Palliative Paramedicine: Broadening the Role of Paramedics Delivering Palliative and End-of-Life Care in Australian Communities

Abstract

This thesis explored the emerging field of palliative paramedicine and developed a framework to standardise best practice across Australia. A systematic integrative review of 22 studies described the role, barriers and enablers of paramedic-delivered palliative care, highlighting this model can facilitate home-based deaths and reduce avoidable hospital admissions. A collaborative qualitative analysis audited Australian and international palliative paramedicine guidelines. Qualitative interviews with thematic analysis explored experiences of palliative paramedicine. Key stakeholders: paramedics (n=17), palliative care doctors (n=7), palliative care nurses (n=8), GPs (n=5), aged care nurses (n=5) and bereaved family carers (n=8) saw a dichotomy in the paramedic role: lifesaver and community responder. Participants expressed inconsistencies in ambulance services’ governance, training and interdisciplinary approaches. Opportunities for improvement were identified: macro (policy and frameworks; funding and education; accessing medical records; and a widening scope); meso-level (service-level training; interprofessional understanding and communities of practice; and community expectations); and micro-level (palliative care subspecialty; debriefing and selfcare; and partnering with families). Participants recommended inclusion of paramedicine in interdisciplinary palliative care, and greater investment in generalist and specialist roles.

The above studies informed the development of a draft palliative paramedicine framework. A Delphi study with international experts (n=68) identified 32 essential, implementable framework components to standardise national best practice. Experts called for support to paramedics making complex clinical decisions and navigating holistic care pathways, stronger inclusion of bi-directional training and multidisciplinary debriefing opportunities between paramedics and other palliative care providers.