Gage Caleb Hanson, Gwyther Liz, Stassen Willem
Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Interdisciplinary Palliative Care and Medicine, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa.
Afr J Emerg Med. 2024 Dec;14(4):231-239. doi: 10.1016/j.afjem.2024.08.007. Epub 2024 Aug 30.
Due to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations.
A qualitative design employing individual semi-structured interviews was implemented. Ten interviews with experienced doctors and nurses holding post-graduate palliative medicine qualifications were conducted. Verbatim transcriptions of interviews were subjected to content analysis with an inductive-dominant approach to develop codes and categories.
Four categories were developed: (1) Disposition towards EMS, (2) Perceived EMS challenges, (3) Positive EMS impact across patients' palliative care journeys and (4) Methods of EMS and palliative care system integration. Participants maintained an overall positive view of EMS and palliative care integration, noting the beneficial impact of EMS and suggesting various methods of integration, while also highlighting challenges and concerns.
EMS and palliative care integration would be mutually beneficial to both systems while benefiting patient well-being and the broader healthcare system. Potentially low-cost, high-impact interventions suggested by participants, such as palliative care cards for patients and enhancing EMS and palliative care system communication, represent efficacious and judicious use of limited resources within the SA context. Pilot studies investigating these suggestions should be conducted.
由于紧急医疗服务（EMS）经常与姑息治疗情况相交，且全球对姑息治疗的需求不断增加，人们越来越认识到将姑息治疗与EMS整合的必要性。然而，在许多低收入和中等收入国家，如南非（SA），EMS和姑息治疗系统仍然相互隔离。本研究的目的是收集南非姑息治疗提供者对姑息治疗情况下EMS的看法。
采用个人半结构化访谈的定性设计。对10名具有姑息医学研究生资格的经验丰富的医生和护士进行了访谈。访谈的逐字记录采用归纳为主的方法进行内容分析，以制定代码和类别。
形成了四类：（1）对EMS的态度，（2）感知到的EMS挑战，（3）EMS对患者姑息治疗全程的积极影响，以及（4）EMS与姑息治疗系统整合的方法。参与者对EMS和姑息治疗整合总体持积极看法，指出了EMS的有益影响并提出了各种整合方法，同时也强调了挑战和担忧。
EMS与姑息治疗整合对两个系统都将是互利的，同时有利于患者福祉和更广泛的医疗系统。参与者提出的潜在低成本、高影响的干预措施，如为患者提供姑息治疗卡以及加强EMS与姑息治疗系统的沟通，代表了在南非背景下对有限资源的有效和明智利用。应开展调查这些建议的试点研究。
