Thursday, February 13, 2025

Paramedics facing challenging end-of-life care demands

University of Southampton

Paramedics in England are experiencing wide-ranging challenges in responding to the increasing number of end-of-life care patients they are being called out to, according to a study from the University of Southampton.

The study published in BMC Palliative Care highlights the issues paramedics face when responding to patients at end-of-life, including a lack of patient information, barriers to administering medication, and insufficient training.

It was funded by Marie Curie and supported by National Institute for Health and Care Research (NIHR) Applied Research Collaboration Wessex.

An ageing population coupled with shortfalls in community healthcare services is placing an increasing reliance on paramedics to deliver care during a patient’s last year of life.

Dr Natasha Campling, Associate Professor at the University of Southampton and lead author of the paper says: “Often ambulance paramedics respond to acute conditions via 999 calls where their role is to preserve life, treating patients quickly on scene to stabilise them so they can then be transferred to hospital.

“For patients at end of life, when paramedics are called to scene they need to be able to, for example, distinguish between reversible causes that require hospital treatment and those associated with underlying condition(s) or the dying process that can be relieved through palliative care and appropriate symptom management.

“Our research shows that paramedics are being asked to make such complex decisions without all of the necessary information, support, resources and training to do so.”

Researchers at the University of Southampton conducted an online survey of over 900 paramedics across all 11 NHS trusts employing paramedics in England to understand their experience of delivering this kind of care.

Paramedics frequently attend patients in their last year of life, with 57 per cent estimating that they do so at least every seven shifts, and 89 per cent at least every 14 shifts.

But prior to arrival, 45 per cent of paramedics reported never or rarely knowing the patient’s end-of-life status – just 14 per cent said they often or always knew.

Paramedics regularly lacked access to crucial information, such as patient medical history and advance care planning documents, which state preferences and wishes for care. Frequently, prior discussions around advance care planning had not happened at all.

As such, over half of paramedics often or always encountered conflicting views on how best to care for the patient, for example between the crew, family members and the GP. Paramedics found it difficult to challenge another healthcare professional’s recommendation that the patient be taken to hospital if they didn’t think this was the right course of action.

Furthermore, advice from, and referral to other healthcare professionals or teams was problematic, particularly out-of-hours and to community nursing and specialist palliative care teams.

Dr Sarah Holmes, Chief Medical Officer at Marie Curie, said: “We know that pressures on ambulance services are significant, and this study highlights the importance of equipping paramedics with the right tools to do their work.

“Life preservation is their primary role, but this study shows they will also often be faced with palliative care scenarios, too. It is vital that we take the wishes of those at the end of life to heart where at all possible and put robust plans in place to help health care professionals do their jobs, at every step of the process.”

Nearly three-quarters of paramedics reported sometimes or often not having access to specific anticipatory medicines needed to relieve symptoms at end of life. Most ambulance crews don’t carry these so called ‘just in case’ drugs, so they more often come from a patient’s own supplies.

However, authorisation to administer the patient’s drugs is dependent on a Medicines Authorisation and Administration Record (MAAR), which paramedics frequently had problems accessing.

Paramedics also highlighted a lack of pre-registration training in end-of-life care and insufficient continuing professional development in this area.

“Taken together, these challenges have left many paramedics fearful of making the wrong decisions and lacking full confidence in their ability to care for and meet the needs of patients at end of life,” says Professor Sue Latter from the University of Southampton, a co-author on the paper.

The researchers make several recommendations for service improvement, focusing on end-of-life training and education; access to records and documentation; access to referral pathways including 24/7 palliative care advice; and anticipatory medications carried by crews with the authority to administer them.

On improving access to medications, Professor Latter added: “Realistically, it’s likely that paramedics will continue to play an important role in end-of-life care provision and therefore finding effective ways for them to access, supply and administer crucial medicines to end-of-life patients in order to avoid unnecessary conveyance to hospital needs full consideration and evaluation.”

Paramedics providing end-of-life care: an online survey of practice and experiences is published in BMC Palliative Care and is available online.

