Abstract
BackgroundAt the time of the first wave of the COVID-19 pandemic in Sweden, little was known about how effective our regular end-of-life care strategies would be for patients dying from COVID-19 in hospitals. The aim of the study was to describe and evaluate end-of-life care for patients dying from COVID-19 in hospitals in Sweden up until up until 12 November 2020.MethodsData were collected from the Swedish Register of Palliative Care. Hospital deaths during 2020 for patients with COVID-19 were included and compared to a reference cohort of hospital patients who died during 2019. Logistic regression was used to compare the groups and to control for impact of sex, age and a diagnosis of dementia.ResultsThe COVID-19 group (1476 individuals) had a lower proportion of women and was older compared to the reference cohort (13,158 individuals), 81.8 versus 80.6 years (p < .001). Breathlessness was more commonly reported in the COVID-19 group compared to the reference cohort (72% vs 43%, p < .001). Furthermore, anxiety and delirium were more commonly and respiratory secretions, nausea and pain were less commonly reported during the last week in life in the COVID-19 group (p < .001 for all five symptoms). When present, complete relief of anxiety (p = .021), pain (p = .025) and respiratory secretions (p = .037) was more often achieved in the COVID-19 group. In the COVID-19 group, 57% had someone present at the time of death compared to 77% in the reference cohort (p < .001).ConclusionsThe standard medical strategies for symptom relief and end-of-life care in hospitals seemed to be acceptable. Symptoms in COVID-19 deaths in hospitals were relieved as much as or even to a higher degree than in hospitals in 2019. Importantly, though, as a result of closing the hospitals to relatives and visitors, patients dying from COVID-19 more frequently died alone, and healthcare providers were not able to substitute for absent relatives.
Highlights
The first cases of a new coronavirus disease, COVID-19, were reported in December 2019 in China [1, 2]
Though, as a result of closing the hospitals to relatives and visitors, patients dying from COVID-19 more frequently died alone, and healthcare providers were not able to substitute for absent relatives
In a recent study by our group, we showed that nursing home residents who died in hospital with COVID-19 were younger and more often suffered from breathlessness and delirium during end of life compared to those who died with COVID-19 in their nursing home [25]
Summary
The first cases of a new coronavirus disease, COVID-19, were reported in December 2019 in China [1, 2]. Some symptoms may seem obvious in a lethal viral infection affecting the lungs, like breathlessness and respiratory secretions Other symptoms such as nausea, delirium, pain and anxiety are frequently seen near death in other conditions. It was not known how common those symptoms would be in hospitalised patients dying from COVID-19 or how well such symptoms could be alleviated. Little was known about the effect of our regular end-of-life care strategies, including drugs for symptom management in hospitals, for patients dying from COVID-19. At the time of the first wave of the COVID-19 pandemic in Sweden, little was known about how effective our regular end-of-life care strategies would be for patients dying from COVID-19 in hospitals. The aim of the study was to describe and evaluate end-of-life care for patients dying from COVID-19 in hospitals in Sweden up until up until 12 November 2020
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