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Forbat L, Macgregor A, Spilsbury K, McCormack B, Rutherford A, Hanratty B, Hockley J, Davison L, Ogden M, Soulsby I, McKenzie M. Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-134. [PMID: 39046763 DOI: 10.3310/krwq5829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Background Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this. Objective To co-design and implement a scalable UK model of Needs Rounds. Design A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework. Setting Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each. Participants Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings). Interventions (1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings. Main outcome measures A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement. Data sources Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members. Results The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality. Limitations COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care. Conclusions Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff. Future work Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Aisha Macgregor
- Faculty of Social Science, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- Queen Margaret University Edinburgh, Scotland, UK
- Østfold University College, Norway
| | | | - Barbara Hanratty
- Faculty of Medical Sciences, University of Newcastle, England, UK
| | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, UK
| | - Lisa Davison
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Margaret Ogden
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Irene Soulsby
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Maisie McKenzie
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
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Lourenço M, Gomes T, Araujo F, Ventura F, Silva R. Challenges for palliative care in times of COVID-19: a scoping review. Front Public Health 2024; 12:1330370. [PMID: 38596518 PMCID: PMC11002222 DOI: 10.3389/fpubh.2024.1330370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Many of the essential practices in palliative care (PC) had to be adapted to the COVID-19 pandemic. This global spread of the infectious respiratory disease, caused by SARS-CoV-2, created unprecedented obstacles. The aim of this research was to comprehensively assess the experiences and perceptions of healthcare professionals, individuals, and families in palliative and end-of-life situations during the COVID-19 pandemic. Methods A scoping review was conducted using the databases CINAHL Complete, MEDLINE, Scopus, SciELO, Cochrane Central Register of Controlled Trials, Psychology and Behavioral Sciences, MEDIClatina, and Portugal's Open Access Scientific Repository. The review followed the JBI® methodological approach for scoping reviews. Results Out of the initially identified 999 articles, 22 studies were included for analysis. The deprivation of relationships due to the safety protocols required to control the spread of COVID-19 was a universally perceived experience by healthcare professionals, individuals in PC, and their families. Social isolation, with significant psychological impact, including depersonalization and despair, was among the most frequently reported experiences by individuals in palliative situation. Despite healthcare professionals' efforts to mitigate the lack of relationships, the families of these individuals emphasized the irreplaceability of in-person bedside contact. Systematic review registration https://osf.io/xmpf2/.
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Affiliation(s)
- Marisa Lourenço
- Nursing School of Porto, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Tânia Gomes
- Urology Department - Santo António University Hospital Center, Porto, Portugal
| | - Fátima Araujo
- Nursing School of Porto, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Filipa Ventura
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Coimbra, Portugal
| | - Rosa Silva
- Nursing School of Porto, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), Coimbra, Portugal
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Manglus L, Lenz P, Dasch B. [Places of death of COVID-19 patients: an observational study based on evaluated death certificates from the city of Muenster, Germany (2021)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:962-971. [PMID: 37233810 PMCID: PMC10214335 DOI: 10.1007/s00103-023-03702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/12/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The places of death of COVID-19 patients have so far hardly been investigated in Germany. METHODS In a places of death study in Westphalia (Germany), statistical evaluations were carried out in the city of Muenster on the basis of all death certificates from 2021. Persons who had died with or from a COVID-19 infection were identified by medical information on cause of death and analyzed with descriptive statistical methods using SPSS. RESULTS A total of 4044 death certificates were evaluated, and 182 deceased COVID-19 patients were identified (4.5%). In 159 infected patients (3.9%), the viral infection was fatal, whereby the distribution of places of death was as follows: 88.1% in hospital (57.2% in the intensive care unit; 0.0% in the palliative care unit), 0.0% in hospice, 10.7% in nursing homes, 1.3% at home, and 0.0% in other places. All infected patients < 60 years and 75.4% of elderly patients ≥ 80 years died in hospital. Only two COVID-19 patients, both over 80 years old, died at home. COVID-19 deaths in nursing homes (17) affected mostly elderly female residents. Ten of these residents had received end-of-life care from a specialized outpatient palliative care team. DISCUSSION The majority of COVID-19 patients died in hospital. This can be explained by the rapid course of the disease with a high symptom burden and the frequent young age of the patients. Inpatient nursing facilities played a certain role as a place of death in local outbreaks. COVID-19 patients rarely died at home. Infection control measures may be one reason why no patients died in hospices or palliative care units.
