ORCID Profile
0000-0001-5500-4330
Current Organisations
University of Sydney
,
HammondCare
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Publisher: SAGE Publications
Date: 12-2022
DOI: 10.1177/02692163211059342
Abstract: There is a growing demand for community palliative care and home-based deaths worldwide. However, gaps remain in this service provision, particularly after-hours. Paramedicine may help to bridge that gap and avoid unwanted hospital admissions, but a systematic overview of paramedics’ potential role in palliative and end-of-life care is lacking. To review and synthesise the empirical evidence regarding paramedics delivering palliative and end-of-life care in community-based settings. A systematic integrative review with a thematic synthesis was undertaken in accordance with Whittemore and Knafl’s methodology. Prospero: CRD4202119851. MEDLINE, CINAHL, PsycINFO and Scopus databases were searched in August 2020 for primary research articles published in English, with no date limits applied. Articles were screened and reviewed independently by two researchers, and quality appraisal was conducted following the Mixed-Methods Appraisal Tool (2018). The search retrieved 5985 articles 23 articles satisfied eligibility criteria, consisting of mixed-methods ( n = 5), qualitative ( n = 7), quantitative descriptive ( n = 8) and quantitative non-randomised studies ( n = 3). Through data analysis, three key themes were identified: (1) Broadening the traditional role, (2) Understanding patient wishes and (3) Supporting families. Paramedics are a highly skilled workforce capable of helping to deliver palliative and end-of-life care to people in their homes and reducing avoidable hospital admissions, particularly for palliative emergencies. Future research should focus on investigating the efficacy of palliative care clinical practice guideline implementation for paramedics, understanding other healthcare professionals’ perspectives, and undertaking health economic evaluations of targeted interventions.
Publisher: SAGE Publications
Date: 08-08-2022
DOI: 10.1177/02692163221110419
Abstract: Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current ambulance services’ approach to palliative and end-of-life care. To examine the quality and content of existing Australian palliative paramedicine guidelines with a s le of guidelines from comparable Anglo-American ambulance services. We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines. Eight palliative care ambulance service clinical practice guidelines (five Australian one New Zealand one Canadian one United Kingdom). None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled in idual domain percentage scores varied across the guidelines: scope and purpose (8%–92%), stakeholder involvement (14%–53%), rigour of development (0%–20%), clarity of presentation (39%–92%), applicability (2%–38%) and editorial independence (0%–38%). Six themes were developed from the content analysis: (1) audience and approach (2) communication is key (3) assessing and managing symptoms (4) looking beyond pharmaceuticals (5) seeking support and (6) care after death. It is important that ambulance services’ palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.
Publisher: SAGE Publications
Date: 14-07-2023
DOI: 10.1177/02692163231186451
Abstract: Paramedic practice is ersifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. To elicit paramedics’, palliative care doctors and nurses’, general practitioners’, residential aged care nurses’ and bereaved families and carers’ experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. A purposive s le of 50 stakeholders from all Australian jurisdictions participated. Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder) creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.
Publisher: Frontiers Media SA
Date: 25-04-2023
DOI: 10.3389/FPSYT.2023.1137970
Abstract: People living with dementia in care homes can benefit from palliative approaches to care however, not all will require specialist palliative care. The generalist aged care workforce is well placed to provide most of this care with adequate training and support systems in place, but little is known about their experiences. To describe staff perspectives on providing quality end-of-life care for people living with dementia in residential care and their families. Focus groups and semi-structured interviews were conducted with residential aged care managerial and frontline staff in Australia who were caring for residents living with dementia and end-of life needs. A comprehensive, then snowballing s ling strategy was used in participating care homes. Transcripts were analyzed using reflexive thematic analysis. Fifteen semi-structured interviews and six focus groups were undertaken with 56 participants across 14 sites across two Australian states. Five themes were identified: putting the resident at the center (creating homes not hospitals, knowing the in idual, a case management approach) articulating goals to grant wishes (initiating the conversation, broadening death literacy, avoiding hospitalization) a collective call to action (staffing the home, recognizing deterioration and escalating issues, communication channels and engaging GPs, managing medications, psychosocial supports) educating to empower staff (governance and guidance, mentoring juniors, self-care) and facilitating family acceptance (setting expectations, partnering in care, access at all hours). Aged care staff are committed to providing person-centered palliative and end-of-life care for people living with dementia, recognizing the intrinsic value of each resident, regardless of their declining state. Frontline and managerial staff consider advance care planning, collectively working as part of a multidisciplinary team, access to targeted palliative and end-of-life education and training, and engaging families as key priorities to providing high quality care in care homes.
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/26323524231163195
Abstract: Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place connect patients to health and community supports integrate alternative pathways by engaging multidisciplinary teams of care and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
No related grants have been discovered for Madeleine Juhrmann.