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J Appl Res Intellect Disabil. 2017 Nov;30(6):1057-1064. doi: 10.1111/jar.12363. Epub 2017 May 24.

Emergency medical services providers' perspective of end-of-life decision making for people with intellectual disabilities.

Author information

1
School of Social Work, University at Buffalo, Buffalo, NY, USA.
2
Department of Emergency Medicine, University at Buffalo, Buffalo, NY, USA.

Abstract

BACKGROUND:

Emergency medical services (EMS) providers are often called to rapidly determine and act upon patients' wishes for end-of-life care. People with intellectual disabilities are living increasingly longer with complex conditions leading to international calls for person-centred advance care planning. Yet, best estimates suggest that very few people with intellectual disabilities document their wishes.

METHODS:

This exploratory-descriptive study incorporated mixed methods to analyse data collected consecutively (surveys, n = 239; interviews, n = 48) with EMS providers from five agencies. Data were subjected to a sequential quantitative-qualitative analysis applying a critical discourse analysis framework.

RESULTS:

Findings indicate that 62.7% had treated a person with intellectual disability who had medical orders directing end-of-life care. Three themes (provider familiarity, organizational processes, sociocultural context) offer insights about how medical orders inform EMS providers during calls involving people with intellectual disabilities.

CONCLUSION:

Multiple contexts influence how wishes are documented and care provided to people with intellectual disabilities near life's end.

KEYWORDS:

advance directives; critical discourse analysis; emergency medical services; end-of-life; intellectual disabilities; medical orders

PMID:
28544078
DOI:
10.1111/jar.12363
[Indexed for MEDLINE]

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