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de Andrade CRM, Luz FST, de Oliveira NR, Kopittke L, Santa Rosa LMM, Gomes AGDR, Bartolazzi F, Francisco SC, da Costa FR, Jorge ADO, Cimini CCR, Carneiro M, Ruschel KB, Schwarzbold AV, Ponce D, Ferreira MAP, Guimarães Júnior MH, Silveira DV, Aranha FG, de Carvalho RLR, de Godoy MF, Viana LMP, Hirakata VN, Bicalho MAC, Marcolino MS. Palliative care and COVID-19: acknowledging past mistakes to forge a better future. Front Med (Lausanne) 2024; 11:1390057. [PMID: 39118660 PMCID: PMC11306131 DOI: 10.3389/fmed.2024.1390057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024] Open
Abstract
Context COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. Objectives To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves. Methods This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG). Results Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves. Conclusion A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.
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Affiliation(s)
| | | | | | - Luciane Kopittke
- Hospital Nossa Senhora da Conceição. Av. Francisco Trein, Porto Alegre, Brazil
- Hospital Cristo Redentor. R. Domingos Rubbo, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | - Marcelo Carneiro
- Hospital Santa Cruz. Universidade de Santa Cruz do Sul. R. Fernando Abott, Santa Cruz do Sul, Brazil
| | - Karen Brasil Ruschel
- Hospital Universitário Canoas. Av. Farroupilha, Canoas, Brazil
- Hospital Mãe de Deus. R. José de Alencar, Porto Alegre, Brazil
| | | | - Daniela Ponce
- Hospital das Clínicas da Faculdade de Medicina de Botucatu. Rod. Domingos Sartori, Botucatu, Brazil
| | | | | | | | | | - Rafael Lima Rodrigues de Carvalho
- Hospital Universitário Professor Edgard Santos. R. Augusto Viana, S/N, Salvador, Brazil
- Escola de Enfermagem da Universidade Federal da Bahia. Basílio da Gama, Salvador, Bahia, Brazil
| | | | | | | | - Maria Aparecida Camargos Bicalho
- Instituto Nacional de Ciência e Tecnologia Neurotec R. Av. Professor Alfredo Balena, Belo Horizonte, Brazil
- Hospital João XXIII, Av. Prof. Alfredo Balena, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, Belo Horizonte, Brazil
- Fundação Hospitalar do Estado de Minas Gerais, FHEMIG. Al. Vereador Álvaro Celso, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, Belo Horizonte, Brazil
- Department of Internal Medicine, Medical School & Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, Belo Horizonte, Brazil
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Garg I, Gangu K, Zabel KM, Shuja H, Sohail AH, Nasrullah A, Sohail S, Combs SA, Sheikh AB. Trends in utilisation of palliative care services in COVID-19 patients and their impact on hospital resources in the USA: insights from the national inpatient sample. BMJ Support Palliat Care 2024:spcare-2023-004621. [PMID: 38135484 DOI: 10.1136/spcare-2023-004621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Poor prognosis and lack of effective therapeutic options have made palliative care an integral part of the management of severe COVID-19. However, clinical studies on the role of palliative care in severe COVID-19 patients are lacking. The objective of our study was to evaluate the utility of palliative care in intubated COVID-19 patients and its impact on in-hospital outcomes. METHODS Rate of palliative care consult, patient-level variables (age, sex, race, income, insurance type), hospital-level variables (region, type, size) and in-hospital outcome variables (mortality, cost, disposition, complications) were recorded. RESULTS We retrospectively analysed 263 855 intubated COVID-19 patients using National Inpatient Sample database from 1 January 2020 to 31 December 2020. 65 325 (24.8%) patients received palliative care consult. Factors associated with an increased rate of palliative care consults included: female gender (p<0.001), older age (p<0.001), Caucasian race (p<0.001), high household income (p<0.001), Medicare insurance (p<0.001), admission to large-teaching hospitals (p<0.001), patients with underlying comorbidities, development of in-hospital complications and the need for intensive care procedures. Patients receiving palliative consults had shorter hospital length of stay (LOS) (p<0.001) and no difference in hospitalisation cost (p=0.15). CONCLUSIONS Palliative care utilisation rate in intubated COVID-19 patients was reflective of disease severity and disparities in healthcare access. Palliative care may help reduce hospital LOS. Our findings also highlight importance of improving access to palliative care services and its integration into the multidisciplinary management of severe COVID-19 patients.
