Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK.
Lancaster Medical School, Lancaster University, Lancaster, LA1 4YT, UK.
BMC Emerg Med. 2023 Aug 2;23(1):81. doi: 10.1186/s12873-023-00848-0.
Paramedics are increasingly being called to attend patients dying from advanced incurable conditions. However, confidence to deal with such calls varies, with many feeling relatively unskilled in this aspect of their role. A number of interventions have been piloted to improve their skills in end-of-life care (EoLC) but without a fully specified theoretical model. Theory of Change models can provide theoretical and testable links from intervention activities to proposed long-term outcomes and indicate the areas for assessment of effectiveness. This study aimed to develop an intervention for improving paramedic EoLC for patients in the community.
A Theory of Change approach was used as the overarching theoretical framework for developing an intervention to improve paramedic end-of-life skills. Nine stakeholders - including specialist community paramedics, ambulance call handlers and palliative care specialists - were recruited to five consecutive online workshops, ranging between 60 and 90 min. Each workshop had 2-3 facilitators. Over multiple workshops, stakeholders decided on the desired impact, short- and long-term outcomes, and possible interventions. During and between these workshops a Theory of Change model was created, with the components shared with stakeholders.
The stakeholders agreed the desired impact was to provide consistent, holistic, patient-centred, and effective EoLC. Four potential long-term outcomes were suggested: (1) increased use of anticipatory and regular end-of-life medications; (2) reduced end-of-life clinical and medication errors; (3) reduced unnecessary hospitalisations; (4) increased concordance between patient preferred and actual place of death. Key interventions focused on providing immediate information on what to do in such situations including: appraising the situation, developing an algorithm for a treatment plan (including whether or not to convey to hospital) and how to identify ongoing support in the community.
A Theory of Change approach was effective at identifying impact, outcomes, and the important features of an end-of-life intervention for paramedics. This study identified the need for paramedics to have immediate access to information and resources to support EoLC, which the workshop stakeholders are now seeking to develop as an intervention.
护理人员越来越多地被派往照顾患有绝症的临终病人。然而，他们对处理此类电话的信心各不相同，许多人觉得自己在这方面的技能相对欠缺。已经尝试了一些干预措施来提高他们在临终关怀（EoLC）方面的技能，但没有一个完全指定的理论模型。变革理论模型可以为干预活动与拟议的长期结果之间提供理论和可测试的联系，并指出评估有效性的领域。本研究旨在为改善社区护理人员的临终护理技能制定一项干预措施。
变革理论方法被用作制定干预措施以改善护理人员临终技能的总体理论框架。九位利益相关者-包括专业社区护理人员、救护车呼叫处理人员和姑息治疗专家-被招募参加五个连续的在线研讨会，每个研讨会的时间为 60-90 分钟。每个研讨会都有 2-3 名主持人。在多次研讨会上，利益相关者决定了预期的影响、短期和长期结果以及可能的干预措施。在这些研讨会期间和之间，创建了一个变革理论模型，并与利益相关者分享了模型的各个组成部分。
利益相关者一致认为，预期的影响是提供一致、全面、以患者为中心和有效的临终关怀。提出了四个潜在的长期结果：（1）增加使用预期和常规临终药物；（2）减少临终临床和用药错误；（3）减少不必要的住院治疗；（4）增加患者首选和实际死亡地点之间的一致性。关键干预措施侧重于提供有关如何在这种情况下采取行动的即时信息，包括：评估情况、为治疗计划制定算法（包括是否告知医院）以及如何识别社区中的持续支持。
变革理论方法有效地确定了对护理人员临终干预的影响、结果和重要特征。本研究确定了护理人员需要即时访问信息和资源以支持临终关怀的需求，研讨会利益相关者现在正在寻求开发该干预措施。
