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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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Biney A, Sarfo JO, Poku CA, Deegbe DA, Atibila F, Ti-Enkawol Nachinab G, Anaba E, Dzansi G, Attafuah PYA. Challenges and coping strategies when caring for terminally ill persons with cancer: perspectives of family caregivers. BMC Palliat Care 2024; 23:175. [PMID: 39020352 PMCID: PMC11253565 DOI: 10.1186/s12904-024-01518-z] [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: 09/21/2023] [Accepted: 07/12/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. METHODS An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. RESULTS From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. CONCLUSION The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.
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Affiliation(s)
| | - Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Collins Atta Poku
- School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Atsu Deegbe
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Fidelis Atibila
- School of Life and Medical sciences Centre for postgraduate medicine and Public Health, University of Hertfordshire UK, College Lane Campus, Hertfordshire, UK
| | - Gilbert Ti-Enkawol Nachinab
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Emmanuel Anaba
- School of Public Health, University of Ghana, Accra, Ghana
| | - Gladys Dzansi
- Ghana College of Nurses and Midwives, Accra, Ghana
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Priscilla Yeye Adumoah Attafuah
- Ghana College of Nurses and Midwives, Accra, Ghana.
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana.
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Hernández-Zambrano SM, Carrillo-Algarra AJ, Manotas-Solano OE, Ibáñez-Gamboa SE, Mejia-Mendez LM, Martínez-Montoya OH, Fernández-Alcántara M, Hueso-Montoro C. Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review. ENFERMERIA INTENSIVA 2024:S2529-9840(23)00069-1. [PMID: 38910066 DOI: 10.1016/j.enfie.2023.08.009] [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: 06/18/2023] [Accepted: 08/24/2023] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.
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Affiliation(s)
- S M Hernández-Zambrano
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia.
| | - A J Carrillo-Algarra
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O E Manotas-Solano
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - S E Ibáñez-Gamboa
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - L M Mejia-Mendez
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O H Martínez-Montoya
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | | | - C Hueso-Montoro
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Jaén, Spain
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Boateng SA, Okyere J, Attafuah PYA, Dzansi G. Institutional drivers for integrating palliative care services in a hospital in a sub-Saharan African military hospital context. Palliat Care Soc Pract 2024; 18:26323524241262327. [PMID: 38911601 PMCID: PMC11191610 DOI: 10.1177/26323524241262327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024] Open
Abstract
Background The growing burden of life-threatening illnesses and advancements in care interventions call for the intentional integration of palliative care services into existing care systems. The absence of active, functioning palliative care services in most hospitals in Ghana is a major concern. This study explored the factors influencing the integration of palliative care services in one of such institutions. Objectives The aim of the study was to explore the institutional drivers of palliative care integration in a military health facility. Design Exploratory qualitative study. Methods We employed a qualitative exploratory study design situated within a constructivist paradigm. A purposive sampling method was used to select and interview 11 healthcare professionals. A semistructured interview was used to conduct face-to-face, in-depth interviews with participants between April and May 2022. A thematic data analysis was done based on the Braun and Clarke analysis process with the aid of QSR NVivo-12. Results The six themes that describe the institutional driving factors for integrating palliative care services were cognitive restructuring, supportive logistics and infrastructure, staffing, healthcare professional skills, institutional policies and priorities, and utilization of focal persons. It was observed that a paradigm shift in the mindset of healthcare professionals and administrators was a major driver that would determine the integration of palliative care services. A cognitive restructuring will facilitate a more aggressive integration of palliative care services because logistics, staffing, and medication access will be prioritized. Conclusion Institutions have the responsibility of aligning with the WHO policy on palliative care service access and must invest in training, staffing, prioritizing palliative care needs and policies, procurement of essential drugs, and the provision of logistics and supportive infrastructure to scale up the implementation of palliative care services.
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Affiliation(s)
- Samuel Asamoah Boateng
- Faculty of Palliative Care Nursing, Ghana College of Nursing and Midwifery, Accra, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Gladys Dzansi
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, PO Box LG 43, Legon, Accra 233, Ghana
- Faculty of Palliative Care Nursing, Ghana College of Nursing and Midwifery, Accra, Ghana
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Iqbal J, Moineddin R, Fowler RA, Krzyzanowska MK, Booth CM, Downar J, Lau J, Le LW, Rodin G, Seow H, Tanuseputro P, Earle CC, Quinn KL, Hannon B, Zimmermann C. Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19. JAMA Netw Open 2024; 7:e240503. [PMID: 38411960 PMCID: PMC10900963 DOI: 10.1001/jamanetworkopen.2024.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Importance The COVID-19 pandemic had a profound impact on the delivery of cancer care, but less is known about its association with place of death and delivery of specialized palliative care (SPC) and potential disparities in these outcomes. Objective To evaluate the association of the COVID-19 pandemic with death at home and SPC delivery at the end of life and to examine whether disparities in socioeconomic status exist for these outcomes. Design, Setting, and Participants In this cohort study, an interrupted time series analysis was conducted using Ontario Cancer Registry data comprising adult patients aged 18 years or older who died with cancer between the pre-COVID-19 (March 16, 2015, to March 15, 2020) and COVID-19 (March 16, 2020, to March 15, 2021) periods. The data analysis was performed between March and November 2023. Exposure COVID-19-related hospital restrictions starting March 16, 2020. Main Outcomes and Measures Outcomes were death at home and SPC delivery at the end of life (last 30 days before death). Socioeconomic status was measured using Ontario Marginalization Index area-based material deprivation quintiles, with quintile 1 (Q1) indicating the least deprivation; Q3, intermediate deprivation; and Q5, the most deprivation. Segmented linear regression was used to estimate monthly trends in outcomes before, at the start of, and in the first year of the COVID-19 pandemic. Results Of 173 915 patients in the study cohort (mean [SD] age, 72.1 [12.5] years; males, 54.1% [95% CI, 53.8%-54.3%]), 83.7% (95% CI, 83.6%-83.9%) died in the pre-COVID-19 period and 16.3% (95% CI, 16.1%-16.4%) died in the COVID-19 period, 54.5% (95% CI, 54.2%-54.7%) died at home during the entire study period, and 57.8% (95% CI, 57.5%-58.0%) received SPC at the end of life. In March 2020, home deaths increased by 8.3% (95% CI, 7.4%-9.1%); however, this increase was less marked in Q5 (6.1%; 95% CI, 4.4%-7.8%) than in Q1 (11.4%; 95% CI, 9.6%-13.2%) and Q3 (10.0%; 95% CI, 9.0%-11.1%). There was a simultaneous decrease of 5.3% (95% CI, -6.3% to -4.4%) in the rate of SPC at the end of life, with no significant difference among quintiles. Patients who received SPC at the end of life (vs no SPC) were more likely to die at home before and during the pandemic. However, there was a larger immediate increase in home deaths among those who received no SPC at the end of life vs those who received SPC (Q1, 17.5% [95% CI, 15.2%-19.8%] vs 7.6% [95% CI, 5.4%-9.7%]; Q3, 12.7% [95% CI, 10.8%-14.5%] vs 9.0% [95% CI, 7.2%-10.7%]). For Q5, the increase in home deaths was significant only for patients who did not receive SPC (13.9% [95% CI, 11.9%-15.8%] vs 1.2% [95% CI, -1.0% to 3.5%]). Conclusions and Relevance These findings suggest that the COVID-19 pandemic was associated with amplified socioeconomic disparities in death at home and SPC delivery at the end of life. Future research should focus on the mechanisms of these disparities and on developing interventions to ensure equitable and consistent SPC access.
