South African paramedic perspectives on prehospital palliative care

Gage, Caleb Hanson; Geduld, Heike; Stassen, Willem

doi:10.1186/s12904-020-00663-5

Cited by 17 publications

(65 citation statements)

References 27 publications

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“…If only 47 (40%) of paramedics reported prior formal POLST training, this demonstrates a major curriculum gap and an area for targeted future trainings. The findings of this study are overall consistent with previous literature that demonstrates a paucity of formal training and guidelines around caring for patients near the end of life [ 10 , 11 , 12 ].…”

Section: Discussionsupporting

confidence: 90%

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

et al. 2022

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Background Physician Order for Life-Sustaining Treatment forms (POLST) exist in some format in all 50 states. The objective of this study is to determine paramedic interpretation and application of the California POLST for medical intervention and transportation decisions. Methods This study used a prospective, convenience sample of California Bay Area paramedics who reviewed six fictional scenarios of patients and accompanying mock POLST forms. Based on the clinical case and POLST, paramedics identified medical interventions that were appropriate (i.e. non-invasive positive pressure airway) as well as transportation decisions (i.e. non-transport to the hospital against medical advice). EMS provider confidence in their POLST interpretation was also assessed. Results There were 118 paramedic participants with a mean of 13.3 years of EMS experience that completed the survey. Paramedics routinely identified the selected medical intervention on a patients POLST correctly as either comfort focused, selective or full treatment (113-118;96%-100%). For many clinical scenarios, particularly when a patient’s POLST indicated comfort focused treatment, paramedics chose to use online medical oversight through base physician contact (68-73;58%-62%). In one case, a POLST indicated “transport to hospital only if comfort needs cannot be met in current location”, 13 (14%) paramedics elected to transport the patient anyway and 51 (43%) chose “Non-transport, Against Medical Advice”. The majority of paramedics agreed or strongly agreed that they knew how to use a POLST to decide which medical interventions to provide (106;90%) and how to transport a patient (74;67%). However, after completing the cases, similar proportions of paramedics agreed (42;36%), disagreed (43;36%) or were neutral (30;25%) when asked if they find the POLST confusing. Conclusion The POLST is a powerful tool for paramedics when caring patients with serious illness. Although paramedics are confident in their ability to use a POLST to decide appropriate medical interventions, many still find the POLST confusing particularly when making transportation decisions. Some paramedics rely on online medical oversight to provide guidance in challenging situations. Authors recommend further research of EMS POLST utilization and goal concordant care, dedicated paramedic POLST education, specific EMS hospice and palliative care protocols and better nomenclature for non-transport in order to improve care for patients with serious illness.

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Section: Discussionsupporting

confidence: 90%

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

et al. 2022

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“…27–30 Paramedics are trained in decision-making processes, communication, handover processes, analgesic care, and acting as mediators between the pre- and in-hospital services. 17 These competencies may also help them to offer palliative care. Previous studies 9,17,18,23,24,31 have shown that conflicts in care goals, legal issues, organizational policy, and clinical practice guidelines may challenge paramedics when treating palliative patients.…”

Section: Introductionmentioning

confidence: 99%

“…17 These competencies may also help them to offer palliative care. Previous studies 9,17,18,23,24,31 have shown that conflicts in care goals, legal issues, organizational policy, and clinical practice guidelines may challenge paramedics when treating palliative patients. Paramedics report minimal training in palliative care 8,14,17,32 although further education may improve their competency.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies 9,17,18,23,24,31 have shown that conflicts in care goals, legal issues, organizational policy, and clinical practice guidelines may challenge paramedics when treating palliative patients. Paramedics report minimal training in palliative care 8,14,17,32 although further education may improve their competency. 14 Only little is known of paramedics’ own perceptions of challenging situations in end-of-life care at home and their educational needs.…”

Section: Introductionmentioning

confidence: 99%

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Paramedics’ experiences and educational needs when participating end-of-life care at home: A mixed method study

et al. 2022

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Background: Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. Aim: To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. Design: A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. Setting/Participants: The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. Results: Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. Conclusions: Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients’ and families’ views on the paramedics’ participation in end-of-life care should be evaluated in the future.

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“…Understanding the phenomenon of EMS responses to patients enrolled in hospice programs could support patient-and family-centered end-of-life care, improve the working interface between EMS systems and hospice programs, and optimize utilization of EMS resources. Numerous studies using individual interviews, focus groups, and surveys have explored the recollections and perceptions of hospice staff, 12 family members, 13 and EMS providers [14][15][16][17][18][19][20][21][22][23] of the role of EMS and hospitalization in palliative care. (It should be noted that terms like "palliative care" are sometimes used loosely in the literature, and it may not be limited to patients formally enrolled in a hospice program.)…”

Section: Introductionmentioning

confidence: 99%

EMS responses to hospice patients: a qualitative study

Kukol

Ryan

2022

Preprint

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In the palliative care community, multiple emergency department visits and hospitalizations are considered an indicator of poor-quality end of life care. There is substantial research on the events surrounding ED visits, and subsequent hospitalizatons, by hospice patients. It is important however to understand that these hospital arrivals often begin with an ambulance response to the home. Emergency medical services (EMS) responses to hospice patients have been less well-studied. We conducted a retrospective study of 170 consecutive electronic patient care reports produced contemporaneously by EMS providers in several US counties during the normal course of their responses to hospice patients. We summarized descriptive epidemiology of the patients and of the incidents, and we explored the provider narratives for recurring themes. To our knowledge this is the first study to explore the contemporaneously-documented on-scene circumstances of pre-hospital care for patients enrolled in a hospice program. The median patient age was 76. Cancer, chronic lung disease, and heart failure were the most common hospice-qualifying diagnoses. Transportation of the patient from the scene occurred in 111 cases (65.3\%). Consistent with previous studies based on interviews of EMS providers, the most common chief complaints included pain, dyspnea, and altered mental status. EMS was frequently called for confirmation of death, a finding not previously reported. Transitions of care, such as from curative medical care to hospice care, and from hospital to home, were a recurring theme. Gaps in care around these transitions were often evident, with EMS being called upon to fill them. Care transitions around weekends were prominent. Also emerging from the narratives was the concept that hospice enrollment is not a single event but rather a step-wise process; we developed a preliminary coding taxonomy to classify those enrollment stages. The hospice-EMS interface can be complex. Although all care by EMS providers is with the literal or implied consent of the patient, the arrival of an ambulance to a scene where emotions are running high carries a certain momentum and could lead to a cascade of interventions that, in retrospect and given other options, the patient may not have wanted. A better understanding of the hospice-EMS interface might illuminate changes that could be made to improve it, with a goal of ensuring that hospice patients and their families receive emergency medical services when they need and can benefit from them but receive other, non-EMS, services when those are more suitable to their needs. It might also improve the efficiency of an already overburdened EMS system.

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South African paramedic perspectives on prehospital palliative care

Cited by 17 publications

References 27 publications

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

Paramedics’ experiences and educational needs when participating end-of-life care at home: A mixed method study

EMS responses to hospice patients: a qualitative study

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