Is paramedic palliative care different in rural compared to urban settings: A mixed methods study

Nova Scotia (NS) Paramedics have been provided with palliative care training, allowing for care at home without the requirement of transport to the emergency department. It is largely unknown if rural populations have different experiences with paramedic palliative support services (transport vs no transport assessed/treated).

The aim of this research was to describe differences between Paramedics Providing Palliative Care in rural versus urban settings, specifically paramedic call characteristics (reason, level of responder) and outcome (transport, non-transport), challenges, and benefits.

A mixed methods study including triangulation of: (1) quantitative analysis of paramedic responses for patients of the palliative care program, (2) qualitative interviews with paramedics, and (3) mailed survey for patients/families. Quantitative data were analyzed descriptively and comparative thematic analyses for the qualitative data.

Participants were the providers and user of the Paramedics Providing Palliative Care at Home Program in Nova Scotia, Canada.

A total of 5697 calls for palliative care were received from 3008 individuals, 72% of rural calls resulted in hospital transport compared to 64% in urban communities (p = 0.024). Paramedics described challenges of older rural homes having less accessible layouts and trip hazards, and themselves as the connection point for the health system.

Rurality has an impact on the use and call outcomes for patients receiving paramedic palliative care. Rural areas have fewer resources to support remaining home, structural barriers, and strong connection to home and community. Paramedics play an important role in rural access to palliative care.