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Affiliation(s)
- Lukas Manglus
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W30, 48149, Münster, Deutschland
| | - Philipp Lenz
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W30, 48149, Münster, Deutschland
| | - Burkhard Dasch
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W30, 48149, Münster, Deutschland.
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Frey R, Balmer D. The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: An integrative review. Palliat Support Care 2023:1-13. [DOI: 10.1017/s1478951523000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
The growing demand for palliative care has been accelerated due to the COVID-19 pandemic. However, providing community-based palliative care was also more difficult to do safely and faced several challenges. The goal of this integrative review was to identify, describe, and synthesize previous studies on the challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic.
Methods
Searches were carried out on the Ovid MEDLINE, CINAHL, PsycINFO, Social Care Online, PubMed, Embase, and Expanded Academic databases. Journals typically reporting palliative care and community health studies were also searched (Palliative Medicine, Journal of Pain and Symptom Management, and Health & Social Care in the Community). All articles were peer-reviewed and published in English between December 2019 and September 2022.
Results
Database and hand searches identified 1231 articles. After duplicates were removed and the exclusion criteria applied, 27 articles were included in the final review. Themes in the research findings centered on 6 interconnected categories. The challenges imposed by the pandemic (lack of resources, communication difficulties, access to education and training, and interprofessional coordination), as well as the varying levels of success of the health-care responses, impacted the well-being of health professionals and, in turn, the well-being and care of patients and families.
Significance of results
The pandemic has provided the impetus for rethinking flexible and innovative approaches to overcome the challenges of delivering community palliative care. However, existing governmental and organizational policies require revision to improve communication and effective interprofessional collaboration, and additional resources are needed. A blended model of virtual and in-person palliative care delivery may provide the best solution to community palliative care delivery moving forward.
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Kaiser U, Vehling-Kaiser U, Kalteis M, Hoffmann A, Schmidt J, Kaiser F. SAPV-Patienten in der COVID-19-Krise. DIE ONKOLOGIE 2022. [PMCID: PMC9131981 DOI: 10.1007/s00761-022-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund COVID-19 betrifft im ambulanten Bereich vor allem auch Palliativpatienten, die im Rahmen der spezialisierten ambulanten Palliativversorgung (SAPV) versorgt werden. Zur Vermeidung von Infektionen wurde die Implementierung von neuen Sicherheitsvorkehrungen und telemedizinischen Kommunikationsmöglichkeiten in die an der Studie beteiligten SAPV erforderlich. Ziel der Arbeit Die Studie untersucht die Auswirkungen der COVID-19-Pandemie auf die persönlichen und sozialen Probleme von Palliativpatienten und ihre Erfahrungen mit der betreuenden SAPV. Material und Methoden 20 SAPV-Patienten wurden in halbstrukturierten Telefoninterviews zu ihren Problemen im Zusammenhang mit der Pandemie und Erfahrungen mit der SAPV-Betreuung befragt. Ergebnisse Angst vor Einsamkeit und Infektion belasten Palliativpatienten sehr. Die meisten Patienten wollten Krankenhausaufenthalte wegen erhöhter Infektionsgefahr vermeiden. Schutzmaßnahmen der SAPV gaben ihnen ein Gefühl der Sicherheit und wurden trotz Einschränkung des persönlichen Kontakts akzeptiert. Moderne Kommunikationsformen waren nützlich, konnten aber den persönlichen Kontakt nicht ersetzen. Diskussion Die Pandemie führte zu Veränderungen in der SAPV und hatte Auswirkungen auf das soziale Umfeld von Palliativpatienten. Schutzmaßnahmen sind für das Sicherheitsgefühl der betreuten Palliativpatienten wichtig. Die Versorgungsqualität der an COVID-19 angepassten SAPV-Struktur wird von den Patienten meist nicht als verschlechtert wahrgenommen. Ängste vor sozialer Isolation nehmen bei den Palliativpatienten einen hohen Stellenwert ein und können durch die SAPV abgebaut werden. Der persönliche Kontakt zur SAPV kann durch moderne Kommunikationsmöglichkeiten nicht ersetzt werden, wobei die Patienten Telemedizin im Sinne einer „Notlösung“ durchaus akzeptieren.