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Affiliation(s)
- Ishan Garg
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Karthik Gangu
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Hina Shuja
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Amir Humza Sohail
- NYU Langone Health, New York, New York, USA
- NYU Langone, NYU Grossman Long Island School of Medicine, New York, New York, USA
| | | | | | - Sara A Combs
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Abu Baker Sheikh
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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3
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Younan S, Cardona M, Sahay A, Willis E, Ni Chroinin D. Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned. FRONTIERS IN HEALTH SERVICES 2023; 3:1242413. [PMID: 37780404 PMCID: PMC10541151 DOI: 10.3389/frhs.2023.1242413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
Background The importance of advance care planning (ACP) has been highlighted by the advent of life-threatening COVID-19. Anecdotal evidence suggests changes in implementation of policies and procedures is needed to support uptake of ACPs. We investigated the barriers and enablers of ACP in the COVID-19 context and identify recommendations to facilitate ACP, to inform future policy and practice. Methods We adopted the WHO recommendation of using rapid reviews for the production of actionable evidence for this study. We searched PUBMED from January 2020 to April 2021. All study designs including commentaries were included that focused on ACPs during COVID-19. Preprints/unpublished papers and Non-English language articles were excluded. Titles and abstracts were screened, full-texts were reviewed, and discrepancies resolved by discussion until consensus. Results From amongst 343 papers screened, 123 underwent full-text review. In total, 74 papers were included, comprising commentaries (39) and primary research studies covering cohorts, reviews, case studies, and cross-sectional designs (35). The various study types and settings such as hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and care which is unwanted/not aligned with goals. Enablers of ACP included targeted public awareness, availability of telehealth, easy access to online tools and adopting person-centered approach, respectful of patient autonomy and values. The emerging barriers were uncertainty regarding clinical outcomes, cultural and communication difficulties, barriers associated with legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems. Conclusion The pandemic has provided opportunities for rapid implementation of ACP in creative ways to circumvent social distancing restrictions and high demand for health services. This review suggests the pandemic has provided some impetus to drive adaptable ACP conversations at individual, local, and international levels, affording an opportunity for longer term improvements in ACP practice and patient care. The enablers of ACP and the accelerated adoption evident here will hopefully continue to be part of everyday practice, with or without the pandemic.
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Affiliation(s)
- Sarah Younan
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Ashlyn Sahay
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Eileen Willis
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Danielle Ni Chroinin
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
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Perumalswami CR, Chen E, Martin C, Goold SD, De Vries R, Griggs JJ, Jagsi R. "I'm Being Forced to Make Decisions I Have Never Had to Make Before": Oncologists' Experiences of Caring for Seriously Ill Persons With Poor Prognoses and the Dilemmas Created by COVID-19. JCO Oncol Pract 2022; 18:e89-e97. [PMID: 34324387 PMCID: PMC8758089 DOI: 10.1200/op.21.00119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has created a new set of problems for clinicians. This study examines the experiences of oncologists providing care to seriously ill persons near the end of life in the context of the COVID-19 pandemic. METHODS Between January 2020 and August 2020, we conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Deidentified transcripts of the interviews were examined using thematic analysis. RESULTS Our respondents described several novel problems created by the COVID-19 pandemic, including: (1) ethical challenges, (2) the need to manage uncertainty-physically and emotionally-on the part of both patients and oncologists, and (3) the difficulty of integrating technology and communication for seriously ill persons. These problems were made more complex by features of the pandemic: resource scarcity (and the need to fairly allocate poor resources), delays in care, high levels of fear, and the increased importance of advance care planning. Nonabandonment served as a way to cope with increased stress, and the use of telemedicine became an increasingly important medium of communication. CONCLUSION This study offers an in-depth exploration of the problems faced by oncologists as a result of the COVID-19 pandemic and how they navigated them. Optimal decision making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgment of the ethical challenges involved, the emotions experienced by both patients and their oncologists, and the urgent need to integrate technology with compassionate communication in determining patient preferences.
