Exploring preferences around paramedic decision-making during adult out of hospital cardiac arrest: a mixed methods phenomenological study and discrete choice experiment

Abstract

Background
During adult out of hospital cardiac arrest (OHCA) paramedics make decisions to commence, continue or terminate resuscitation. There is variability in when resuscitation is provided, and evidence suggests these decisions are influenced by factors other than patient clinical characteristics, such as provider preference.
Methods
A descriptive phenomenological study was undertaken to understand paramedic experiences, perspectives and preferences around OCHA. This was followed by a discrete choice experiment (DCE), undertaken to measure how paramedic preferences around resuscitation vary within the context of the unique characteristics that comprise OHCA events.
Findings
Paramedic stories about OHCA speak of how the role of paramedic is bound to Selfhood and identity, uncertainty regarding when death has occurred versus a sudden reversible event and an ethical obligation to Others. Participants indicated patient age and condition were important factors in an offer of resuscitation and that current resuscitation guidelines could not always aid decision-making. Respondents in the DCE expressed a general preference to offer resuscitation (p=<0.01). All attributes except patient sex were statistically significant and important regarding an offer of resuscitation. Cut-offs where an offer of resuscitation was less likely were patient age of 73 years (p=>0.05), mild dementia (p=>0.05) and moderate frailty (p=<0.01). Paramedic characteristics of female sex, longest (>10 years) and shortest (<5 years) period qualified, lower academic qualification, lower skill level and attending fewer OHCA’s were more likely to result in an offer of resuscitation.
Conclusions
Resuscitation has significant ritualistic value and serves important social functions in death recognition. Paramedics use objective and non-objective factors to make pragmatic decisions regarding an offer of resuscitation. Future research should focus on how variability in decision-making impacts patient outcomes and how to support

Date of Award	24 Jul 2025
Original language	English
Awarding Institution	Northumbria University
Supervisor	Angela Bate (Supervisor), Mark Bevan (Supervisor) & Claire Dosdale (Supervisor)