Is paramedic palliative care different in rural compared to urban settings: A mixed methods study

Abstract

Background:

Nova Scotia (NS) Paramedics have been provided with palliative care training, allowing for care at home without the requirement of transport to the emergency department. It is largely unknown if rural populations have different experiences with paramedic palliative support services (transport vs no transport assessed/treated).

Aim:

The aim of this research was to describe differences between Paramedics Providing Palliative Care in rural versus urban settings, specifically paramedic call characteristics (reason, level of responder) and outcome (transport, non-transport), challenges, and benefits.

Design:

A mixed methods study including triangulation of: (1) quantitative analysis of paramedic responses for patients of the palliative care program, (2) qualitative interviews with paramedics, and (3) mailed survey for patients/families. Quantitative data were analyzed descriptively and comparative thematic analyses for the qualitative data.

Setting/participants:

Participants were the providers and user of the Paramedics Providing Palliative Care at Home Program in Nova Scotia, Canada.

Results:

A total of 5697 calls for palliative care were received from 3008 individuals, 72% of rural calls resulted in hospital transport compared to 64% in urban communities (p = 0.024). Paramedics described challenges of older rural homes having less accessible layouts and trip hazards, and themselves as the connection point for the health system.

Conclusion:

Rurality has an impact on the use and call outcomes for patients receiving paramedic palliative care. Rural areas have fewer resources to support remaining home, structural barriers, and strong connection to home and community. Paramedics play an important role in rural access to palliative care.

Keywords

Paramedicine emergency medical services palliative care rural health services qualitative research surveys and questionnaires health administrative data

Get full access to this article

View all access options for this article.

References

Hill

Stukel

, et al. Trends in site of death and health care utilization at the end of life: a population-based cohort study. CMAJ Open 2019; 7(2): E306–E315.

Lord

Andrew

Henderson

, et al. Palliative care in paramedic practice: a retrospective cohort study. Palliat Med 2019; 33(4): 445–451.

Bakitas

Allen Watts

Malone

, et al. Forging a new frontier: providing palliative care to people with cancer in rural and remote areas. J Clin Oncol 2020; 38(9): 963–973.

Lavergne

Lethbridge

Johnston

, et al. Examining palliative care program use and place of death in rural and urban contexts: a Canadian population-based study using linked data. Rural Remote Health 2015; 15: 3134.

Carter

AJE

Arab

Harrison

, et al. Paramedics providing palliative care at home: a mixed-methods exploration of patient and family satisfaction and paramedic comfort and confidence. CJEM 2019; 21(4): 513–522.

Sullivan-Bolyai

Bova

Harper

. Developing and refining interventions in persons with health disparities: the use of qualitative description. Nurs Outlook 2005; 53(3): 127–133.

Sandelowski

. Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-methods studies. Res Nurs Health 2000; 23: 246–255.

von Elm

Altman

Egger

, et al. The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4): 344–349.

Tong

Sainsbury

Craig

. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349–357.

10.

Creswell

Plano Clark

. Designing and conducting mixed methods research. 2nd ed. Los Angeles, CA: Sage Publications, 2011.

11.

Dumont

Jacobs

Turcotte

, et al. Palliative care costs in Canada: a descriptive comparison of studies of urban and rural patients near end of life. Palliat Med 2015; 29(10): 908–917.

12.

Mullholland

Stirling

Walker

. Roles of the rural paramedic much more thank clinical expertise. In: 10th national rural health conference proceedings (ed G

Gregory

), Canberra, Australia, 17–20 May 2009, pp.1–13.

13.

Agarwal

Lee

McLeod

, et al. Social factors in frequent callers: a description of isolation, poverty and quality of life in those calling emergency medical services frequently. BMC Public Health 2019; 19(1): 684.