Stakeholders’ views on paramedic screening and referral intervention

What are stakeholders’ views on a paramedic screening and referral intervention aimed at improving advanced care planning in patients in the last year of life?

Study team

  • Kim Kirby (South Western Ambulance Service NHS Foundation Trust), Chief Investigator 
  • Professor Jonathan Benger (UWE Bristol)
  • Dr Sarah Voss (UWE Bristol)
  • Alyesha Proctor (UWE Bristol), Study Coordinator
  • Dr Sarah Black (South Western Ambulance Service NHS Foundation Trust)
  • Dr Lucy Pocock (University of Bristol)
  • Dr Hazel Taylor (RDS)
  • Joanne Stonehouse (South Western Ambulance Service NHS Foundation Trust)
  • Sally Richardson, PPI
  • Dr Laura Goodwin, Research Fellow - Emergency Care (UWE Bristol)

Study summary

Quality in end of life care is variable and identifying patients in the end of life phase is poorly done, particularly in those people with diagnoses other than cancer. It is important that patients approaching the end of life are identified early as this allows comprehensive community support to be organised. Early recognition leads to better planning, allowing the patient to die in their place of choice, avoiding a crisis where the patient’s condition worsens and they are taken to a busy Emergency Department unnecessarily.

Advanced care planning is a process of formal decision making that aims to help patients establish decisions about future care that take effect when end of life patients lose capacity. Current use of advanced care planning is variable, greater emphasis is required as initiating advanced care planning allows patients to get the most out of the process and improve care. The role of the ambulance service in recognising patients in their last year of life is often overlooked. There is audit data that demonstrates that ambulance staff frequently attend patients in their last year of life. This indicates the opportunity for early identification and referral to the GP for advanced care planning.

The Gold Standards Framework Proactive identification Guidance (PIG) is an established and evidenced based screening tool for clinicians to support earlier identification of patients nearing the end of their life. Screening and referral utilising PIG in the acute setting by paramedics could have the potential to contribute to improved outcomes for end of life patients, and reduce costs.

The aim of this study is to explore relevant stakeholder’s views on utilising a paramedic screening and referral intervention aimed at improving advanced care planning in patients in the last year of life. This exploratory work will provide the necessary evidence to inform the main future grant proposal. The ultimate aim is to identify whether a paramedic screening and referral intervention increases early advanced care planning and improves outcomes for patients in the last year of life.

We will conduct semi structured telephone interviews with 20 stakeholders, including paramedics, GPs, community nurses and emergency department staff, all of whom have experience and/or interest in the care of end of life patients. The interviews will be transcribed and thematically analysed.

The findings are expected to provide an understanding of different stakeholders’ views on utilising a paramedic screening and referral intervention aimed at improving advanced care planning in patients in the last year of life.

The results of this study will help to inform further research, with the ultimate aim of increasing paramedic recognition and referral to GPs for patients in the last year of life, and improving patient outcome, as well as reducing costs.

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