Paramedics experiences and expectations concerning advance directives: A prospective, questionnaire-based, bi-centre study

Palliative Medicine, 08/31/2011

Taghavi M et al. – Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.

Methods

  • Questionnaire-based investigation using self-administered survey instrument
  • Paramedics of two cities (Hamburg and Goettingen, Germany) were included
  • Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, ‘Do not attempt resuscitation’ orders and palliative crisis cards

Results

  • Questionnaires were returned by 728 paramedics (response rate: 81%)
  • Majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations
  • Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility
  • More extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula
  • Palliative crisis cards should be integrated into end-of-life care

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