Experiences, challenges and perspectives for ensuring end-of-life patient care: A national online survey with general practitioners in Germany

Jannik M. Tielker,Jan P. Weber,Nils Schneider,Stephanie Stiel,Claudia Bausewein,Steffen T. Simon,David M. Ojcius

doi:10.1371/journal.pone.0254056

Abstract

BackgroundThe SARS-CoV-2 (COVID-19) pandemic is posing major challenges for health care systems. In Germany, one such challenge has been that adequate palliative care for the severely ill and dying (with and without COVID-19), as well as their loved ones, has not been available at all times and in all settings., the pandemic has underlined the significance of the contribution of general practitioners (GPs) to the care of severely ill and dying patients.ObjectivesTo describe GPs’ experiences, challenges and perspectives with respect to end-of-life care during the first peak of the pandemic (spring 2020) in Germany.Materials and methodsIn November and December 2020, a link to an Unipark online survey was sent to GPs registered on nationwide distribution lists.ResultsIn total, 410 GPs responded; 61.5% indicated that the quality of their patients’ end-of-life care was maintained throughout the pandemic, 36.8% reported a decrease in quality compared to pre-pandemic times. Of the GPs who made home visits to severely ill and dying patients, 61.4% reported a stable number of visits, 28.5% reported fewer visits. 62.7% of the GPs reported increased telephone contact and reduced personal contact with patients; 36.1% offered video consultations in lieu of face-to-face contact. The GPs reported that relatives were restricted (48.5%) or prohibited from visiting (33.4%) patients in nursing homes. They observed a fear of loneliness among patients in nursing homes (91.9%), private homes (87.3%) and hospitals (86.1%).ConclusionsThe present work provides insights into the pandemic management of GPs and supports the development of a national strategy for palliative care during a pandemic.To effectively address end-of-life care, GPs and palliative care specialists should be involved in COVID-19 task forces on micro, meso and macro levels of health care.

Highlights

The SARS-CoV-2 (COVID-19) pandemic is posing major challenges for health care systems across the world
In Germany, one such challenge has been that adequate palliative care for the severely ill and dying, as well as their loved ones, has not been available at all times and in all settings., the pandemic has underlined the significance of the contribution of general practitioners (GPs) to the care of severely ill and dying patients
410 GPs responded; 61.5% indicated that the quality of their patients’ end-of-life care was maintained throughout the pandemic, 36.8% reported a decrease in quality compared to pre-pandemic times

Summary

Introduction

The SARS-CoV-2 (COVID-19) pandemic is posing major challenges for health care systems across the world. In the first peak of infections in spring 2020, the German federal government, in consultation with the federal states, enacted containment measures for the general public, including social distancing, the isolation of positive or suspected cases, a ban on admissions to nursing homes and a ban on visitation in hospitals, nursing homes and hospices [1,2,3,4,5] These were helpful strategies to reduce infection and mortality [6, 7], by March 2021, more than 70,000 people had died from or with COVID-19 in Germany [8]. In Germany, one such challenge has been that adequate palliative care for the severely ill and dying (with and without COVID-19), as well as their loved ones, has not been available at all times and in all settings., the pandemic has underlined the significance of the contribution of general practitioners (GPs) to the care of severely ill and dying patients.

Objectives

Results

Conclusion