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Affiliation(s)
- Javaid Iqbal
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medicine, University of Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care, Ottawa, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, University Health Network, Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig C Earle
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Kieran L Quinn
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
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Collier A, Balmer D, Gilder E, Parke R. Patient safety and hospital visiting at the end of life during COVID-19 restrictions in Aotearoa New Zealand: a qualitative study. BMJ Qual Saf 2023; 32:704-711. [PMID: 36788035 DOI: 10.1136/bmjqs-2022-015471] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Visiting restrictions were enacted in Aotearoa New Zealand to reduce transmission of COVID-19 and protect the healthcare system. This research aimed to investigate the experiences of families and clinicians of hospital visiting for people with palliative and end-of-life care needs during restrictions. METHODS Semistructured interviews were completed between March and October 2021 with family members and clinicians who had personally experienced enactment of visiting restrictions during pandemic restrictions. A critical realist ontology was used to approach data analysis, sorting and coding to generate themes. RESULTS Twenty-seven participants were interviewed, 13 being families who had experienced bereavement of a family member during the restrictions: seven nurses or physicians and seven being non-bereaved family members. Four themes were generated: patient safety-(re)defining the 'Visitor'; the primacy of SARS-CoV-2-patient safety and negotiating risk; dying alone: enduring harms; and agency, strategies and workarounds. CONCLUSION Visitor rights and visitor policy at the end of life require greater protection during a pandemic. Transparent, coherent, publicly available evidence-based guidelines that key stakeholders, including patients, families and ethicists, are included in producing, are urgently required. We want to avert a legacy of disenfranchised grief in future pandemics.
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Affiliation(s)
- Aileen Collier
- Research Centre for Palliative Care Death and Dying (RePaDD), Flinders University, Adelaide, South Australia, Australia
| | - Deborah Balmer
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eileen Gilder
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Rachael Parke
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
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Cherba M, Funk L, Scott E, Salman B, Rounce A, Mackenzie C, Stajduhar K, Dujela C, Krawczyk M, Cohen SR. How initial policy responses to COVID-19 contributed to shaping dying at home preferences and care provision: key informant perspectives from Canada. BMC Health Serv Res 2023; 23:1330. [PMID: 38037107 PMCID: PMC10691158 DOI: 10.1186/s12913-023-10340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES In response to COVID-19's first wave, provincial governments rapidly implemented several public health directives, including isolation measures and care facility visitor restrictions, which profoundly affected healthcare delivery at the end of life and dying experiences and perceptions. The objective of this study was to identify implications of early policy changes for dying at home. METHODS Analysis of interviews with 29 key informants with expertise in the policy and practice context of dying at home and care for those dying at home was conducted as part of a larger mixed-methods study on dying at home in Canada. RESULTS Initial pandemic policy responses, especially visitor restrictions and limitations to home care services, shaped dying at home in relation to three themes: (1) increasing preferences and demand for, yet constrained system ability to support dying at home; (2) reinforcing and illuminating systemic reliance on and need for family/friend caregivers and community organizations, while constraining their abilities to help people die at home; and (3) illuminating challenges in developing and implementing policy changes during a pandemic, including equity-related implications. CONCLUSION This study contributes to broader understanding of the multifaceted impacts of COVID-19 policy responses in various areas within Canadian healthcare systems. Implications for healthcare delivery and policy development include (1) recognizing the role of family/friend caregivers and community organizations in end-of-life care, (2) recognizing health inequities at the end of life, and (3) considering possible changes in future end-of-life preferences and public attitudes about dying at home and responsibility for end-of-life care.
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Affiliation(s)
| | - Laura Funk
- University of Manitoba, Winnipeg, Canada
| | - Erin Scott
- University of Manitoba, Winnipeg, Canada
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Lawlor P, Cohen L, Adeli SR, Besserer E, Gratton V, Murphy R, Warmels G, Bruni A, Kabir M, Noel C, Heidinger B, Anderson K, Arsenault-Mehta K, Wooller K, Lapenskie J, Webber C, Bedard D, Enright P, Desjardins I, Bhimji K, Dyason C, Iyengar A, Bush SH, Isenberg S, Tanuseputro P, Vanderspank-Wright B, Downar J, Parsons H. Comorbidities, symptoms and end-of-life medication use in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada. BMJ Open 2023; 13:e075518. [PMID: 37669840 PMCID: PMC10481717 DOI: 10.1136/bmjopen-2023-075518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To compare comorbidities, symptoms and end-of-life (EoL) palliative medication (antisecretories, opioids, antipsychotics and sedatives) use among decedents before and during the COVID-19 pandemic. DESIGN In a retrospective cohort study, decedent records in three acute care hospitals were abstracted, generating a prepandemic (November 2019-February 2020) group (pre-COVID) and two intrapandemic (March-August 2020, wave 1) groups, one without (COVID-ve) and one with COVID-19 infection (COVID+ve). Control group decedents were matched 2:1 on age, sex and care service (medicine/intensive care unit (ICU)) with COVID+ve decedents. SETTING Three regional acute care teaching hospitals in Ottawa, Canada PARTICIPANTS: Decedents (N=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170). MAIN OUTCOME MEASURES Data were abstracted regarding demographics, admission comorbidities and symptoms, and EoL medication use; opioid doses were standardised to parenteral morphine equivalent daily dose (MEDD), and the predictors of upper quartile MEDD in the last 24 hours of life were examined in multivariable logistic regression with adjusted ORs (aORs) and 95% CIs. RESULTS The prevalence of dementia (41% vs 28% and 26%, p=0.03), breathlessness (63.5% vs 42% and 47%, p<0.01), cough (40% vs 27% and 19%, p<0.01) and fever (54% vs 9% and 13.5%) was higher in COVID+ve versus pre-COVID and COVID-ve groups, respectively. The median (IQR) of MEDD over the last 72 hours of life was 16.7 (9-36.5) vs 13.5 (5.7-21.8) and 10.5 (5.3-23.8) for COVID+ve versus pre-COVID and COVID-ve groups, respectively, (p=0.007). Male sex, COVID+ve grouping, ICU death and high-flow nasal cannula use predicted upper quartile MEDD dose, aORs (95% CIs): 1.84 (1.05 to 3.22), 2.62 (1.29 to 5.3), 5.14 (2.47 to 10.7) and 1.93 (1.05 to 3.52), respectively. COVID+ve group decedents used highest lorazepam and propofol doses. CONCLUSIONS COVID-19 decedents, particularly those in ICU, required higher EoL opioid and sedating medication doses than matched prepandemic or intrapandemic controls. These findings should inform and guide clinical practice.
