How ambos could help palliative care patients fulfill their wish to die at home

New research supported by HammondCare will investigate how paramedics can actively support the preference of a large majority of Australians with life-limiting illnesses to die at home with their loved ones.

The HammondCare Foundation will financially support research that aims to assist the development of a national best practice clinical palliative care guideline to broaden the role of paramedics in delivering palliative and end-of-life care in Australian communities, and reduce avoidable hospital admissions.

PhD candidate Madeleine JuhrmannPhD candidate Madeleine Juhrmann, who has a background in paramedicine, will explore Australian and international literature on the topic, investigate current paramedic approaches to palliative care in community settings, and conduct a content analysis of each state and territory ambulance service’s relevant clinical practice guidelines.

Ms Juhrmann said paramedics are a unique workforce, attending to patients in their homes 24 hours a day in the case of medical emergencies.

The traditional scope of practice for paramedics has been limited to sustaining interventions for acute emergencies, usually involving hospital conveyance, rather than home-based care.

“General practitioners, community nurses and specialist palliative care services may not always be available to visit a palliative care patient at short notice as part of a rapid response to an emerging clinical situation, especially after hours,” Ms Juhrmann said. “The default in this situation is to call an ambulance, more often than not resulting in the patient being transported to hospital.

“However, for people who have a progressive life-limiting condition, an acute hospital admission may not be wanted or the best setting to deliver palliative care.”

Recent research by the Grattan Institute found 70% of Australians want to die at home, but only 14% currently have that wish granted. About 54% die in hospitals and 32% in residential aged care facilities. 1

As Australia’s population continues to age, the demand for palliative care services is increasing. According to the Australian Institute of Health and Welfare, hospitals saw a 19.2% rise in palliative-care related hospitalisations between 2010 and 2015. 2

Ms Juhrmann’s research will be primarily supervised by Prof Josephine Clayton, Director of HammondCare’s Centre for Learning & Research in Palliative Care and Professor of Palliative Care at the University of Sydney.

Prof Clayton said, “As a palliative care physician serving communities in various settings over many years, I can see the enormous value of this research to improve and complement community palliative care in emergency situations.”

The four-year research project Palliative Paramedicine: Broadening the Role of Paramedics Delivering Palliative & End-of-Life Care in the Australian Community, is one of two PhDs supported by the HammondCare Foundation Postgraduate Research Scholarships.

Dr Graham Grove has also received funding for research on cultural and spiritual influences on euthanasia views in a changing world. His project will be supervised by Prof Melanie Lovell, Medical Head of Palliative Care, HammondCare Health.

HammondCare Head of Fundraising, Claire McCarthy, said the scholarships offered through the University of Sydney were the result of a generous donation received from The David & Judith Taylor Foundation.

“The donation supports innovative palliative care research and related research into cancer pain at HammondCare.” Ms McCarthy said. “On behalf of the HammondCare Foundation, I extend my heartfelt thanks for this generous gift to support our work to ensure best practice delivery in palliative care.”

The research complements HammondCare’s commitment to palliative care services offered through inpatient and outpatient settings in sub-acute hospitals, and through specialised services and programs in the community.

[1] Swerissent H, Duckett S. Dying well [Internet]. Carlton (AU): Grattan Institute; 2014 [cited 2019 Dec. 10]

[2] Australian Institute of Health and Welfare (AIHW) Palliative care services in Australia [Internet]; Canberra; AIHW; 2017