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Affiliation(s)
- Ulrich Kaiser
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Deutschland
| | | | | | - Ana Hoffmann
- VK&K Studien GbR Landshut, Landshut, Deutschland
| | - Jörg Schmidt
- Institut für Marktforschung im Gesundheitswesen München, München, Deutschland
| | - Florian Kaiser
- Onkologisches und Palliativmedizinisches Netzwerk Landshut, Landshut, Deutschland
- Klinik für Hämatologie und medizinische Onkologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Russell B, William L, Chapman M. An Ethical Framework for Visitation of Inpatients Receiving Palliative Care in the COVID-19 Context. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:191-202. [PMID: 35175512 PMCID: PMC8853187 DOI: 10.1007/s11673-022-10173-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/10/2022] [Indexed: 05/03/2023]
Abstract
Human connection is universally important, particularly in the context of serious illness and at the end of life. The presence of close family and friends has many benefits when death is close. Hospital visitation restrictions during the Coronavirus (COVID-19) pandemic therefore warrant careful consideration to ensure equity, proportionality, and the minimization of harm. The Australian and New Zealand Society for Palliative Medicine COVID-19 Special Interest Group utilized the relevant ethical and public health principles, together with the existing disease outbreak literature and evolving COVID-19 knowledge, to generate a practical framework of visiting restrictions for inpatients receiving palliative and end-of-life care. Expert advice from an Infectious Diseases physician ensured relevance to community transmission dynamics. Three graded levels of visitor restrictions for inpatient settings are proposed, defining an appropriate level of minimum access. These depend upon the level of community transmission of COVID-19, the demand on health services, the potential COVID-19 status of the patient and visitors, and the imminence of the patient's death. This framework represents a cohesive, considered, proportionate, and ethically robust approach to improve equity and consistency for inpatients receiving palliative care during the COVID-19 pandemic and may serve as a template for future disease outbreaks.
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Affiliation(s)
- Bethany Russell
- Palliative Nexus Research Group, University of Melbourne & St Vincent’s Hospital Melbourne, St Vincent’s Hospital, 41 Victoria Pde, Fitzroy, Victoria 3065 Australia
- Department of Palliative Care, St Vincent’s Hospital Melbourne, St Vincent’s Hospital, 41 Victoria Pde, Fitzroy, Victoria 3065 Australia
| | - Leeroy William
- Supportive & Palliative Care Unit, Eastern Health, Monash University, Melbourne, Australia
- Eastern Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Public Health Palliative Care Unit, La Trobe University, Wantirna Health, 251 Mountain Highway, Wantirna, 3152 Australia
| | - Michael Chapman
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Department of Palliative Care, Canberra Hospital, PO Box 11, Woden, ACT 2606 Australia
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Tavares P, Rodrigues C, Neto IG. The Impact of COVID-19 on Palliative Care: Perspective of Healthcare Professionals. Cureus 2021; 13:e19522. [PMID: 34934544 PMCID: PMC8666880 DOI: 10.7759/cureus.19522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has negatively impacted the provision of Palliative Care (PC), challenging the teams aiming to provide adequate care. This is a qualitative study that intends to know, from the perspective of health professionals of a Palliative Care Unit (PCU), the main challenges in providing PC during a pandemic and describes the strategies to be adopted to solve the identified difficulties. We utilized the content analysis, according to Bardin, for data analysis of written narratives of health professionals from a PCU (n=14). In the analysis of the difficulties in providing PC, from the perspective of health professionals, were identified five themes: 1) Altered relationship between healthcare professional and patients, 2) altered relationship between healthcare professional and family, 3) altered communication with patients and their family, 4) altered working dynamic within the PCU, and 5) altered use of healthcare resources. Concerning the strategies to be implemented, the health professionals identified two themes: 1) Strategies to implement between the patient and family members and 2) strategies to implement for the healthcare professionals. The provision of PC is affected by changes in the relationship between the health professional and the patient/caregiver or family, in communication with the patient/caregiver or family, and the use of health resources. In an attempt to lessen the impact of these changes, participants identified strategies to improve PC delivery in these circumstances. During this pandemic, it is imperative to implement rigorous strategies for managing specialized human resources. Physical distance and personal protective equipment are barriers to communication and emotional support, which is essential in PC and this barrier is further accentuated by the required physical distance from family members and caregivers. PC´s main aim continues to be the mitigation of suffering.
