What factors influence and promote effective management by paramedics when caring for patients requiring end of life decision-making? A literature review
Posted on 12th June 2020 by William Barber
During the final year of their Paramedic Science (BSc Hons) course at Oxford Brookes University, students carry out a literature review and critical appraisal of a topic relevant to their future practice. This blog presents the abstract of a literature review on ‘factors which influence and promote effective management by paramedics when caring for patients requiring end of life decision-making’. Other Paramedic topic blogs can be found here.
End of life care is increasingly being presented and required in significance to paramedics within the pre-hospital environment. Modern pre-hospital paramedic practice is consistently evolving, however, paramedics still lack the necessary education and preparation around end of life care. In this regard, paramedics’ decisions repeatedly manipulate the location and experience of how a patient dies and if their wishes are expressed.
The intention of this literature review is to explore modern research, articles and conceptions relevant to paramedic practice, regarding what factors influence paramedics’ abilities to generate knowledge-based decisions that benefit the dying patient in the community.
Investigation of the literature was undertaken (using similar formulations acquired in systematic reviews) using the following databases: CINAHL, PubMed, Cochrane and MEDLINE. Relevant studies and literature were then chosen with the application of inclusion and exclusion criteria. Subsequently, the final relevant studies remaining were critically appraised in order to assess their quality and significance.
When reviewing the chosen studies and literature, an independent student paramedic dissected the methods and results of each paper against a modified CASP tool in order to minimise researcher bias. The author acknowledges the limitations of a singular researcher regarding the reliability of the results.
When discussing the results, the author decided to apply a thematic approach to increase significance with results, in addition to relevance to paramedic practice. Four key themes were identified:
- Education and training specific to end of life care decision-making
- Documentation and directives
- Paramedic personal beliefs, views and values around end of life care
- Family dynamics and conflicts
These themes were then analysed for similarity and correlation between them, which was then explored in comparison to paramedic practice.
Conclusion and recommendations
This literature review highlighted significant thematic factors that influence the decision-making skills formulated by paramedics regarding end of life care within the pre-hospital environment. Decision making is complex, thus, paramedics require extensive education and training to produce competent practitioners within every unique situation.
Complementary to this, this literature review correlated the importance of education within the application and comprehension of documentation and directives, family dynamics and conflicts, and paramedics’ own personal views/beliefs around end of life care. Developing an understanding around these thematic factors will enable the author, and hopefully the paramedic profession as a whole, to provide a holistic, patient-centred approach to the management of end of life patients, ensuring decisions are confidently expressed throughout.