Table 2 Outline of discussions in each Theory of Change workshop
From: Improving paramedic responses for patients dying at home: a theory of change-based approach
Workshop | Central theme(s) | Structure | Outputs |
|---|---|---|---|
1 | Deliberated desired impact of intervention. Stakeholders were asked: “What impact are you looking for in relation to responding to calls where the person is at the end of life?” | Rapport building Presentations Discussion of paramedic responses to end-of-life calls | Four end-of-life impacts proposed: Holistic, patient-centred, end-of-life care delivered in a timely manner; continuity and consistency of response; unnecessary hospitalisations avoided; improved process of responding to calls |
2 | Final decision on intervention impact. Stakeholders started identifying long-term outcomes and preconditions. | Discussion and deliberation | Impacts were discussed, reworded, and reduced to two: holistic, patient-centred, and effective end-of-life care; and continuous end-of-life care and consistent response to emergency calls across professions. Initial discussions had on measurable short term outcomes (preconditions) for an intervention. |
3 | Further discussion to decide appropriate impacts and outcomes. Group began exploring intervention designs. | Discussion and deliberation | Workshop attendees agreed to merge impacts into one: Consistent, holistic, patient-centred, and effective end-of-life care. Discussion produced list of long-term outcomes, such as increase use of medication and reduction in errors, and short term outcomes (preconditions), such as knowledge, identification of end-of-life care patients, and recognising dying. Possible education, communication, and referral based interventions discussed. |
4 | Intervention development. | Discussions on signs/symptoms of dying and key elements for care of the patient in paramedic practice Presentation and demonstration of existing tools for assessing need. | Limitations and strengths of existing tools and resources identified. Identified need to develop an online training and/or a prompt card with QR codes to signpost to relevant material. Identified need for public facing information resource. |
5 | Finalising intervention | Presentation of evidence from literature Discussion of intervention components. | Developed ideas for decision-making algorithm. Agreed that: intervention should be incorporated into information sources used by paramedics; identifying a patient as being at the end of life is key and should be the focus, followed up with further guidance; foundational knowledge is important; prompt card is good idea; public information leaflet not suitable for this project given time, resource, and focus. |