Prohibit, Protect, or Adapt? The Changing Role of Volunteers in Palliative and Hospice Care Services During the COVID-19 Pandemic. A Multinational Survey (Covpall).

Catherine Walshe,Lesley Dunleavy,Sabrina Bajwah,Andy Bradshaw,Matthew Maddocks,Lorna K Fraser,Katherine E Sleeman,Nancy Preston,Irene J Higginson,Fliss Em Murtagh,Rachel L Cripps,Adejoke O Oluyase,Ian Garner,Mevhibe Hocaoglu

doi:10.34172/ijhpm.2021.128

Abstract

Volunteers are common within palliative care services, and provide support that enhances care quality. The support they provided, and any role changes, during the coronavirus disease 2019 (COVID-19) pandemic are unknown. The aim of this study is to understand volunteer deployment and activities within palliative care services, and to identify what may affect any changes in volunteer service provision, during the COVID-19 pandemic. Multi-national online survey disseminated via key stakeholders to specialist palliative care services, completed by lead clinicians. Data collected on volunteer roles, deployment, and changes in volunteer engagement. Analysis included descriptive statistics, a multivariable logistic regression, and analysis of free-text comments using a content analysis approach. 458 respondents: 277 UK, 85 rest of Europe, and 95 rest of the world. 68.5% indicated volunteer use pre-COVID-19 across a number of roles (from 458): direct patient facing support (58.7%), indirect support (52.0%), back office (48.5%) and fundraising (45.6%). 11% had volunteers with COVID-19. Of those responding to a question on change in volunteer deployment (328 of 458) most (256/328, 78%) indicated less or much less use of volunteers. Less use of volunteers was associated with being an in-patient hospice, (odds ratio [OR]=0.15, 95% CI=0.07-0.3, P<.001). This reduction in volunteers was felt to protect potentially vulnerable volunteers, with policy changes preventing volunteer support. However, adapting was also seen where new roles were created, or existing roles pivoted to provide virtual support. Volunteers were mostly prevented from supporting many forms of palliative care which may have quality and safety implications given their previously central roles. Volunteer re-deployment plans are needed that take a more considered approach, using volunteers more flexibly to enhance care while ensuring safe working practices. Consideration needs to be given to widening the volunteer base away from those who may be considered to be most vulnerable to COVID-19.

Highlights

They are closely involved in the symptom management of those who are dying or who have challenging symptoms and, at times, services have provided additional bed capacity to help manage the surge in patient numbers in the wider healthcare system
The multivariable logistic regression (Table 4) shows that there was a significant association between providing inpatient hospice care and reporting less use of volunteers than usual during the pandemic
Services who care for adult patients only were significantly associated with more volunteer use

Summary

Introduction

Specialist palliative and hospice care services have proven to be critically important as part of the whole-system management of the coronavirus disease 2019 (COVID-19) pandemic.[1,2,3] They are closely involved in the symptom management of those who are dying or who have challenging symptoms (both dying with COVID-19 and from COVID-19) and, at times, services have provided additional bed capacity to help manage the surge in patient numbers in the wider healthcare system. Volunteers offer stability; a Belgian survey identified that most volunteers had been in their current care organisation for at least 6 years (57%), and 36% for over 10 years.[6]

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Discussion

Conclusion