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Affiliation(s)
- Peter Lawlor
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Leila Cohen
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | | | - Ella Besserer
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Valérie Gratton
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Medicine, Hopital Monfort, Ottawa, Ontario, Canada
| | - Rebekah Murphy
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Grace Warmels
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Adrianna Bruni
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Monisha Kabir
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Chelsea Noel
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Brandon Heidinger
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Koby Anderson
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | | | - Krista Wooller
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, Division of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Lapenskie
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel Bedard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Paula Enright
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabelle Desjardins
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, Division of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Khadija Bhimji
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Claire Dyason
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Akshai Iyengar
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Sarina Isenberg
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henrique Parsons
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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9
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Heidinger BA, Downar A, Frolic A, Downar J, Isenberg SR. Physician and administrator experience of preparing to implement Ontario's intensive care unit Triage Emergency Standard of Care during the COVID-19 pandemic: a qualitative study. CMAJ Open 2023; 11:E838-E846. [PMID: 37726116 PMCID: PMC10516683 DOI: 10.9778/cmajo.20220168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND As the COVID-19 pandemic created a surge in demand for critical care resources, the province of Ontario, Canada, released the Adult Critical Care Clinical Emergency Standard of Care for Major Surge (Emergency Standard of Care [ESoC]), a triage framework to guide the allocation of critical care resources in the expectation that intensive care units would be overwhelmed. Our aim was to understand physicians' and administrators' experiences and perceptions of planning to implement the ESoC, and to identify ways to improve critical care triage processes for future pandemics. METHODS We conducted semistructured qualitative interviews with critical care, emergency and internal medicine physicians, and hospital administrators from various Ontario health regions who were involved in their hospital's or region's ESoC implementation planning. Interviews were conducted virtually between April and October 2021. We analyzed the data using thematic analysis. RESULTS We conducted interviews with 11 physicians and 10 hospital administrators representing 9 health regions. We identified 4 themes regarding participants' preparation to implement the ESoC: infrastructure to enable effective triage implementation; social, medical and political supports to enable effective triage implementation; moral dimensions of triage implementation; and communication of triage results. Participants outlined administrative and implementation-related improvements that could be provided at the provincial level, such as billing codes for ESoC. They also suggested improving ethical supports for the usability and quality of the ESoC (e.g., designating an ethicist in each region), and ways to improve the efficiency and usability of the tools for assessing short-term mortality risk (e.g., create information technology solutions such as a dashboard). INTERPRETATION The implementation of a jurisdiction-level triage framework poses moral challenges for a health care system, but it also requires dedicated infrastructure, as well as institutional supports. Lessons learned from Ontario's process to prepare for ESoC implementation, as well as participants' suggestions, can be used for planning for current and future pandemics.
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Affiliation(s)
- Brandon A Heidinger
- Bruyère Research Institute (Heidinger, A. Downar, J. Downar, Isenberg), Ottawa, Ont.; Department of Family Medicine (Frolic), McMaster University; Hamilton Health Sciences (Frolic), Hamilton, Ont.; Division of Palliative Care (J. Downar, Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont
| | - Ariane Downar
- Bruyère Research Institute (Heidinger, A. Downar, J. Downar, Isenberg), Ottawa, Ont.; Department of Family Medicine (Frolic), McMaster University; Hamilton Health Sciences (Frolic), Hamilton, Ont.; Division of Palliative Care (J. Downar, Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont
| | - Andrea Frolic
- Bruyère Research Institute (Heidinger, A. Downar, J. Downar, Isenberg), Ottawa, Ont.; Department of Family Medicine (Frolic), McMaster University; Hamilton Health Sciences (Frolic), Hamilton, Ont.; Division of Palliative Care (J. Downar, Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont
| | - James Downar
- Bruyère Research Institute (Heidinger, A. Downar, J. Downar, Isenberg), Ottawa, Ont.; Department of Family Medicine (Frolic), McMaster University; Hamilton Health Sciences (Frolic), Hamilton, Ont.; Division of Palliative Care (J. Downar, Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont
| | - Sarina R Isenberg
- Bruyère Research Institute (Heidinger, A. Downar, J. Downar, Isenberg), Ottawa, Ont.; Department of Family Medicine (Frolic), McMaster University; Hamilton Health Sciences (Frolic), Hamilton, Ont.; Division of Palliative Care (J. Downar, Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont.
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10
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Suleman S, O'Brien JM, McIlduff C, Benson B, Labine N, Khan S, Tse T, Kawchuk J, Kapur P, Abramyk C, Reimche E, Valiani S. Understanding equitable and affirming communication moments and relationship milestones during the intensive care unit journey: findings from stage 1 of a design thinking project. Can J Anaesth 2023; 70:995-1007. [PMID: 37188836 PMCID: PMC10184968 DOI: 10.1007/s12630-023-02456-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/21/2022] [Accepted: 07/06/2022] [Indexed: 05/17/2023] Open
Abstract
PURPOSE Communication is vital to facilitate patient and family-centred care (PFCC) and to build trusting relationships between intensive care unit (ICU) health care providers, the patient, and their loved ones in the ICU. The focus of this investigation was to identify, define, and refine key moments of communication, connection, and relationship building in the ICU through a lens of Equity, Diversity, Decolonization, and Inclusion (EDDI) to encourage meaningful communication and development of trusting relationships. METHODS We conducted 13 journey mapping interviews with ICU health care providers, patients, and their loved ones as the first stage in a design thinking project. We used directed content analysis to identify intersections where principles of EDDI directly or indirectly impacted communication, relationships, and trust throughout the ICU journey. To serve diverse patients and their loved ones, accessibility, inclusivity, and cultural safety were foundational pillars of the design thinking project. RESULTS Thirteen ICU health care providers, patients, and their loved ones participated in journey mapping interviews. We defined and refined 16 communication moments and relationship milestones in the journey of a patient through the ICU (e.g., admission, crises, stabilization, discharge), and intersections where EDDI directly or indirectly impacted communication and connection during the ICU journey. CONCLUSION Our findings highlight that diverse intersectional identities impact communication moments and relationship milestones during an ICU journey. To fully embrace a paradigm of PFCC, consideration should be given to creating an affirming and safe space for patients and their loved ones in the ICU.
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Affiliation(s)
- Salima Suleman
- Speech Language Pathologist, Independent Research Consultant, Edmonton, AB, Canada
| | - Jennifer M O'Brien
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Cari McIlduff
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brittany Benson
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nicole Labine
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sahar Khan
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tiffanie Tse
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joann Kawchuk
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Puneet Kapur
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Candace Abramyk
- Patient and Family Partners, Saskatchewan Center for Patient Oriented Research, Saskatoon, SK, Canada
| | - Eileen Reimche
- Patient and Family Partners, Saskatchewan Center for Patient Oriented Research, Saskatoon, SK, Canada
| | - Sabira Valiani
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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11
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Kiss A, Zhang Q, Carley M, Smith M, Légaré F, Archambault P, Stacey D. Quality of patient decision aids to support the public making COVID-19 decisions: An online environmental scan. PATIENT EDUCATION AND COUNSELING 2023; 114:107797. [PMID: 37244134 PMCID: PMC10197540 DOI: 10.1016/j.pec.2023.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify and appraise the quality of COVID-19 patient decision aids (PtDAs). METHODS We conducted an environmental scan of online publicly available COVID-19 PtDAs. Two reviewers independently searched and extracted data. We calculated median International Patient Decision Aid Standards (IPDAS) scores and proportion scoring > 70% on Patient Education Materials Information Tool (PEMAT) adequate for understandability and actionability. RESULTS Of 876 resources identified, 12 were PtDAs. Decisions focused on initial COVID-19 vaccination series (n = 9), location of care for elderly (n = 2), and social distancing (n = 1). All 12 PtDAs were written materials and two had accompanying videos. The median IPDAS score minimizing risk of biased decisions was 4 of 6 items (IQR 1, range 2-4). For PEMAT, 92% had adequate for understandability and none for actionability. CONCLUSIONS We identified few online publicly available COVID-19 PtDAs and none were about COVID-19 vaccination boosters or treatment. PtDAs scored poorly on actionability and none met all IPDAS criteria for minimizing risk of biased decisions. PRACTICE IMPLICATIONS PtDA developers for COVID-19 and future pandemics should ensure their PtDAs meet all IPDAS criteria for minimizing risk of bias, have adequate scores for actionability, and are disseminated in the A to Z inventory.
