Background Paramedics are frequently called to people with dementia due to high rates of co-morbidities and complex needs, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. A small number of qualitative studies have looked at paramedics’ decision-making in relation to dementia, but these studies have not specifically investigated the involvement of people with dementia in decisions. This study aimed to explore how paramedics make decisions when attending people with dementia, with a particular focus on understanding the factors that impact on whether, how, and to what degree paramedics involve people with dementia in decisions about their care.

Methods A generic qualitative research approach was used, informed by social constructivism and by the researcher’s commitment to the concept of ‘personhood’ in dementia care. Data were collected through semi-structured individual interviews with seven paramedics, each lasting between 40 and 80 minutes. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis.

Results Four themes were identified that all touched on challenges to delivering person-centred care for people with dementia. Themes identified were: 1. Paramedics’ differing approaches to assessing capacity and making best interest decisions. 2. Communication and developing a rapport. 3. Interconnections with others important to the person with dementia. 4. The impact of paramedics’ values and attitudes.

Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care.