Document resource
Background End of Life Care (EoLC) in the community is a complex, multi-disciplinary area of healthcare, predominantly provided by primary care and palliative care teams. Anticipatory or ‘Just In Case’ (JIC) medicines are often prescribed, to ease symptoms such as breathlessness, anxiety or pain and to enable people to remain and die in their place of choice. For paramedics, JIC medications are typically only available if previously prescribed, but in response to Covid, one UK ambulance service began providing JIC medications for administration by paramedics following telephone consultation with prescribing doctors. The RELIEF study evaluated this initiative and included a qualitative component aiming to understand paramedic perspectives and experiences.Methods We interviewed 19 paramedics who had experience of administering JIC medications through the initiative. We also conducted one focus group and one interview with 5 paramedics who had not experienced administering JIC medications through the initiative. All fieldwork was conducted remotely via MS Teams, with transcripts summarising recordings. Analysis was undertaken using a Framework approach.Findings Paramedics were generally positive about the initiative, as they were keen to optimise the care they were able to provideAttending patients at the end of life is not a common part of the role, and many lacked confidenceIt was hard to disentangle decision-making about JIC medications from the decision not to convey the patient to hospitalSome paramedics who had not administered JIC medications expressed anxiety about the need to negotiate with prescribers, and about being seen by family members to be hastening the patient’s deathConclusions The ambulance JIC medications initiative seems to be acceptable to paramedics and supported by them, though further training and reassurance may be required.