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Affiliation(s)
- Alda Kiss
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada
| | - Qian Zhang
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada
| | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Maureen Smith
- Patient Partner and Cochrane Consumer Network Executive, Ottawa, Canada
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Pavillon Landry-Poulin, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Université Laval, Québec, Canada
| | - Patrick Archambault
- Centre de Recherche Intégrée Pour un Système Apprenant en Santé et Services Sociaux, Lévis, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Lévis, Canada; VITAM - Centre de Recherche en Santé Durable, Québec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada.
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12
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Hodiamont F, Schatz C, Schildmann E, Syunyaeva Z, Hriskova K, Rémi C, Leidl R, Tänzler S, Bausewein C. The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care. BMC Palliat Care 2023; 22:36. [PMID: 37024852 PMCID: PMC10077306 DOI: 10.1186/s12904-023-01151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year. METHODS Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10-12/2019 and 10-12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital's cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests. RESULTS Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro). CONCLUSIONS The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Oncological Palliative Care & Charité Comprehensive Cancer Center, Berlin, Germany
| | - Zulfiya Syunyaeva
- Charité Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Berlin, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Susanne Tänzler
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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13
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Zee MS, Bagchus L, Becqué YN, Witkamp E, van der Heide A, van Lent LGG, Goossensen A, Korfage IJ, Onwuteaka-Philipsen BD, Pasman HR. Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study). BMJ Open 2023; 13:e063267. [PMID: 36878652 PMCID: PMC9990162 DOI: 10.1136/bmjopen-2022-063267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands. METHODS An in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis. RESULTS Several aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains. CONCLUSION The palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.
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Affiliation(s)
- Masha S Zee
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
| | - Lotje Bagchus
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
| | - Yvonne N Becqué
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Erica Witkamp
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Liza G G van Lent
- Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands
| | | | - Ida J Korfage
- Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
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14
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Kelly M, Mitchell I, Walker I, Mears J, Scholz B. End-of-life care in natural disasters including epidemics and pandemics: a systematic review. BMJ Support Palliat Care 2023; 13:1-14. [PMID: 33731463 DOI: 10.1136/bmjspcare-2021-002973] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Natural disasters are becoming more frequent and severe, and place additional strains on end-of-life care services and users. Although end-of-life and palliative care are considered essential components of disaster planning and response, there are gaps in understandings about their real-life application, and how natural disasters impact end-of-life care. OBJECTIVE To synthesise existing evidence of the impacts of natural disasters (eg, bushfires, communicable pandemics, etc) on end-of-life care. METHODS A systematic review with a narrative synthesis was undertaken. The review was registered on PROSPERO (registration: CRD42020176319). PubMed, Scopus, PsycINFO, Science Direct and Web of Science were searched for studies published in English between 2003 and 2020, with findings explicitly mentioning end-of-life care impacts in relation to a natural disaster. Articles were appraised for quality using a JBI-QARI tool. RESULTS Thirty-six empirical studies met the inclusion criteria and quality assessment. Findings were synthesised into three key themes: impacts on service provision, impacts on service providers and impacts on service users. This review demonstrates that natural disasters impact profoundly on end-of-life care, representing a stark departure from a palliative care approach. CONCLUSIONS Clinical practitioners, policy makers and researchers must continue to collaborate for viable solutions to achieve universal access to compassionate and respectful end-of-life care, during natural disasters. Using models, policies and practices already developed in palliative care, involving those most impacted in disaster planning and anticipating barriers, such as resource shortages, enables development of end-of-life care policies and practices that can be rapidly implemented during natural disasters.
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Affiliation(s)
- Marguerite Kelly
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Imogen Mitchell
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Iain Walker
- Research School of Psychology, Australian National University, Acton, Australian Capital Territory, Australia
| | - Jane Mears
- School of Social Science, Western Sydney University - Liverpool City Campus, Liverpool, New South Wales, Australia
| | - Brett Scholz
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
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15
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Bzura M, Kubba H, West S, Schramm L, Clay AT, Nilson S. Engagement and attitudes towards advanced care planning in primary care during COVID-19: A cross-sectional survey of older adults. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2152987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Matthew Bzura
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Haidar Kubba
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Steve West
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Lori Schramm
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Adam T. Clay
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Solveig Nilson
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
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16
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Buchman DZ, Lo S, Ding P, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies, and programs and guidelines. Palliat Med 2022; 37:426-443. [PMID: 36522840 PMCID: PMC9760505 DOI: 10.1177/02692163221143153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. AIM To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. DESIGN Scoping review. DATA SOURCES We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. RESULTS Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. CONCLUSIONS Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics.
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Affiliation(s)
- Daniel Z Buchman
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philip Ding
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Naheed Dosani
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
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Sina-Odunsi AJ, Sina-Odunsi AB. COVID-19 and the current state of palliative care in the United States. Health Promot Perspect 2022; 12:273-276. [PMID: 36686046 PMCID: PMC9808903 DOI: 10.34172/hpp.2022.34] [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: 03/31/2022] [Accepted: 08/14/2022] [Indexed: 01/15/2023] Open
Abstract
Palliative care is becoming increasingly pertinent to be strengthened across health systems around the world, and the United States is not an exception. The emergence of the COVID-19 pandemic has disrupted provision and access to palliative care among patients with serious and complex illnesses, critically ill persons, and their families in the United States. Prior to the emergence of the pandemic, the United States faced a number of challenges ranging from racial discrimination, a stressed medical workforce, a lack of passable reimbursement for palliative care, and legal barriers, among others. Unfortunately, these issues have gotten worse amid the pandemic. This further revealed the need to invest more in innovative strategies that will ensure the provision of palliative care services during public health emergencies. In this article, we comment on the current state of palliative care in the United States.
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Affiliation(s)
- Ayobami Jadesola Sina-Odunsi
- All Saints University College of Medicine, Saint Vincent and The Grenadines,Corresponding Author: Ayobami Jadesola Sina-Odunsi, Emails: ,
| | - Ayomide Busayo Sina-Odunsi
- School of Medicine, University of Aberdeen, Aberdeen, United Kingdom,AB Global Health Initiative, Nigeria
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18
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Shin J, Kim Y, Yoo SH, Sim JA, Keam B. Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:150-158. [PMID: 37674665 PMCID: PMC10179996 DOI: 10.14475/jhpc.2022.25.4.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 09/08/2023]
Abstract
Purpose Social distancing and strict visitor restrictions at hospitals have been national policies since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This has challenged the concept of a good death in comfort with the opportunity to say goodbye. Little is known about how these measures have influenced end-of-life (EOL) care among cancer patients who die in acute care hospitals. This study examined changes in the EOL care of cancer patients during the COVID-19 pandemic. Methods We retrospectively analyzed 1,456 adult cancer patients who died in 2019 (n=752) and 2020 (n=704) at a tertiary hospital. Data on EOL care-symptom control and comfort care in an imminently dying state, preparation for death, place of death, and aggressive care in the last month-were reviewed. Results The 1,456 patients had a median age of 67 years, and 62.5% were men. Patients who died in 2020 were more likely to experience agitation or delirium before death (17.2% vs. 10.9%), to use inotropes/vasopressors near death (59.2% vs. 52.3%), and to receive cardiopulmonary resuscitation in their last months (16.3% vs. 12.5%) than those who died in 2019. Additionally, the number of deaths in the emergency room doubled in 2020 compared to 2019 (from 7.1% to 14.1%). Conclusion This study suggests that EOL care for cancer patients who died in a tertiary hospital deteriorated during the COVID-19 pandemic. The implementation of medical care at the EOL and the preferred place of death should be discussed carefully in advance for high-quality EOL care.
