Original Article Accepted.doc

Original Article Accepted.doc - The perceptions and...

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The perceptions and confidence of paramedics in their role in end-of-life care in the community INTRODUCTION The key to quality, dignified care for all palliative patients is to ensure access to the most appropriate healthcare and holistic support, and it is paramount that patients are involved in decisions affecting their treatment (Leadership Alliance for the Care of Dying People (LACDP, 2014); National Institute of Clinical Excellence (NICE, 2015)). The LACDP (2014) identifies five priorities for care which are fundamental to ensure the dying person becomes the focus of care in the last few days/hours of life. Ambulance services across the world are now a key resource in the team approach providing end- of-life (EoL) care, which supports patients dying at home ((Stone et al., 2009; Lord et al., 2012; Taghavi et al., 2012; Wiese et al., 2012; Public Health England, 2013; Social Care Institute for Excellence (SCIE, 2013); Waldrop et al., 2014). Historically, ambulance services were seen as an emergency transportation system focussed on the management of acute medical and trauma emergencies (National End- of-life Care Programme (NEoLCP, 2012); Brady, 2014). The ambulance service now has a wider role, with clinicians managing a broader range of complex health needs 1
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(Association of Ambulance Chief Executives (AACE, 2011); Lord et al., 2012; Brady, 2014) of which palliative medicine is a key area. There is little published data in the United Kingdom (UK) for the number of EoL patients encountered by paramedics, however in one study just over thirty-three per cent of ambulance clinicians estimated that they attended to a terminally ill patient at least once a shift, and a further twenty-nine percent once every two to five shifts (Munday et al., 2011). A study in Germany identified that EoL calls account for between three to five per cent of all pre-hospital emergencies (Taghavi et al., 2012). Worldwide, paramedics report an increase in the number of EoL calls attended. In each international study, many paramedics feel unprepared to deal with this patient group and there is a widespread call for more integrated education and training (Wiese et al., 2012; Waldrop et al., 2014). Although there has been an increase in the teaching time allocated to palliative medicine for junior doctors in the UK, concerns persist as to whether this is sufficient for the undergraduate medical profession (Charlton and Smith, 2000; Field and Wee, 2002; Mason and Ellershaw, 2010; Walker et al., 2016). In the UK, paramedic education and training has undergone a pivotal shift from traditional vocational training to being university based (AACE, 2011; NEoLCP, 2012). Despite this, there still appears to be a deficiency in pre-hospital education pertaining to End-of-life care (EoLC). 2
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It is highlighted that ‘paramedics are not well trained in, or made aware of, EoL care priorities and choices and advance decisions refusing resuscitation’ (SCIE, 2013, p41), due to the absence of palliative care education within traditional curricula (NEoLCP, 2012). This has resulted in conflict with paramedics’ perceptions of their role (Lord et al., 2012).
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