Background: Paramedics are a highly skilled and unique workforce, attending to patients in the community 24/7 across all locations. As global populations age and community preferences to die at home increase, new models of paramedic practice are required to respond to the growing needs of palliative care patients, especially out-of-hours.
Aim: To explore the role of paramedics delivering palliative and end-of-life care in Australian communities and develop a palliative paramedicine framework suitable for national implementation.
Methods: Four empirical studies were undertaken: (1) systematic integrative review; (2) comparative clinical practice guideline analysis; (3) qualitative interviews; (4) Delphi study.
Setting, data collection and analysis: 22 studies were thematically analysed for the systematic review. Eight palliative care guidelines from Australian, New Zealand, UK and Canadian ambulance services were quality appraised and content analysed. 50 Australian paramedics’, palliative care doctors’ and nurses’, GPs’, residential age care nurses’ and bereaved family members’ experiences and perspectives were thematically analysed. Consensus regarding essential framework components was gained from 70 Australian and international palliative paramedicine experts.
Results/findings:
Participants reported and supported a role for paramedics in providing emergency support to patients approaching end-of-life, facilitating home-based deaths and reducing avoidable hospital admissions. They felt many existing paramedic skills can be leveraged to suit the palliative care context but reported challenges in this setting. Paramedics expressed vulnerability when taking this approach to care, and require additional training, support and clinical back-up. Components gaining consensus from the expert panel for inclusion in the framework will be reported.
Conclusion/lessons learnt: Strong consensus exists amongst experts that a multi-faceted framework is required to address the structural, service, community and individual factors influencing practice. Implementing this framework, in partnership with ambulance services and the palliative care community, will aim to standardise best practice and strengthen a culture of interdisciplinary palliative care across Australia.