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Affiliation(s)
- Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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19
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Barasa L, Shah J, Kihoro I, Shah R, Ali SK. Utilization of Palliative Care Services in Patients with COVID-19 Admitted to an Intensive Care Unit at a Tertiary Hospital in Kenya. J Pain Symptom Manage 2022; 64:e313-e316. [PMID: 35868448 PMCID: PMC9293856 DOI: 10.1016/j.jpainsymman.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/21/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Linda Barasa
- Department of Medicine (L.B., J.S., I.K., R.S., S.K.A.), Aga Khan University, Nairobi, Kenya; Brain and Mind Institute (J.S.), Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Department of Medicine (L.B., J.S., I.K., R.S., S.K.A.), Aga Khan University, Nairobi, Kenya; Brain and Mind Institute (J.S.), Aga Khan University, Nairobi, Kenya
| | - Ikambili Kihoro
- Department of Medicine (L.B., J.S., I.K., R.S., S.K.A.), Aga Khan University, Nairobi, Kenya; Brain and Mind Institute (J.S.), Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Medicine (L.B., J.S., I.K., R.S., S.K.A.), Aga Khan University, Nairobi, Kenya; Brain and Mind Institute (J.S.), Aga Khan University, Nairobi, Kenya
| | - Sayed K Ali
- Department of Medicine (L.B., J.S., I.K., R.S., S.K.A.), Aga Khan University, Nairobi, Kenya; Brain and Mind Institute (J.S.), Aga Khan University, Nairobi, Kenya.
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20
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Werner L, Fischer M, van Oorschot B, Ziegaus A, Schwartz J, Reuters MC, Schallenburger M, Henking T, Neuderth S, Simon S, Bausewein C, Roch C, Neukirchen M. [Generalist palliative care in hospitals during the first wave of the COVID-19 pandemic]. Dtsch Med Wochenschr 2022; 147:e102-e113. [PMID: 36279861 PMCID: PMC9592153 DOI: 10.1055/a-1918-6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the research network of German university palliative care centers (PallPan), as part of Network University Medicine (NUM), recommendations for action were developed in regard to the care provided for seriously ill and dying patients during a pandemic. For this purpose, the experiences and needs of hospital staff working closely with patients outside of specialized palliative care units during the first wave of the COVID-19 pandemic were also examined. MATERIALS AND METHODS Nationwide online survey of 8,882 physicians, nurses and therapists working in acute inpatient care in the period from December 2020 to January 2021 by means of a newly developed and piloted questionnaire on changes, burdens and cooperation with specialized palliative care. Grouping based on the changes in the number of seriously ill and dying people in the first wave of the pandemic. Due to the exploratory character of the survey, the data were analyzed descriptively. RESULTS 505/8882 completed questionnaires were evaluated (5.7 %). 167/505 (33.1 %) of the respondents reported a lower quality of care for the critically ill and dying. 464/505 (91.8 %) reported exemptions in place for visiting the dying. The most frequently mentioned stress factor was the perceived loneliness of the seriously ill and dying 437/505 (86.5 %), followed by stricter hygiene rules 409/505 (81 %), increased workload 372/505 (73.3 %) and perceived psychological stress on relatives and survivors 395/505 (78.2 %). 141/505 (27.9 %) of respondents used Tablet PCs to support patient-family communication. 310/505 (61.4 %) involved palliative care professionals in patient care, and 356/505 (70.5 %) of respondents found other palliative care services helpful. CONCLUSION Experiences and suggestions for improving palliative care in pandemic times are integrated into the PallPan recommendations for action. Family visits should be allowed and supplemented by digital offers. Palliative Care should also be integrated into both pandemic and contingency plans.
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Affiliation(s)
- Liane Werner
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Marius Fischer
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Birgitt van Oorschot
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Anke Ziegaus
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jacqueline Schwartz
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - Marie-Christine Reuters
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - Tanja Henking
- Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Institut für Angewandte Sozialwissenschaften (IFAS), Würzburg
| | - Silke Neuderth
- Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Institut für Angewandte Sozialwissenschaften (IFAS), Würzburg
| | - Steffen Simon
- Zentrum für Palliativmedizin und Centrum für Integrierte Onkologie Aachen Bonn Cologne Düsseldorf (CIO ABCD), Universitätsklinikum Köln, Köln, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU-Klinikum München, Deutschland
| | - Carmen Roch
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland,Klinik für Anästhesie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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21
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Vincent D, Peixoto C, Quinn KL, Kyeremanteng K, Lalumiere G, Kurahashi AM, Gilbert N, Isenberg SR. Virtual home-based palliative care during COVID-19: A qualitative exploration of the patient, caregiver, and healthcare provider experience. Palliat Med 2022; 36:1374-1388. [PMID: 36071621 PMCID: PMC9596681 DOI: 10.1177/02692163221116251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the COVID-19 pandemic, many community palliative healthcare providers shifted from providing care in a patient's home to providing almost exclusively virtual palliative care, or a combination of in-person and virtual care. Research on virtual palliative care is thus needed to provide evidence-based recommendations aiming to enhance the delivery of palliative care during and beyond the pandemic. AIM To explore the experiences and perceptions of community palliative care providers, patients and caregivers who delivered or received virtual palliative care as a component of home-based palliative care during the COVID-19 pandemic. DESIGN Qualitative study using phone and video-based semi-structured interviews. Data were analyzed using thematic analysis. SETTING/PARTICIPANTS A total of 37 participants, including community palliative care patients/caregivers (n = 19) and healthcare providers (n = 18) recruited from sites in Ottawa and Toronto, Ontario, Canada. RESULTS Overall, participants preferred in-person palliative care compared to virtual care, but suggested virtual care could be a useful supplement to in-person care. The findings are presented in three main themes: (1) Impact of COVID-19 pandemic on community palliative care services; (2) Factors influencing transition from exclusively virtual model of care back to a blended model of care; and (3) Recommended uses and implementation of virtual palliative care. CONCLUSIONS Incorporating virtual palliative care into healthcare provider practice models (blended care models) may be the ideal model of care and standard practice moving forward beyond the COVID-19 pandemic, which has important implications toward organization and delivery of community palliative care services and funding of healthcare providers.
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Affiliation(s)
- Daniel Vincent
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | | | - Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | | | - Genevieve Lalumiere
- Regional Palliative Consultation Team, Elizabeth Bruyère Hospital, Ottawa, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Nathalie Gilbert
- Home and Community Care Support Services Champlain, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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22
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Xi Y, Elkana O, Jiao WE, Li D, Tao ZZ. Associations between social support and anxiety during the COVID-19 lockdown in young and middle-aged Israelis: A cross-sectional study. World J Psychiatry 2022; 12:1194-1203. [PMID: 36186497 PMCID: PMC9521534 DOI: 10.5498/wjp.v12.i9.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study examined the associations between social support and anxiety during the coronavirus disease 2019 (COVID-19) in an Israeli sample.
AIM To examine the associations between social support and anxiety during the COVID-19 in an Israeli sample.
METHODS Data for this cross-sectional study were retrieved from an online survey. Linear regression, logistic regression and restricted cubic spline models were conducted to test for associations between social support and anxiety.
