South African paramedic perspectives on prehospital palliative care

Caleb Hanson Gage,Heike Geduld,Willem Stassen

doi:10.1186/s12904-020-00663-5

Caleb Hanson Gage, Heike Geduld + Show 1 more

Open Access

https://doi.org/10.1186/s12904-020-00663-5

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Abstract

BackgroundPalliative 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.MethodsA 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.ResultsFour 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.ConclusionChallenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

Highlights

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]
The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private Emergency Medical Service (EMS) sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice
The aim of this study was to begin exploring the topic of South African prehospital palliative care by gathering the perspectives of ALS providers within the South African private EMS sector concerning prehospital palliative care importance, feasibility and barriers to practice

Summary

Introduction

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] Such treatment is typically performed by palliative care specialists who work in-hospital. As the first point of medical contact, EMS providers are 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]. In the United States of America (USA) only 5–6% of EMS systems have protocols for palliative

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