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

• Published in: Canadian journal of emergency medicine Vol. 21; no. 4; pp. 513 - 522
• Main Authors: Carter, Alix J E, Arab, Marianne, Harrison, Michelle, Goldstein, Judah, Stewart, Barbara, Lecours, Mireille, Sullivan, James, Villard, Carolyn, Crowell, Wilma, Houde, Katherine, Jensen, Jan L, Downer, Kathryn, Pereira, Jose
• Format: Journal Article
• Language: English
• Published: England Springer Nature B.V 01.07.2019
• Subjects: Cancer; Caregivers; Data analysis; Data collection; Emergency medical care; Health care access; Hospice care; Hospitals; Interviews; Legal medicine; Mixed methods research; Palliative care; Paramedics; Patients; emergency medical services; paramedic; mobile integrated health; community paramedicine; extended scope of practice
• ISSN: 1481-8035; 1481-8043
• DOI: 10.1017/cem.2018.497

Paramedics 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. In 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. In 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. After 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.