The role of paramedics in End of Life planning

 

Funding

Bristol, North Somerset and South Gloucestershire CCG Research Capability Funding (Local development)

What is the research question?

Does the introduction of a paramedic screening and referral pathway increase early advanced care planning and improve outcomes for patients in the last year of life?

What is the problem?

Identifying patients in the End of Life (EoL) phase is poorly done, particularly in those people with diagnoses other than cancer, such as frailty and dementia.

It is important that patients approaching EoL are identified early as this allows comprehensive community support to be organised, to identify and tailor needs, and to honour their wishes, such as enabling people to die in their place of choice. The worst-case scenario is when a patient is conveyed to a busy hospital Emergency Department and dies in hospital when they would have preferred to die peacefully at home.

Advance Care Planning (ACP) is defined as ‘a process of formal decision making that aims to help patients establish decisions about their future care that take effect when they lose capacity’. The current use of ACP within the NHS is variable many patients presenting to the ambulance service do not appear to have care planning in place, even when they were at the very end of life. With in-hospital costs for EoL patients estimated at £180 million per year, reducing these costs whilst improving ACP for patients is necessary.

What is the aim of the research?

Ambulance services are in a position to instigate personalised care and the provision of care closer to home in those patients who have not been identified at EoL previously and access the ambulance service through a 999 call. This study aims to understand if the identification of EoL patients by paramedics can increase ACP and improve outcomes for these patients.

How will this be achieved?

Paramedics will be asked to use an established screening tool, the Gold Standards Framework Proactive Identification Guidance (PIG) and a corresponding referral to the patient’s GP surgery, to notify the GP that the patient is approaching EoL and requires ACP review.

Realist evaluation methodology will allow an in-depth understanding of how this intervention can be used to identify and refer patients in the last year of their lives, and how this might influence patient outcomes and experience, carer’s experiences, resource use, and the effect on the primary care and paramedic workforce.

Who is leading the research?

Kim Kirby, Senior Research Fellow (Paramedic Science), Centre for Health and Clinical Research, University of the West of England.

Further information

For more information or to get involved in this project, please contact bnssg.research@nhs.net.