Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis

Sage Palliative Medicine & Chronic Care

This episode features Madeleine Juhrmann (Northern Clinical School, University of Sydney, Sydney, NSW, Australia. HammondCare Centre for Learning and Research in Palliative Care, Greenwich Hospital, Greenwich, NSW, Australia). Global demand for palliative care is increasing and the reliance on exclusively specialist hospital-based care is becoming unsustainable. Community preferences also favour home-based deaths. 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. However, their role is traditionally limited to providing life-sustaining interventions for acute emergencies and conveyance to hospital. No overview of the role paramedics play in delivering palliative and end-of-life care in community-based settings currently exists. The findings of the review suggest paramedics can play an important role in providing emergency support to patients approaching end-of-life, help facilitate home-based deaths, and reduce avoidable hospital admissions where this is the patient’s preference. The review identified untimely access to documented wishes, family discordance and the medico-legal ambiguity associated with palliative paramedicine as key barriers preventing paramedics from adopting a palliative approach to care. Key enablers highlighted within the review include strengthening communication and support channels with multidisciplinary teams, targeted palliative care training for paramedics, partnering in care with families and palliative care specific clinical practice guidelines to broaden the current scope of practice. This review underscores the opportunities for health services to consider paramedic involvement in integrated models of community palliative care delivery, especially as an adjunct support in palliative emergencies in collaboration with other services. Further research developing and evaluating systems to enable paramedics better access to patients documented palliative care plans, targeted palliative care training programmes and palliative care specific clinical practice guidelines is needed.