RESULTS A total of 655 individuals took part in the present study. In the univariate linear regression model, there is a negative correlation between the Generalized Anxiety Disorder-7 score (GAD-7) and the Multidimensional Perceived Social Support Scale (MSPSS) score. For MSPSS score, the multivariable adjusted regression coefficient and 95% confidence interval (CI) of GAD-7 score were -0.779 (-1.063 to -0.496). In the univariate logistic regression model, there was a negative correlation between anxiety (GAD-7 ≥ 9) and MSPSS score, and there was still a negative correlation in multivariate logical regression analysis. The odds ratios and 95%CI were 0.709 (0.563-0.894).
CONCLUSION Social support was inversely correlated with anxiety during COVID-19 in an Israeli sample.
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Affiliation(s)
- Yang Xi
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yafo, Jaffa 61083, Israel
| | - Wo-Er Jiao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Di Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Ze-Zhang Tao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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23
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Sullivan DR, Iyer AS, Enguidanos S, Cox CE, Farquhar M, Janssen DJA, Lindell KO, Mularski RA, Smallwood N, Turnbull AE, Wilkinson AM, Courtright KR, Maddocks M, McPherson ML, Thornton JD, Campbell ML, Fasolino TK, Fogelman PM, Gershon L, Gershon T, Hartog C, Luther J, Meier DE, Nelson JE, Rabinowitz E, Rushton CH, Sloan DH, Kross EK, Reinke LF. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement. Am J Respir Crit Care Med 2022; 206:e44-e69. [PMID: 36112774 PMCID: PMC9799127 DOI: 10.1164/rccm.202207-1262st] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.
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Dobbs D, Skarha J, Gordon L, Jester DJ, Peterson LJ, Dosa DM. Mortality among Nursing Home Residents Enrolled in Hospice and Hospice Utilization Post-Hurricane Irma. J Palliat Med 2022; 25:1355-1360. [PMID: 35325566 PMCID: PMC9492905 DOI: 10.1089/jpm.2021.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Nursing home (NH) residents are vulnerable to increased mortality after a natural disaster such as hurricanes but the specific vulnerability of NH residents on hospice and the impact on admission to hospice are unknown. Objectives: Exposure to Hurricane Irma (2017) was used to evaluate increased mortality among Florida NH residents by hospice status compared with the same time period in a nonhurricane year. Difference in hospice utilization rates poststorm for short- and long-stay NH residents was also examined. Setting/Subjects: Subject were all Florida NH residents of age 65 years and older utilizing fee-for-service Medicare claims data exposed to Hurricane Irma in 2017 compared with a control group of residents residing at the same NHs in 2015. Analysis: Mortality rates were calculated by hospice status, rates of hospice enrollment, and the corresponding odds ratios (ORs). Results: Hurricane exposure was associated with an increase in mortality 30 days poststorm (OR = 1.12, 95% confidence interval [CI]: 1.00-1.26) but not 90 days poststorm (OR = 1.02, 95% CI: 0.95-1.10) for residents on hospice. For the rate of hospice enrollment poststorm among residents previously not on hospice, there was an increase in odds of enrollment among long-stay residents in 30 days (OR = 1.15, 95% CI: 1.02-1.23) and 90 days (OR = 1.12, 95% CI: 1.05-1.20) but not short-stay residents within 30 (OR = 1.02, 95% CI: 0.91-1.15) and 90 days (OR = 1.07, 95% CI: 0.99-1.15). Conclusion: Mortality in NH residents on hospice care increased in the aftermath of Hurricane Irma. In addition, NH residents not on hospice were more likely to be referred to hospice in the 30 days after the storm.
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Affiliation(s)
- Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Julianne Skarha
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Lily Gordon
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Lindsay J Peterson
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - David M. Dosa
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Providence VAMC, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island, USA
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25
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Gauder S, Pralong A, Rémi C, Hodiamont F, Klinger I, Heckel M, Simon ST, Bausewein C. Development of a national strategy with recommendations for the care of seriously ill and dying people and their relatives in pandemics: A modified Delphi study. Palliat Med 2022; 36:1285-1295. [PMID: 36062725 PMCID: PMC9446431 DOI: 10.1177/02692163221114536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic is a constant challenge for health care systems, also in Germany. Care of seriously ill and dying people and their relatives is often neglected and suffering increased due to sub-optimal symptom management, visiting restrictions and lonely dying. The project "Palliative Care in Pandemics (PallPan)" intended to develop a national strategy including evidence- and consensus-based recommendations for the care of seriously ill and dying people and their relatives during pandemic times in Germany. AIM To reach consensus on evidence-based recommendations for the care of seriously ill and dying people and their relatives in pandemics. METHODS Three-step consensus process comprising two online Delphi rounds and an expert workshop conducted from April to June 2021. One hundred twenty experts from various areas of healthcare, administration, and politics in Germany were included. RESULTS During the consensus-process, pre-formulated evidence-based recommendations were refined step-by-step. This resulted in consensus on 33 recommendations on the topics of "supporting patients and their relatives," "supporting staff," and "supporting and maintaining structures and provision of palliative care." The recommendations address professional carers and various responsibilities on a governmental, federal state and municipal level, and in healthcare facilities. CONCLUSION We provide evidence and consensus-based recommendations for the care of seriously ill and dying people and their relatives in pandemics in Germany. This is an important step towards a pandemic preparedness and hopefully improves the future palliative care response to pandemics.
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Affiliation(s)
- Sonja Gauder
- Department of Palliative Medicine, LMU Munich, Munich University Hospital, Germany
| | - Anne Pralong
- Faculty of Medicine and University Hospital, Department of Palliative Medicine and Center for Integrated Oncology, University of Cologne, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, LMU Munich, Munich University Hospital, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU Munich, Munich University Hospital, Germany
| | - Isabell Klinger
- Department of Palliative Medicine, University Hospital Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, University Hospital Erlangen, Germany
| | - Steffen T Simon
- Faculty of Medicine and University Hospital, Department of Palliative Medicine and Center for Integrated Oncology, University of Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU Munich, Munich University Hospital, Germany
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Klinger I, Heckel M, Shahda S, Kriesen U, Schneider C, Kurkowski S, Junghanss C, Ostgathe C. COVID-19: Challenges and solutions for the provision of care to seriously ill and dying people and their relatives during SARS-CoV-2 pandemic - perspectives of pandemic response team members: A qualitative study on the basis of expert interviews (part of PallPan). Palliat Med 2022; 36:1092-1103. [PMID: 35637612 PMCID: PMC9248004 DOI: 10.1177/02692163221099114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the SARS-CoV-2 pandemic's initial waves, bans on visiting and isolation measures placed limits on providing services for seriously ill and dying people and their relatives. Pandemic response teams at governmental level (macro), at federal state and municipal level (meso) and in healthcare facilities (micro) played their role in pandemic management procedures. AIM To explore pandemic-related challenges and solutions of pandemic response teams regarding the provision of care to seriously ill and dying people and their relatives. Findings were to be integrated into a national strategy (PallPan). DESIGN Semi-structured expert interviews (10/2020-2/2021) analysed via structured content analysis. SETTINGPARTICIPANTS We interviewed 41 members, who discussed the work of 43 German pandemic response teams (micro n = 23; meso n = 20; no members were available at macro level) from 14 German federal states. RESULTS Twenty-nine of 43 teams took account of the needs of seriously ill and dying. Their main challenges resulted from pandemic-related legal requirements in hospitals and long-term care facilities. The implementation of such was in the remits of the meso level. Dysfunctional or non-existent communication between the levels was reported to be challenging. To foster patient-related solutions the micro level pandemic response teams supported individual decisions to enable patient-relative contact for example, visiting and saying goodbye outside, meeting via digital solutions. CONCLUSIONS Pandemic response teams evidently struggled to find appropriate solutions to ease pandemic-related impact on the care of seriously ill and dying patients and their relatives. We recommend bringing palliative care expertise on board.
