Just-in-case medication use by ambulance paramedics responding to end-of-life care in the community: protocol for a multi-method study (RELIEF).

Introduction: At the end of life, anticipatory or just-in-case (JIC) medications may help manage patients' symptoms. Sometimes, emergency ambulances attend patients for whom JIC medications have not been prescribed. In Wales, UK, a Welsh Ambulance Services University NHS Trust (WAST) JIC intervention was launched in May 2020 in response to COVID-19, to enable ambulance paramedics to administer JIC medications to patients for whom they had not previously been prescribed. The ambulance JIC intervention is an ongoing feature of WAST pre-hospital care but has received limited evaluation. This study will explore the rationale, usage, costs and views of stakeholders of the WAST JIC medications intervention.

Methods: We will employ a multi-method observational study design that incorporates both quantitative and qualitative aspects, informed by implementation science. We will prepare a detailed description of the WAST JIC medications intervention, its rationale and its use. We will interview paramedics and doctors who have provided the intervention, as well as paid and informal carers who were present during the care episode. We will also hold a focus group with paramedics who have not administered the intervention and undertake a cost analysis to estimate costs and savings associated with the intervention. We will use descriptive statistics to analyse quantitative data and a framework approach for qualitative data.

Conclusion: This study, which focuses on the voices of patient advocates and practitioners, has the potential to shape future provision of this and similar services in WAST and other care providers.