Abstract
ContextSystematic data on the care of people dying with COVID-19 are scarce. ObjectivesTo understand the response of and challenges faced by palliative care services during the COVID-19 pandemic, and identify associated factors. MethodsWe surveyed palliative care and hospice services, contacted via relevant organizations. Multivariable logistic regression identified associations with challenges. Content analysis explored free text responses. ResultsA total of 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world; 81% cared for patients with suspected or confirmed COVID-19, 77% had staff with suspected or confirmed COVID-19; 48% reported shortages of Personal Protective Equipment (PPE), 40% staff shortages, 24% medicines shortages, 14% shortages of other equipment. Services provided direct care and education in symptom management and communication; 91% changed how they worked. Care often shifted to increased community and hospital care, with fewer admissions to inpatient palliative care units. Factors associated with increased odds of PPE shortages were: charity rather than public management (OR 3.07, 95% CI 1.81–5.20), inpatient palliative care unit rather than other settings (OR 2.34, 95% CI 1.46–3.75). Being outside the UK was associated with lower odds of staff shortages (OR 0.44, 95% CI 0.26–0.76). Staff described increased workload, concerns for their colleagues who were ill, whilst expending time struggling to get essential equipment and medicines, perceiving they were not a front-line service. ConclusionPalliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics.
Highlights
COVID-19 evolved from a mystery illness to a pandemic in 93 days, overwhelming services in many countries.[1]
Palliative care is multidisciplinary, holistic and personcentered treatment, care and support for people with life-limiting illness, and those important to them, such as family and friends. It is recommended in respiratory[5,6] and infectious diseases,[7] and in recent guidance from the European Respiratory Society in COVID-19.8,9 In the COVID-19 pandemic, palliative care has an important role in ensuring symptom control, training of nonspecialists in symptom management and care of dying patients, compassionate communication, psychosocial support for patients, carers and health care professionals, advance care planning and bereavement support,[8,10] supporting patients wherever they want to be cared for (Table 1).[11]
This study aimed to understand the response of and challenges faced by palliative care services during the COVID-19 pandemic, and to identify factors associated with challenges experienced, in particular shortages of equipment, medicines and staff
Summary
COVID-19 evolved from a mystery illness to a pandemic in 93 days, overwhelming services in many countries.[1]. Palliative care is multidisciplinary, holistic and personcentered treatment, care and support for people with life-limiting illness, and those important to them, such as family and friends. It is recommended in respiratory[5,6] and infectious diseases,[7] and in recent guidance from the European Respiratory Society in COVID-19.8,9 In the COVID-19 pandemic, palliative care has an important role in ensuring symptom control, training of nonspecialists in symptom management and care of dying patients, compassionate communication, psychosocial support for patients, carers and health care professionals, advance care planning and bereavement support,[8,10] supporting patients wherever they want to be cared for (Table 1).[11]. The review concluded hospice and palliative care services are essential in the response to COVID-19 but systematic data are urgently needed to inform how to improve care for those who are likely to die, and/or have severe symptoms
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