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Affiliation(s)
- Chithra R. Perumalswami
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Chithra R. Perumalswami, MD, MSc, Center for Bioethics and Social Sciences in Medicine, University of Michigan North Campus Research Complex, 2800 Plymouth Rd, Building 14-Room G011, Ann Arbor, MI 48109-2800; Twitter: @ChithraMD; e-mail:
| | - Emily Chen
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Carly Martin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Susan D. Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer J. Griggs
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI
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Schloesser K, Simon ST, Pauli B, Voltz R, Jung N, Leisse C, van der Heide A, Korfage IJ, Pralong A, Bausewein C, Joshi M, Strupp J. "Saying goodbye all alone with no close support was difficult"- Dying during the COVID-19 pandemic: an online survey among bereaved relatives about end-of-life care for patients with or without SARS-CoV2 infection. BMC Health Serv Res 2021; 21:998. [PMID: 34551766 PMCID: PMC8455806 DOI: 10.1186/s12913-021-06987-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND During the SARS-CoV2 pandemic, protection measures, as well as visiting restrictions, had a severe impact on seriously ill and dying patients and their relatives. The study aims to describe the experiences of bereaved relatives of patients who died during the SARS-CoV2 pandemic, regardless of whether patients were infected with SARS-CoV2 or not. As part of this, experiences related to patients' end-of-life care, saying goodbye, visiting restrictions and communication with the healthcare team were assessed. METHODS An open observational post-bereavement online survey with free text options was conducted with 81 bereaved relatives from people who died during the pandemic in Germany, with and without SARS-CoV2 diagnosis. RESULTS 67/81 of the bereaved relatives were female, with a mean age of 57.2 years. 50/81 decedents were women, with a mean age of 82.4 years. The main underlying diseases causing death were cardiovascular diseases or cancer. Only 7/81 of the patients were infected with SARS-CoV2. 58/81 of the relatives felt burdened by the visiting restrictions and 60/81 suffered from pandemic-related stress. 10 of the patients died alone due to visiting restrictions. The burden for relatives in the hospital setting was higher compared to relatives of patients who died at home. 45/81 and 44/81 relatives respectively reported that physicians and nurses had time to discuss the patient's condition. Nevertheless, relatives reported a lack of proactive communication from the healthcare professionals. CONCLUSIONS Visits of relatives play a major role in the care of the dying and have an impact on the bereavement of relatives. Visits must be facilitated, allowing physical contact. Additionally, virtual contact with the patients and open, empathetic communication on the part of healthcare professionals is needed. TRIAL REGISTRATION German Clinical Trials Register (DRKS00023552).
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Affiliation(s)
- Karlotta Schloesser
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Steffen T Simon
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Berenike Pauli
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research. Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Agnes van der Heide
- Department of Public Health, University Medical Center Rotterdam, Erasmus, MC, the Netherlands
| | - Ida J Korfage
- Department of Public Health, University Medical Center Rotterdam, Erasmus, MC, the Netherlands
| | - Anne Pralong
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital Munich, Munich, Germany
- Comprehensive Cancer Centre Munich (CCCM), Munich, Germany
| | - Melanie Joshi
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
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Abbott J, Ferraro K, Johnson D, Statland B, Massone J, Fowler C, Budai P, Cantrill SV. Colorado Palliative Care and Hospice Crisis Standards: Moving Beyond Critical Care Planning. J Pain Symptom Manage 2021; 61:1287-1296. [PMID: 33348027 DOI: 10.1016/j.jpainsymman.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.
