Utilization of Palliative Care Screening Tool to Early Identify Patients with COVID-19 Needing Palliative Care: A Cohort Study.

Yung-Feng Yen,Hsiao-Yun Hu,Yi-Chang Chou,Chin-Yu Ho,Chu-Chieh Chen

doi:10.3390/ijerph19031054

Abstract

There are very few programs that identify patients with coronavirus disease 2019 (COVID-19) who need palliative care. This cohort study presents a model to use a validated palliative care screening tool (PCST) to systematically identify hospitalized patients with COVID-19 in need of palliative care. In this prospective study, we consecutively recruited patients with COVID-19 admitted to Taipei City Hospital between 1 January and 30 July 2021. Patients’ palliative care needs were determined by using the PCST. Advance care planning (ACP) and advance directives (AD) were systemically provided for all patients with a PCST score ≥ 4. Of 897 patients, 6.1% had a PCST score ≥ 4. During the follow-up period, 106 patients died: 75 (8.9%) with a PCST score < 4 and 31 (56.4%) with a PCST score ≥ 4. The incidence of mortality was 2.08 and 0.58/100 person-days in patients with PCST scores ≥ 4 and <4, respectively. After controlling for other covariates, a PCST score ≥ 4 was associated with a higher risk of mortality in patients with COVID-19 (adjusted HR = 2.08; 95% CI: 1.22–3.54; p < 0.001). During hospitalization, 55 patients completed an ACP discussion with their physicians, which led to 15 of them completing the AD. Since hospitalized patients with COVID-19 had a high mortality rate, it is imperative to implement a comprehensive palliative care program to early identify patients needing palliative care and promotion of AD and ACP.

Highlights

The checklist of palliative care screening tool (PCST) consists of four categories, namely (A) primary diseases associated with palliative care, (B) secondary comorbidities, (C) functional status score according to the Eastern
This study found that 25.5% of patients with PCST scores ≥ 4 had advance care planning (ACP) communication with healthcare providers, which was lower than 37.5% before the COVID-19 pandemic [9]
Our study presents the first known model to use a validated PCST to screen all patients with COVID-19 needing palliative care and promote ACP and advance directives (AD) for them

Summary

Introduction

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic since January 2020. As of November 2021, 248 million individuals worldwide have been infected with SARS-CoV-2, with the death toll reaching five million [1]. While many patients with COVID-19 have mild symptoms [2], older or hospitalized patients with COVID-19 have a high mortality risk [3,4]. A study conducted in the USA showed that in-hospital mortality rates for patients diagnosed with COVID-19 were between 9.3 and 19.7% [3]. 86% of such patients receiving intubation and mechanical ventilation died during hospitalization [5].

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Results

Discussion

Conclusion