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Paramedics and serious illness: communication training
  1. Nikki Jane Pease1,
  2. Jenifer Jeba Sundararaj2,
  3. Edward O'Brian3,
  4. Joanne Hayes4,
  5. Edward Presswood5 and
  6. Samantha Buxton6
  1. 1Department of Palliative Medicine, Velindre Hospital, Cardiff, UK
  2. 2Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  3. 3Macmillan End of Life Care Lead, Welsh Ambulance Service Trust, Cwmbran, UK
  4. 4Marie Curie Hospice, Cardiff and the Vale, Penarth, UK
  5. 5Wales Deanery, Ty Dysgu, Cefn Coed, Nantgarw, UK
  6. 6School of Management, Swansea University, Swansea, UK
  1. Correspondence to Dr Nikki Jane Pease, Department of Palliative Medicine, Velindre Hospital, Whitchurch, Cardiff CF14 2TL, UK; Nikki.Pease{at}


Objectives The need to empower Ambulance Service staff at the point of delivery of end of life care (EoLC) is crucial. We describe the delivery, outcomes and potential impact of the Serious Illness Conversation project delivered to Welsh Ambulance Service Trust (WAST) staff. Over an 18-month period, 368 WAST staff attended face-to-face teaching, which included serious illness conversation communication skills, symptom control and ‘shared decision making’.

Method Data collected from WAST staff were used to gain insight on perception of their role and challenges within the context of EoLC, understand the impact of teaching on self-confidence and identify impact on the wider service. A mixed methods approach was used for data analysis.

Results WAST staff view themselves in several important roles, acting as ‘facilitators’ to patient-centred, seamless care, providing support, liaison between services and practical help in patient care at the end of life. The difficult questions and situations pertaining to EoLC were related to discussions on death and dying and managing expectation. The predominant barriers identified related to communication. Quantitative outcomes on the six communication domains indicate statistically significant improvement in self-assessed confidence. The overall impact to the wider ambulance service suggests a trend towards better use of resources.

Conclusion The perceived roles and challenges identified by paramedics can help in customising training objectives. The initial outcomes from the ongoing project with WAST demonstrate increased confidence in handling communication issues. Initial successive surveys suggest teaching is making a real life impact on patient care at end of life.

  • communication
  • end of life care
  • supportive care
  • symptoms and symptom management
  • paramedic
  • emergency

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  • Contributors NJP led the project design, delivery, data collection, analysis and review/revision of the manuscript in light of the reviewers’ comments. NJP, JH, EP and EO’B each contributed to the design of the project, delivery of the teaching, acquisition, analysis and interpretation of the data. JJS contributed significantly to the design of the work, analysis of the qualitative data, draft of the original manuscript and review and revision of the manuscript in light of the reviewers’ comments. SB contributed to the design of the project, drafting the work, quantitative data analysis and interpretation. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.