South African paramedic perspectives on prehospital palliative care
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RESEARCH ARTICLE
Open Access
South African paramedic perspectives on prehospital palliative care Caleb Hanson Gage1* , Heike Geduld2 and Willem Stassen1
Abstract Background: Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods: A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results: Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion: Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care. Keywords: Palliative, End-of-life, Prehospital, EMS providers, Paramedic
Background The World Health Organisation (WHO) defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.’ [1] This includes a wide variety of situations such as chronic illness and end-of-life care [2]. * Correspondence: [email protected] 1 Division of Emergency Medicine, University of Cape Town, Cape Town 7935, South Africa Full list of author information is available at the end of the article
Such treatment is typically performed by palliative care specialists who work in-hospital. However, emergency medical services (EMS) often encounter patients requiring palliative care as these patients may have acute exacerbations of illness, progress towards end-of-life or require transport to a medical facility [3–9]. As the first point of medical contact, EMS providers are thus uniquely positioned to deliver early palliative care in the home [10]. This has great potential benefit for patient comfort, early identification and relief of suffering and earlier referral to hospice care [10, 11].
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