Just in Case' medicines use by ambulance paramedics Responding to End of Life Care In the Community: a mixed methods study of the Experiences of  Paramedics, Doctors, Family and Carers (RELIEF).

Introduction

This research aims to explore the views and experiences of paramedics and doctors involved in the care of patients in the community, that are experiencing distressing end-of-life symptoms, such as pain, breathlessness and agitation. We also propose to seek the views and experiences of informal carers (family or friend caregivers) and paid care workers , where paramedics have  administered 'Just In Case' (JIC) medicines to their loved ones or patients in their care.

Aim & Objectives

To explore the rationale, usage, costs and views of stakeholders of the Welsh Ambulance Service JIC medicines intervention.

Objectives

1.    To describe the ambulance JIC intervention and its rationale.
2.    To explore the experiences of a) paramedics and doctors, and b) informal carers (family/friend caregivers) and paid carers (care workers).
3.    To estimate the service delivery costs and outcomes in relation to hospital avoidance.

Background to the research

This study is linked to a recently introduced model of care, provided by Welsh Ambulance Service paramedics, in partnership with doctors, which involves the use of medicines to relieve distressing, end-of-life symptoms. 'Just In Case' or anticipatory medicines are commonly prescribed in end-of- life care and are routinely available for use at the patient's home. If available, they can be used by nurses, paramedics, doctors and trained family caregivers(3) . If Just In Case medicines are not available at the address, this can lead to delays in providing relief from distressing symptoms, may lead to avoidable hospital admissions, or delays in securing a prescription and the medicines . The use of Ambulance based 'Just In Case' medicines to manage end-of-life symptoms, when home- based medicines are not available, offers a patient-centred approach to alleviate symptoms and reduce avoidable hospital admissions, but the views and experiences of paramedics, doctors, informal carers and paid carers involved in providing this care has not been previously explored.

What we hope to discover

Some thirty months into the ambulance JIC intervention, there is an opportunity to gain an insight into the impact of the intervention on patient care; the workload and role of paramedics  in relation to the intervention; and perceived benefits, anxieties and risks from the point of view of clinical staff, informal carers and paid carers.

Public Involvement

We presented our initial research idea to a well attended meeting (19 members present) of the Service Users for Primary and Emergency care Research (SUPER) group and used their feedback to develop and improve our proposal, particularly in relation to seeking the views  and experiences of informal and paid carers. We have also recruited two Public contributors as co-applicants , through expressions of interest, facilitated through Health and Care Research Wales inclusion team. They will be invited to take part in all aspects of the research project.

Dissemination

We will seek opportunities to share our findings through published research articles, conference and seminar presentations, and relevant service user support groups such as Macmillan and Marie Curie. We will also prepare easy read materials such as infographics and information sheets, to support information sharing with our participants.