Ends

Contact

Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

Notes for editors

Paramedics providing end-of-life care: an online survey of practice and experiences is published in BMC Palliative Care and is available: https://link.springer.com/article/10.1186/s12904-024-01629-7
For Interviews, please contact Steve Williams, Media Manager, University of Southampton press@soton.ac.uk or 023 8059 3212.

Additional information

About the University of Southampton

The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2025). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk

www.southampton.ac.uk/news/contact-press-team.page

About Marie Curie

Marie Curie is the UK’s leading end of life charity.
The charity provides expert end of life care for people with any illness they are likely to die from, and support for their family and friends, in our hospices and where they live. It is the largest charity funder of palliative and end of life care research in the UK, and campaigns to ensure everyone has a good end of life experience. Whatever the illness, we’re with you to the end.
If you’re living with a terminal illness or have been affected by dying, death and bereavement, Marie Curie can help. Visit mariecurie.org.uk or call the free Marie Curie
Support Line on 0800 090 2309 or email support@mariecurie.org.uk
Marie Curie have partnered with the UK Gas Distribution Networks to help give people with a terminal illness the support they need to cope with energy costs. Dedicated Energy Support Officers can provide information on support available from energy suppliers, grants and energy efficient updates. Visit www.mariecurie.org.uk/energy for more information.

Whatever the illness, wherever you are, Marie Curie is with you to the end.

Journal

BMC Palliative Care

DOI

10.1186/s12904-024-01629-7

Article Title

Paramedics providing end-of-life care: an online survey of practice and experiences

US Consumer stress over grocery prices stands at midpoint

Survey recipients also say they have some understanding of tariffs concept

Purdue University

How much influence do consumers think the government has on food prices? — image:
On a scale from 0 (no influence at all) to 10 (very strong influence), how much influence do you feel the government has over food price inflation in the U.S.? January 2025.
view more
Credit: Purdue University Center for Food Demand Analysis and Sustainability

WEST LAFAYETTE, Ind. — Stress levels due to grocery prices are mixed, and most consumers are at least somewhat familiar with the concept of tariffs, according to the January issue of the Consumer Food Insights Report (CFI).

The survey-based report out of Purdue University’s Center for Food Demand Analysis and Sustainability(CFDAS) assesses food spending, consumer satisfaction and values, support of agricultural and food policies, and trust in information sources. Purdue experts conducted and evaluated the survey, which included 1,200 consumers across the U.S.

The average grocery price stress level rating came in at 5.1 on a scale ranging from no stress at all (0) to extreme stress (10).

“Low- and middle-income households are more likely to report higher stress levels on this scale, with those earning less than $75,000 annually reporting an average rating of close to 6, whereas high-income earners reported an average rating around 4,” said the report’s lead author, Joseph Balagtas, professor of agricultural economics at Purdue and director of CFDAS.

New questions in the latest survey included a section that gauged consumer understanding of tariff policy. This included what they see as the costs and benefits of such policy and how they think tariffs affect food prices.

“The average rating among all consumers is 6.9 on a 0-10 scale, meaning consumers believe the government has moderate influence over the price of food,” Balagtas said. Further exploration of partisan differences in responses to this scale found that this belief is largely bipartisan.

CFDAS researchers gauged consumer understanding of the proposed tariffs as a policy tool and allowed them to express their opinion on the benefits and costs of such a policy. Most consumers — 80% — are at least somewhat familiar with the tariffs concept.

The survey presented consumers with an open response format rather than a list of potential benefits and costs of tariffs. “Around one-third of respondents say there are no benefits to tariffs while 20% are unsure,” Balagtas said. “Helping or protecting domestic industries was the most commonly cited benefit, followed by government revenue and trade fairness, leverage and regulation.”

A greater share of self-identified Democrats say there is no benefit to tariffs (42%) relative to independent (31%) and Republican consumers (21%). Many of the open responses mentioned cost of living and price increases. This was by far the most common theme, particularly in responses from Democratic consumers (63%). Fewer consumers believe there are no costs to tariffs (14%) and around 21% are unsure.

