The dynamic of control: A qualitative analysis of the perspectives of patients and family members with palliative care needs on Emergency Medical Services

Background: Person-centred care requires interdisciplinary collaboration. Within palliative medicine, collaboration is further necessary to meet the increasing global demand for palliative care. One area of developing collaboration involves Emergency Medical Services. However, there remains a dearth of research exploring patient and family member perspectives on Emergency Medical Services in palliative situations. Objectives: To explore perspectives of South African patients and family members with palliative needs concerning Emergency Medical Services use in their care. Design: A qualitative design using individual semi-structured interviews was employed. Methods: Patients and family members with palliative care needs who had previously experienced Emergency Medical Services care for these needs were included. Verbatim transcriptions of interviews were subjected to thematic analysis with an inductive-dominant approach. Results: Ten interviews were conducted. One overarching theme, The Dynamic of Control, and three categories were developed: (1) Loss of control: Heavy burdens of living with chronic and end-of-life illness, (2) Maintaining control: Longings and exigencies in times of suffering, (3) Transferring control: Consequential emergency medical services influence on palliative situations. Conclusion: Understanding the Dynamics of Control in palliative situations is fundamental to the Emergency Medical Services' establishment of a person-centred approach in palliative situations. Practical developments that would allow this approach include alternative care pathways, on-scene information availability, and palliative care education. Including palliative care in Emergency Medical Services education may have benefits beyond improved palliative situation management, as it encourages a cultural shift towards person-centred care.