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Affiliation(s)
- Jean Abbott
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Kelly Ferraro
- Palliative Medicine Physician, Denver Health & Hospital Authority, Denver, Colorado, USA
| | - Daniel Johnson
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Barbara Statland
- Hospitalist and Co Chair Ethics Committee, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - John Massone
- Medical Director, Palliative Care and Hospice, TRU Community Care, Lafayette, Colorado, USA
| | - Carol Fowler
- SCL Health-St. Mary's Hospital Palliative Medicine & Medical Director, HopeWest, Grand Junction, Colorado, USA
| | - Peggy Budai
- Poudre Valley Hospital and Medical Center of the Rockies, Older Adult and Palliative Care Programs, Fort Collins, Colorado, USA
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7
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Albarracin Z, Silverman M, Mineo J, Al-Abbasi B, Koff S, Martell C, Levene RS. Health Care Workers' Knowledge, Attitudes, and Beliefs Related to COVID-19 in Palliative Medicine and Hospice Care. Palliat Med Rep 2020; 1:331-338. [PMID: 34223494 PMCID: PMC8241391 DOI: 10.1089/pmr.2020.0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Although coronavirus disease 2019 (COVID-19) has impacted on a global scale, the knowledge, attitudes, and beliefs of the health care workers who provide the care at the end of life have not been evaluated. Objectives: To assess and understand palliative medicine and hospice care health care workers' knowledge, attitudes, and beliefs related to COVID-19. Design: A web-based survey was created. Primary outcomes included attitudes, beliefs, and knowledge. Secondary outcomes included comparison in between health care workers who described themselves at high risk versus not at high risk of complications related to COVID-19 infection. Setting/Subjects: In total, 1262 adult hospice workers in the United States were invited. Results: A total of 348 workers completed the survey. Of them, 321 were analyzed, 54.52% were over the age of 50 years, 84.74% were females, 41.75% were nurses, 29.6% were administrative staff, and 6.54% were physicians. Of these workers, 39.56% considered themselves at high risk to develop complications related to COVID-19 infection, 74.46% felt neutral to uncomfortable treating these patients, 77.57% believed that the recommended personal protective equipment (PPE) was adequate, 89.41% supported the risk-reduction strategies, 84.73% obtained information from health authorities, 25.55% from social media, 31.46% believed COVID-19 was likely created in a laboratory or intentionally, and 66.14% of hospice workers who considered themselves at high risk of complications felt available PPE was adequate to protect them compared with 85.05% of responders who did not consider themselves at high risk (p < 0.0001). The majority of respondents were incorrect in seven of the eight clinical scenarios. Conclusion: Improving staff knowledge and information related to COVID-19 would enhance staff safety, improve patient care, and relieve anxiety.
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Affiliation(s)
- Zaida Albarracin
- University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, Florida, USA
| | - Michael Silverman
- Geriatrics/Palliative Medicine/Hospice, West Palm Beach VA Medical Center, West Palm Beach, Florida, USA
| | - Jocelyn Mineo
- HCA Healthcare: East Florida Division GME, Ft. Lauderdale, Florida, USA.,HCA Physician Services Group, East Florida Division, Ft. Lauderdale, Florida, USA
| | - Baher Al-Abbasi
- University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, Florida, USA
| | - Susan Koff
- Trustbridge Health, West Palm Beach, Florida, USA
| | | | - Richard S Levene
- University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, Florida, USA.,Trustbridge Health, West Palm Beach, Florida, USA
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Gupta A, Bahl B, Rabadi S, Mebane A, Levey R, Vasudevan V. Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions. Am J Hosp Palliat Care 2020; 38:191-198. [PMID: 33021094 DOI: 10.1177/1049909120963698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.
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Affiliation(s)
- Amol Gupta
- 24508The Brooklyn Hospital Center, NY, USA
| | | | - Saher Rabadi
- 12340University of Texas Health Sciences Center, Houston, TX, USA
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