title: Paramedics experiences and expectations concerning advance directives: a prospective, questionnaire-based, bi-centre study.
abstract: BACKGROUND
  Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions.
  
  
  OBJECTIVE
  To examine paramedics' attitudes towards advance directives and end-of-life care.
  
  
  METHODS
  Questionnaire-based investigation using a self-administered survey instrument.
  
  
  METHODS
  Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards.
  
  
  RESULTS
  Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care.
  
  
  CONCLUSIONS
  Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.
authors.affiliation: University Medical Center Goettingen, Germany.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Taghavi
authors.forename: Alfred
authors.initials: A
authors.lastname: Simon
authors.forename: Stefan
authors.initials: S
authors.lastname: Kappus
authors.forename: Nicole
authors.initials: N
authors.lastname: Meyer
authors.forename: Christoph L
authors.initials: CL
authors.lastname: Lassen
authors.forename: Tobias
authors.initials: T
authors.lastname: Klier
authors.forename: David B
authors.initials: DB
authors.lastname: Ruppert
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Graf
authors.forename: Gerd G
authors.initials: GG
authors.lastname: Hanekop
authors.forename: Christoph H R
authors.initials: CH
authors.lastname: Wiese
mesh_terms: D000328:Adult; D016223:Advance Directives; D000488:Allied Health Personnel; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care; D055815:Young Adult