Most consumers (72%) think that tariffs raise prices to some degree. “How severe the increase also varies by political affiliation,” Balagtas said. “More than half of Democrats say they increase prices a lot relative to 35% of independents and 22% of Republicans.”

This month’s CFI Report includes a new section reporting on monthly consumer diet quality based on a nine-question diet assessment known as the Mini-EAT Tool. The questions asked consumers to report on consumption frequency of a variety of food groups such as fruits, vegetables, whole grains and sweets. Using these responses, CDFAS economists estimated diet quality.

“We estimate an average Mini-EAT score of 61.9 in January,” said Elijah Bryant, a survey research analyst at CFDAS and a co-author of the report. “This has remained relatively stable over time and translates to a diet quality classification of ‘intermediate.’ The threshold for an ‘unhealthy’ diet is scores less than 61, showing there’s plenty of room for improvement in terms of what we eat.”

Overall diet well-being remains stable, with two-thirds of American adults rating their diet as 7-10 (thriving) when asked where their diet fits on a scale from 0 (worst possible diet) to 10 (best possible diet).

Consumers in households on the Supplemental Nutrition Assistance Program (SNAP) rate their diet well-being comparably to those in non-SNAP households, Bryant said. However, a larger share of SNAP consumers put themselves in the “suffering” category (0-4 out of 10) on the diet well-being index.

“Food insecurity is higher among SNAP households compared to non-SNAP households. The gap is striking since SNAP benefits help alleviate food insecurity for low-income households,” Bryant said.

He points out, however, that previous research from the U.S. Department of Agriculture Economic Research Service found that many of those receiving SNAP benefits self-select into the program once they reach severe levels of food insecurity.

“So, while SNAP benefits are crucial for households in need, the positive effect on the food insecurity rate is likely not able to fully overcome the gap between SNAP and non-SNAP households,” Bryant said.

On a scale from never (1) to always (5), consumers in SNAP households choose generic over name-brand food items more often (3.6) than non-SNAP consumers (3.2) when shopping for food. They also report checking labels more often.

“Since most of those receiving SNAP benefits are in low-income households, finding affordable food options such as generic and store brands can be crucial in ensuring that they get the proper amount of foods they need,” Bryant said.

Consumer estimates of food inflation over the past 12 months dropped to 5.2%, following a downward trend since late 2022. Expectations about future food inflation also dropped to 2.6%, just above the consumer price index food inflation rate of 2.5%. The USDA Economic Research Service recently updated its forecast for 2025 food inflation from the original 2.5% to 2.2%.

The Center for Food Demand Analysis and Sustainability is part of Purdue’s Next Moves in agriculture and food systems and uses innovative data analysis shared through user-friendly platforms to improve the food system. In addition to the Consumer Food Insights Report, the center offers a portfolio of online dashboards.

About Purdue Agriculture

Purdue University’s College of Agriculture is one of the world’s leading colleges of agricultural, food, life and natural resource sciences. The college is committed to preparing students to make a difference in whatever careers they pursue; stretching the frontiers of science to discover solutions to some of our most pressing global, regional and local challenges; and, through Purdue Extension and other engagement programs, educating the people of Indiana, the nation and the world to improve their lives and livelihoods. To learn more about Purdue Agriculture, visit this site.

About Purdue University

Purdue University is a public research university leading with excellence at scale. Ranked among top 10 public universities in the United States, Purdue discovers, disseminates and deploys knowledge with a quality and at a scale second to none. More than 107,000 students study at Purdue across multiple campuses, locations and modalities, including more than 58,000 at our main campus in West Lafayette and Indianapolis. Committed to affordability and accessibility, Purdue’s main campus has frozen tuition 13 years in a row. See how Purdue never stops in the persistent pursuit of the next giant leap — including its comprehensive urban expansion, the Mitch Daniels School of Business, Purdue Computes and the One Health initiative — at https://www.purdue.edu/president/strategic-initiatives.

Writer: Steve Koppes

Perceived effect of tariffs on food prices by self-identified political ideology, January 2025.

