• Madeleine L Juhrmann, Phyllis N Butow, Cara M Platts, Paul Simpson, Mark Boughey, and Josephine M Clayton.
• Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
• Palliat Med. 2023 Sep 1; 37 (8): 126612791266-1279.

BackgroundParamedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care.AimTo elicit paramedics', palliative care doctors and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings.DesignA qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised.Setting/ParticipantsA purposive sample of 50 stakeholders from all Australian jurisdictions participated.ResultsFive themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment).ConclusionParamedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.

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