Paramedic utility in screening patients who present to Emergency Medical Services and who may benefit from an Advance Care Plan: A mixed methods study with explanatory sequential design

We used a two-phased mixed methods study with an explanatory sequential design to understand how frequently paramedics attend patients who, on paramedic assessment with the Gold Standards Framework Proactive Identification Guidance, are end-of-life and have advance care planning. We subsequently explored paramedic views on paramedic screening of patients to assess if they are end-of-life and onward referral to their General Practitioner for advance care planning. Paramedics screened and recorded 14.9% of patients as end-of-life and 44.3% of these patients were assessed to have no advance care plan in place. When paramedics screened patients and they did have an advance care plan in place, 36.8% had only a Do Not Attempt Cardiopulmonary Resuscitation. Paramedics found using the Gold Standards Framework Proactive Identification Guidance to screen patients for end-of-life status useful and straightforward and considered themselves well-placed to complete this task. Future research is required to address the practicalities of implementing a paramedic screening and referral tool for end-of-life care that results in the intended outcome of supporting effective advance care planning.