non‐hospital Do Not Resuscitate [DNR] Order and MOLST) for the documentation of end‐of‐life wishes. In a prior study, the MOLST was favourably endorsed by EMS providers for facilitating rapid decision making in the moments before death (Waldrop et al., ). In the absence of documented orders to the contrary, patients typically receive the most aggressive treatment possible (Bigby, Bowers, & Webber, ; IOM, ).…”

Section: Introductionmentioning

confidence: 99%

Emergency medical services providers' perspective of end‐of‐life decision making for people with intellectual disabilities

McGinley

Waldrop

Clemency

2017

Research Intellect Disabil

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Preparation for Frontline End-of-Life Care: Exploring the Perspectives of Paramedics and Emergency Medical Technicians

Abstract: These study results suggest the need for addressing the potential interrelationship between prehospital and EOL care through improved education and protocols for care in the field.

Cited by 24 publications

References 12 publications

Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review

Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review

Use of the Physician Orders for Life‐Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the Literature

Emergency medical services providers' perspective of end‐of‐life decision making for people with intellectual disabilities

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