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Affiliation(s)
- Isabell Klinger
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Maria Heckel, Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, Erlangen, 91054, Germany.
| | - Sophie Shahda
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ursula Kriesen
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Carolin Schneider
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Sandra Kurkowski
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Yim H, Hashmi SS, Dewar B, Dyason C, Kyeremanteng K, Lamb S, Shamy M. “Everything has been tried and his heart can’t recover…”: A Descriptive Review of “Do Everything!” in the Archive of Ontario Consent and Capacity Board. BMC Med Ethics 2022; 23:66. [PMID: 35761229 PMCID: PMC9237977 DOI: 10.1186/s12910-022-00796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers (SDM), though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board (CCB) in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings.
Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs (38/41, 93%), typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed (3/41, 7%), using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases (26/41, 63%), focusing on patients’ “well-being” and “best interests.”
Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable.
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Hasson F, Slater P, Fee A, McConnell T, Payne S, Finlay DA, McIlfatrick S. The impact of covid-19 on out-of-hours adult hospice care: an online survey. BMC Palliat Care 2022; 21:94. [PMID: 35642052 PMCID: PMC9155980 DOI: 10.1186/s12904-022-00985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 04/25/2022] [Indexed: 11/12/2022] Open
Abstract
Background Globally COVID-19 has had a profound impact on the provision of healthcare, including palliative care. However, there is little evidence about the impact of COVID-19 on delivery of out-of-hours specialist palliative care services in the United Kingdom. The aim of the study is to investigate the impact of the COVID-19 pandemic on the delivery of out-of-hours community-based palliative care services. Methods A national online census survey of managers of adult hospices in the United Kingdom was undertaken. Survey were emailed to managers of adult hospices (n = 150) who provided out-of-hours community palliative care services. Fifteen questions related specifically to the impact of COVID-19. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using descriptive content analysis. Results Eighty-one responses to the survey were returned (54% response rate); 59 were complete of which 47 contained COVID-19 data. Findings indicated that COVID-19 impacted on out-of-hours community-based palliative care. To meet increased patient need, hospices reconfigured services; redeployed staff; and introduced new policies and procedures to minimize virus transmission. Lack of integration between charitably and state funded palliative care providers was reported. The interconnected issues of the use and availability of Personal Protective Equipment (n = 21) and infection control screening (n = 12) resulted in changes in nursing practices due to fear of contagion for patients, carers and staff. Conclusions Survey findings suggest that due to increased demand for community palliative care services, hospices had to rapidly adapt and reconfigure services. Even though this response to the pandemic led to some service improvements, in the main, out-of-hours service reconfiguration resulted in challenges for hospices, including workforce issues, and availability of resources such as Personal Protective Equipment. These challenges were exacerbated by lack of integration with wider healthcare services. More research is required to fully understand the implications of such changes on the quality of care provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00985-6.
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Dowling A, Lane H, Haines T. Community preferences for the allocation of scarce healthcare resources during the Covid-19 pandemic: a review of the literature. Public Health 2022; 209:75-81. [PMID: 35849934 PMCID: PMC9212404 DOI: 10.1016/j.puhe.2022.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
Objective The purpose of this thematic review is to examine the literature on the publics’ preferences of scarce medical resource allocation during COVID-19. Study design Literature review. Methods A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles. Results Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members. Conclusion The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.
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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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Légaré F, Stacey D, Forest PG, Archambault P, Boland L, Coutu MF, Giguère AMC, LeBlanc A, Lewis KB, Witteman HO. Shared decision-making in Canada: Update on integration of evidence in health decisions and patient-centred care government mandates. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:22-29. [PMID: 35606312 DOI: 10.1016/j.zefq.2022.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare. Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities. In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute's decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM.
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Affiliation(s)
- France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada.
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Canada; Department of Anesthesiology and Intensive Care Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Laura Boland
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-France Coutu
- Centre for Action in Work Disability Prevention and Rehabilitation affiliated with Hôpital Charles-Lemoyne Research Center, Rehabilitation School, Longueuil Campus - Université de Sherbrooke, Longueuil, Canada
| | - Anik M C Giguère
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Annie LeBlanc
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; University of Ottawa Heart Institute, Ottawa, Canada
| | - Holly O Witteman
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
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Schallenburger M, Reuters MC, Schwartz J, Fischer M, Roch C, Werner L, Bausewein C, Simon ST, van Oorschot B, Neukirchen M. Inpatient generalist palliative care during the SARS-CoV-2 pandemic - experiences, challenges and potential solutions from the perspective of health care workers. Palliat Care 2022; 21:63. [PMID: 35501750 PMCID: PMC9061223 DOI: 10.1186/s12904-022-00958-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has presented major challenges to the health system. Despite high acute case numbers, patients without Covid-19 still need to be cared for. Due to the severity of the disease and a possible stressful overall situation, patients with palliative care needs also require comprehensive care during pandemic times. In addition to specialized palliative care facilities, this also takes place in non palliative care wards. In order to ensure this general palliative care also in pandemic times, the experience of the staff should be used. The aim of this paper is to examine challenges and possible solutions for general palliative care inpatients in relation to the care of seriously ill and dying patients and their relatives. METHODS Qualitative semi-structured focus groups were conducted online for the study. Participants were staff from intensive care or isolation wards or from units where vulnerable patients (e.g. with cognitive impairment) are cared for. The focus groups were recorded and subsequently transcribed. The data material was analysed with the content structuring content analysis according to Kuckartz. RESULTS Five focus groups with four to eight health care professionals with various backgrounds were conducted. Fifteen main categories with two to eight subcategories were identified. Based on frequency and the importance expressed by the focus groups, six categories were extracted as central aspects: visiting regulations, communication with relatives, hygiene measures, cooperation, determination of the patients will and the possibility to say good bye. CONCLUSION The pandemic situation produced several challenges needing specific solutions in order to manage the care of seriously ill and dying patients. Especially visiting needs regulation to prevent social isolation and dying alone. Finding alternative communication ways as well as interprofessional and interdisciplinary cooperation is a precondition for individualised care of seriously ill and dying patients and their relatives. Measures preventing infections should be transparently communicated in hospitals.
