Campling Natasha, Turnbull Joanne, Richardson Alison, Voss Sarah, Scott-Green Jennifer, Logan Shane, Latter Sue
School of Health Sciences, University of Southampton, Southampton, UK.
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
BMC Palliat Care. 2024 Dec 21;23(1):297. doi: 10.1186/s12904-024-01629-7.
Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this. Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics' current practice and experiences providing end-of-life care was undertaken.
A cross-sectional online survey design. Quantitative data were analysed using descriptive statistics and qualitative free text responses using Framework Analysis. The survey link was distributed to registered paramedics employed by all 11 NHS Trusts employing paramedics in England, United Kingdom.
Nine hundred and twenty responses were received. They reported shortfalls in availability of healthcare professionals for advice and/or referral. Respondents often, always or sometimes: lacked patient medical history (91%, 839), access to existing advance care planning documentation (98%, 900) and specific medicines needed (80%, 737); encountered conflicting views (89%, 819); and reported lack of pre-registration training (81%, 743) or continuing professional development (77%, 708) influenced their ability to meet patient needs.
This first national survey of paramedic practice and experiences in delivering end-of-life care provides new evidence and insight into the challenges faced by paramedics and the potential impact of these challenges on their perceived levels of competence and confidence. Respondents reported multiple challenges, which potentially impact their ability to provide good quality end-of-life care and increase the risk of hospital conveyance. Paramedic practice at end-of-life must be supported via improved access to: patient records; anticipatory medicines and authority to administer; 24/7 palliative care advice (for shared decision-making); and paramedic specific palliative and end-of-life care training and education (including via integrative ways of working between palliative care and ambulance services). Action is required to integrate paramedicine within the wider healthcare professional team, with robust education and training to support care delivery.
全球对生命最后一年（临终期）护理的需求正在上升，由于社区医疗服务存在缺口，越来越多地要求护理人员提供此类服务。尽管对护理人员队伍的需求不断增加，但很少有大规模或详细的实证研究评估当前护理人员护理这一患者群体的实践和经验。因此，作为一项评估护理人员临终关怀服务的更广泛研究的一部分，在英格兰开展了一项大规模调查，描述护理人员提供临终关怀服务的当前实践和经验。
采用横断面在线调查设计。定量数据使用描述性统计进行分析，定性自由文本回复使用框架分析法进行分析。调查链接分发给英国英格兰所有11个雇佣护理人员的国民保健服务信托基金雇佣的注册护理人员。
共收到920份回复。他们报告了医疗保健专业人员提供建议和/或转诊方面的不足。受访者经常、总是或有时：缺乏患者病史（91%，839人）、获取现有预先护理计划文件（98%，900人）和所需特定药物（80%，737人）；遇到相互矛盾的观点（89%，819人）；并报告缺乏注册前培训（81%，743人）或持续专业发展（77%，708人）影响了他们满足患者需求的能力。
这项首次全国性的护理人员临终关怀实践和经验调查为护理人员面临的挑战以及这些挑战对其感知的能力和信心水平的潜在影响提供了新的证据和见解。受访者报告了多重挑战，这可能影响他们提供高质量临终关怀服务的能力，并增加住院转运的风险。必须通过改善获取以下方面的条件来支持护理人员的临终关怀实践：患者记录；预期用药和给药权限；全天候姑息治疗建议（用于共同决策）；以及护理人员特定的姑息和临终关怀培训与教育（包括通过姑息治疗和救护车服务之间的综合工作方式）。需要采取行动将护理医学纳入更广泛的医疗保健专业团队，并提供强有力的教育和培训以支持护理服务的提供。
