Paramedics’ perceptions and educational needs with respect to palliative care

Abstract

Introduction: In recent years the scope of palliative care has been redefined to include patients earlier in the course of their illness, and those suffering from life-limiting conditions. Paramedics may be involved in the care of these patients, especially in situations of carer distress, sudden deterioration and imminent death, as well as in non-emergent situations such as inter-facility transfers. In these scenarios, clinical decisions regarding patient care initiated by paramedics may set the trajectory for subsequent care. Objective: To identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes of death. Methods: All 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. Results: Twenty-nine paramedics returned completed surveys. They considered palliative care to be strongly focused 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. Conclusions: Paramedics 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 care occurring in the terminal phase and saw it as being particularly applied to cancer diagnoses. Paramedic palliative care educational efforts should be focused on: ethical issues, end-of-life communication, increasing understanding of the common causes of death, and education regarding those illnesses where a palliative approach might be beneficial.