Credit

Purdue University Center for Food Demand Analysis and Sustainability

Method of Research

Survey

Subject of Research

People

Article Title

Consumer Food Insights January 2025

Article Publication Date

12-Feb-2025

Pennington Biomedical researchers assemble comprehensive history of electronic health records and their role in medical research

Published in the Journal of Medical Internet Research, Dr. Yun Shen and Dr. Gang Hu explore 25 years of electronic health records’ secondary purpose - the interoperability with research

Pennington Biomedical Research Center

BATON ROUGE – Dr. Yun Shen and Dr. Gang Hu of Pennington Biomedical Research Center have recently published a piece in the Journal of Medical Internet Research, or JMIR. The study titled “Twenty-Five Years of Evolution and Hurdles in Electronic Health Records and Interoperability in Medical Research: Comprehensive Review,” explores how electronic health records’ use in medical research has evolved over the past 25 years. Dr. Shen and Dr. Hu have extensive experience in working with electronic health records to study chronic diseases, population health trends, and predictive analytics.

Primarily used for sharing patient data among healthcare providers, the two and a half decades of records have been funneled through big data analytics and the sophisticated applications of artificial intelligence, generating previously unseen patterns and driving medical innovations and insights.

“Medical record keeping technically thousands of years ago as simple record keeping of treatments and symptoms, but modern medical record keeping first incorporated digitization as early as the 1960s,” said Dr. Shen, Assistant Professor of Chronic Disease Epidemiology Research at Pennington Biomedical. “Since that time, this method evolved from an effort to reduce physical storage to contributing to rich troves of data, which have informed and improved healthcare quality, safety and efficiency. Today, the big data generated from electronic medical records is supporting interoperability, seamless health information gathering and scanning of public health trends, even on a global scale.”

A key aspect of electronic health record keeping is the separation of using the records for patient care and using them for research. Healthcare professions are instrumental in accurately documenting and gathering the data on the records, and may also input data related identifying information, patient demographics and billing information. A crucial step before such data is used for secondary research is deidentification, which involves removing or masking identifiable patient information to protect privacy. Data security and privacy concerns often influence how the collected information is used for research, and institutions have governing committees or boards to review research proposals for compliance.

“Electronic Health Records have become a staple of the healthcare industry, and to explore the history of medical records and the growth of their application is crucial to understand how they can be used to advance medicine and improve outcomes,” said Dr. John Kirwan, Executive Director of Pennington Biomedical. “I congratulate Dr. Shen and Dr. Hu on the publication of this retrospective, and I look forward to what may result from it. We have teams of researchers here at Pennington Biomedical that pride themselves on pursuing new knowledge, including an exploration of new innovative AI tools that advance medical research."

The study also includes a glimpse into the upcoming applications for electronic health records given its current trajectory, including precision medicine, social determinants of health, public health data, epidemiology data, data analytics, digital therapeutics, and further applications of artificial intelligence and wearable devices. Meanwhile, by engaging with healthcare institutions, policymakers, and technology developers, they also advocate for interdisciplinary partnerships that maximize the potential of EHRs in advancing precision medicine, epidemiology, and digital health solutions.

Dr. Shen and Dr. Hu of Pennington Biomedical collaborated with Dr. Jiamin Yu and Dr. Jian Zhou of the Department of Endocrinology and Metabolism at the Shanghai Sixth People’s Hospital, which is an affiliate of the Shanghai Jiao Tong University School of Medicine in Shanghai, China.

About the Pennington Biomedical Research Center

The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the triggers of obesity, diabetes, cardiovascular disease, cancer and dementia. Pennington Biomedical has the vision to lead the world in promoting metabolic health and eliminating metabolic disease through scientific discoveries that create solutions from cells to society. The center conducts basic, clinical, and population research, and is a campus in the LSU System.

The research enterprise at Pennington Biomedical includes over 530 employees within a network of 44 clinics and research laboratories, and 13 highly specialized core service facilities. Its scientists and physician/scientists are supported by research trainees, lab technicians, nurses, dietitians, and other support personnel. Pennington Biomedical is a globally recognized state-of-the-art research institution in Baton Rouge, Louisiana.

For more information, see www.pbrc.edu.