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Affiliation(s)
- Pedro Tavares
- Palliative Care Department, Hospital da Luz Lisboa, Lisboa, PRT
| | | | - Isabel G Neto
- Palliative Care Department, Hospital da Luz Lisboa, Lisboa, PRT
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Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211992. [PMID: 34831747 PMCID: PMC8618945 DOI: 10.3390/ijerph182211992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022]
Abstract
Background: The COVID-19 pandemic outbreak has severely affected healthcare organizations worldwide, and the provision of palliative care (PC) to cancer patients has been no exception. The aim of this paper was to analyse the levels of health care provided by the Clinical Management Unit for PC in Córdoba (Spain) for cancer patients. Method: a retrospective cohort study was conducted. It analyzed the PC internal management database including all cancer patients treated in the period of 2018–2021. Results: 1967 cases were studied. There was a drop in cancer cases (p = 0.008), deaths at the PC hospital (p < 0.001), and referrals from primary care (p < 0.001). However, there was a rise in highly complex clinical situations (p = 0.020) and in ECOG performance status scores of 3–4 (p < 0.001). The pandemic was not shown to be a risk factor for survival in the PC program (0.99 [0.82–1.20]; p = 0.931). However, being female (p = 0.005), being older and having a high Karnofsky Performance Status (KPS) score (p < 0.001) could be indicators of a longer stay. Conclusion: The COVID-19 pandemic has presented a challenge in the management of patients requiring PC and has highlighted the urgent needs of the healthcare system if it is to continue providing a level of care which meets the needs of patients and their families.
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Runacres F, Steele P, Hudson J, Bills M, Poon P. 'We couldn't have managed without your team': A collaborative palliative care response to the COVID-19 pandemic in residential aged care. Australas J Ageing 2021; 41:147-152. [PMID: 34755441 PMCID: PMC8646512 DOI: 10.1111/ajag.13013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 01/10/2023]
Abstract
The global COVID‐19 pandemic has challenged healthcare, aged care and palliative care provision in ways previously unimaginable. In Australia, this has been felt particularly amongst our most vulnerable members of society, those residing in residential aged care. Currently representing the majority (75%) of COVID‐19 deaths and health‐care worker infections, this vulnerable sector has borne the greatest impact. A collaborative response comprising a tertiary hospital palliative care outreach service, residential InReach geriatric service and a community palliative care service effectively delivered comprehensive and timely specialist care to residents infected with COVID‐19. Daily videoconferencing rounds were efficient, minimised infection risk and facilitated family members attending virtually during patient assessments and care planning discussions. This model was both reactive and proactive and importantly scalable should further infective outbreaks occur in Australasian residential aged care facilities.
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Affiliation(s)
- Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia.,Department of Palliative Care, Calvary Health Care Bethlehem, Parkdale, Vic., Australia.,The University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Patrick Steele
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia.,Palliative Care South East, Cranbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Parkville, Vic., Australia
| | - Jade Hudson
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia
| | - Maryann Bills
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia
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Affiliation(s)
- Catherine M. Bauld
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Primrose Letcher
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Craig A. Olsson
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
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A reflection on: Breitbart W (2020). Life and death in the age of COVID-19. Palliative and Supportive Care 18, 252-253. Palliat Support Care 2021; 19:265-266. [PMID: 33461635 DOI: 10.1017/s1478951520001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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