Abstract
SummaryObjectiveTo explore the experiences of, and impact on, staff working in palliative care during the COVID-19 pandemic.DesignQualitative multiple case study using semi-structured interviews between November 2020 and April 2021 as part of the CovPall study. Data were analysed using thematic framework analysis.SettingOrganisations providing specialist palliative services in any setting.ParticipantsStaff working in specialist palliative care, purposefully sampled by the criteria of role, care setting and COVID-19 experience.Main outcome measuresExperiences of working in palliative care during the COVID-19 pandemic.ResultsFive cases and 24 participants were recruited (n = 12 nurses, 4 clinical managers, 4 doctors, 2 senior managers, 1 healthcare assistant, 1 allied healthcare professional). Central themes demonstrate how infection control constraints prohibited and diluted participants’ ability to provide care that reflected their core values, resulting in experiences of moral distress. Despite organisational, team and individual support strategies, continually managing these constraints led to a ‘crescendo effect’ in which the impacts of moral distress accumulated over time, sometimes leading to burnout. Solidarity with colleagues and making a valued contribution provided ‘moral comfort’ for some.ConclusionsThis study provides a unique insight into why and how healthcare staff have experienced moral distress during the pandemic, and how organisations have responded. Despite their experience of dealing with death and dying, the mental health and well-being of palliative care staff was affected by the pandemic. Organisational, structural and policy changes are urgently required to mitigate and manage these impacts.
Highlights
COVID-19 has stressed already stretched healthcare systems, influencing how organisations, and professionals that work within them, are able to respond to patient and carer needs
In responding to COVID-19, palliative care professionals have been confronted with constraints that have challenged their ability to provide care in accordance with their professional values
A descriptive qualitative multiple case study,[9] part of the ‘CovPall study’; a project aiming to understand the multinational response of specialist palliative and hospice care services to the COVID-19 pandemic
Summary
COVID-19 has stressed already stretched healthcare systems, influencing how organisations, and professionals that work within them, are able to respond to patient and carer needs. In responding to COVID-19, palliative care professionals have been confronted with constraints (e.g. making complex and difficult decisions, infection control, dealing with uncertainty and recognising deep inequities3,6,7) that have challenged their ability to provide care in accordance with their professional values. These values include alleviating suffering and enhancing the quality of life of dying patients and their families through the adoption of a holistic, compassionate, person-centred, dignified, safe and multidisciplinary approach. Understanding how palliative care professionals, who choose to work with those who are dying, responded to the pandemic is key.
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