Paramedics well-placed to fill gaps in palliative care so more patients can die at home

More patients approaching end of life could die comfortably at home, where this is the person’s preference, if paramedics were better equipped and supported to help them, according to new research.

The research published in leading international palliative care journal Palliative Medicine, based on a review of existing international literature, found there are opportunities for health services to increase paramedic involvement to fill gaps, particularly after-hours, in palliative care to avoid unwanted hospital admissions.

The article, Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis, highlighted key enablers to increasing the role of paramedics, including strengthening their communication and support channels with multidisciplinary palliative care teams.

Other initiatives could include targeted palliative care training for paramedics, partnering in care with families and palliative care-specific clinical practice guidelines to broaden current scope of practice.

The research authored by Madeleine Juhrmann, who is a PhD candidate with the University of Sydney Northern Clinical School, found barriers to paramedics delivering a palliative approach to care at home included unreliable access to documented wishes, family discord and “medical-legal ambiguity” associated with palliative medicine.

Ms Juhrmann said paramedics were well-placed to respond positively to the strong preference in the community in favour of home-based deaths, if supported to do so.

She said global demand for palliative care is increasing due to an aging population and prevalence of chronic non-communicable disease. The present reliance on exclusively specialist hospital-based care is becoming unsustainable.

Within Australia alone, tertiary health services saw a 16.9 per cent increase in palliative care hospitalisations between 2013/14 and 2017/18.

“Paramedics are in a unique position to help deliver palliative and end-of-life care in the home, especially after hours for palliative care emergencies,” Ms Juhrmann said.

“However, their role is traditionally limited to providing life-sustaining interventions for acute emergencies and conveyance to hospital.”

Ms Juhrmann’s research into the role of paramedicine delivering palliative and end-of-life care in Australian communities will involve three more studies including a policy analysis of existing ambulance services’ palliative care clinical practice guidelines, a qualitative study of health professionals, families and carers perspectives and experiences of palliative paramedicine, and a Delphi study to gain broad consensus on the development of best practice guidelines for palliative paramedicine.

The research is funded by The HammondCare Foundation.

To access a copy of Ms Juhrmann’ s latest research in Palliative Medicine, click this link.