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Is paramedic palliative care different in rural compared to urban settings: A mixed methods study
Alix J E Carter1,2,3, Judah Goldstein1,2, Michelle Harrison2,4
1Emergency Health Services Nova Scotia, Halifax, NS, Canada.
Palliative Medicine
|December 2, 2025
Summary
Rural paramedics provide essential palliative care, but rural patients are more likely to be transported to hospitals. Challenges include home accessibility and fewer resources, highlighting paramedics' vital role in rural palliative access.
Area of Science:
- Paramedic Services
- Palliative Care
- Rural Health
Background:
- Nova Scotia paramedics received palliative care training to enable home-based care, reducing emergency department transports.
- The experiences of rural populations with paramedic palliative support services remain largely unexamined.
Purpose of the Study:
- To compare paramedic palliative care in rural versus urban settings.
- To analyze differences in call characteristics, outcomes (transport vs. non-transport), challenges, and benefits.
Main Methods:
- A mixed-methods study triangulating quantitative analysis of paramedic responses, qualitative interviews with paramedics, and patient/family surveys.
- Quantitative data were analyzed descriptively; qualitative data underwent comparative thematic analysis.
Main Results:
- 72% of rural palliative care calls resulted in hospital transport versus 64% in urban settings (p=0.024).
- Paramedics cited challenges in rural areas, including inaccessible home layouts and trip hazards.
- Paramedics identified themselves as crucial connection points within the rural health system.
Conclusions:
- Rurality significantly impacts the utilization and outcomes of paramedic palliative care.
- Rural areas face resource limitations and structural barriers affecting home-based palliative care.
- Paramedics are instrumental in ensuring rural access to palliative care services.
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