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Affiliation(s)
- Manuela Schallenburger
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Marie Christine Reuters
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Marius Fischer
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Carmen Roch
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Liane Werner
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Neukirchen
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany.,Department of Anesthesiology, University Hospital, Heinrich Heine University, Duesseldorf, Germany
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Tracking and predicting COVID-19 radiological trajectory on chest X-rays using deep learning. Sci Rep 2022; 12:5616. [PMID: 35379856 PMCID: PMC8978501 DOI: 10.1038/s41598-022-09356-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/22/2022] [Indexed: 12/29/2022] Open
Abstract
Radiological findings on chest X-ray (CXR) have shown to be essential for the proper management of COVID-19 patients as the maximum severity over the course of the disease is closely linked to the outcome. As such, evaluation of future severity from current CXR would be highly desirable. We trained a repurposed deep learning algorithm on the CheXnet open dataset (224,316 chest X-ray images of 65,240 unique patients) to extract features that mapped to radiological labels. We collected CXRs of COVID-19-positive patients from an open-source dataset (COVID-19 image data collection) and from a multi-institutional local ICU dataset. The data was grouped into pairs of sequential CXRs and were categorized into three categories: ‘Worse’, ‘Stable’, or ‘Improved’ on the basis of radiological evolution ascertained from images and reports. Classical machine-learning algorithms were trained on the deep learning extracted features to perform immediate severity evaluation and prediction of future radiological trajectory. Receiver operating characteristic analyses and Mann-Whitney tests were performed. Deep learning predictions between “Worse” and “Improved” outcome categories and for severity stratification were significantly different for three radiological signs and one diagnostic (‘Consolidation’, ‘Lung Lesion’, ‘Pleural effusion’ and ‘Pneumonia’; all P < 0.05). Features from the first CXR of each pair could correctly predict the outcome category between ‘Worse’ and ‘Improved’ cases with a 0.81 (0.74–0.83 95% CI) AUC in the open-access dataset and with a 0.66 (0.67–0.64 95% CI) AUC in the ICU dataset. Features extracted from the CXR could predict disease severity with a 52.3% accuracy in a 4-way classification. Severity evaluation trained on the COVID-19 image data collection had good out-of-distribution generalization when testing on the local dataset, with 81.6% of intubated ICU patients being classified as critically ill, and the predicted severity was correlated with the clinical outcome with a 0.639 AUC. CXR deep learning features show promise for classifying disease severity and trajectory. Once validated in studies incorporating clinical data and with larger sample sizes, this information may be considered to inform triage decisions.
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Pauli B, Strupp J, Schloesser K, Voltz R, Jung N, Leisse C, Bausewein C, Pralong A, Simon ST. It's like standing in front of a prison fence - Dying during the SARS-CoV2 pandemic: A qualitative study of bereaved relatives' experiences. Palliat Med 2022; 36:708-716. [PMID: 35350933 DOI: 10.1177/02692163221076355] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since the onset of the SARS CoV2 pandemic, protective and isolation measures had a strong impact on the care and support provided to seriously ill and dying people at the end-of-life. AIM Exploring bereaved relatives' experiences of end-of-life care during the SARS-CoV2 pandemic. DESIGN Qualitative interview study with bereaved relatives. PARTICIPANTS Thirty-two relatives of patients who died during the pandemic, regardless of infection with SARS-CoV2. RESULTS Three core categories were identified: needs, burden and best practice. Relatives wished for a contact person responsible for providing information on the medical and mental condition of their family members. The lack of information, of support by others and physical closeness due to the visiting restrictions, as well as not being able to say goodbye, were felt as burdens and led to emotional distress. However, case-by-case decisions were made and creative ways of staying in touch were experienced positively. CONCLUSIONS Our results indicate that the strong need for closeness when a family member was dying could not be met due to the pandemic. This led to suffering that can be prevented. Visits need to be facilitated by making considered decisions on a case-by-case basis. For easy communication with relatives, approaches should be made by healthcare professionals and support for virtual communication should be offered. Furthermore, the results of the study can help to implement or develop ideas to enable dignified farewells even during pandemics.
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Affiliation(s)
- Berenike Pauli
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Karlotta Schloesser
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Germany.,University of Cologne, Faculty of Medicine and University Hospital, Clinical Trials Center (ZKS), Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Health Services Research, Germany
| | - Norma Jung
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, Munich, Germany
| | - Anne Pralong
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Germany
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Campos AT, Dos Santos CH, Gabriel GT, Montevechi JAB. Safety assessment for temporary hospitals during the COVID-19 pandemic: A simulation approach. SAFETY SCIENCE 2022; 147:105642. [PMID: 34955606 PMCID: PMC8692075 DOI: 10.1016/j.ssci.2021.105642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/18/2021] [Accepted: 12/16/2021] [Indexed: 05/15/2023]
Abstract
Amid the devastating effects caused by the pandemic of the new Coronavirus (COVID-19), health leaders around the world are adding efforts to search efficient and effective responses in the fight against the disease. Conventional health centers, such as hospitals and emergency departments have been registering an increase in demand and atypical patterns due to the high transmissibility of the virus. In this context, the adoption of Temporary Hospitals (THs) is effective in trying to relieve conventional hospitals and direct efforts in the treatment of suspected and positive patients for COVID-19. However, some requirements should be considered regarding the processes performed by THs to maintain the health and safety of patients and staff. Based on the literature, we evaluated aspects related to patient safety in THs, especially linked to biosafety of medical facilities, and patient transport and visit. We highlight the analysis of flows and layouts, hospital cleaning and patient care. We described two case studies to demonstrate the proposed approach. As result, simulation tests improved safety metrics, such as waiting time for procedures, movement intensity in each area, length of stay and TH capacity. We conclude that the approach allows us to provide better THs that prevent cross-contamination, provide suitable care, and meet the demand.
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Affiliation(s)
- Afonso Teberga Campos
- Industrial Engineering and Management Institute, Federal University of Itajubá, Av. BPS, 1303 Itajubá, Minas Gerais, Brazil
| | - Carlos Henrique Dos Santos
- Industrial Engineering and Management Institute, Federal University of Itajubá, Av. BPS, 1303 Itajubá, Minas Gerais, Brazil
| | - Gustavo Teodoro Gabriel
- Industrial Engineering and Management Institute, Federal University of Itajubá, Av. BPS, 1303 Itajubá, Minas Gerais, Brazil
| | - José Arnaldo Barra Montevechi
- Industrial Engineering and Management Institute, Federal University of Itajubá, Av. BPS, 1303 Itajubá, Minas Gerais, Brazil
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Psychological impact of COVID-19 pandemic: A cross-sectional study of hospitalized COVID-19 patients in an urban setting, Bangladesh. Heliyon 2022; 8:e09110. [PMID: 35299601 PMCID: PMC8916985 DOI: 10.1016/j.heliyon.2022.e09110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/26/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Aim The deleterious impact of the COVID-19 pandemic on mental health has been reported by earlier studies globally. However, such studies are limited in Bangladesh; therefore, we performed a cross-sectional study to explore the psychological effects of COVID-19 among hospitalized patients. Methodology The cross-sectional study was performed from 1st June to 31st October, 2020, and included a total of 503 real time RT-PCR confirmed stable hospitalized adult (aged ≥18 years) COVID-19 patients using the convenience sampling approach. However, patients with prior mental illness, unstable vital signs, severely ill, oxygen saturation <92%, impaired consciousness were excluded from the study. We collected data by using a semi-structured questionnaire including Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Insomnia Severity Index (ISI-7), and Perceived Stress Scale (PSS-10). Descriptive analysis and multivariable logistic regression were carried out to determine the mental health outcomes. Results The study found that about 42.5 %, 30.7%, 46.7%, and 28.5% of patients suffered from moderate to severe depression, anxiety, stress, and insomnia. The physical symptoms, fever, fatigue, loss of taste or smell, blurred vision, chest pain, and diarrhoea were significantly associated with augmented mental distress among the hospitalized patients. Furthermore, depression, anxiety, stress and insomnia were strongly linked with patients’ education, occupation, infected family members, exposure to COVID-19 patients, smoking, comorbidities, infection among the neighbors or acquaintances, and preexisting stress. Conclusion The negative psychological impact of the COVID-19 pandemic comprising depression, anxiety, insomnia and stress worsened the physical condition of hospitalized COVID-19 patients. These patients' poor mental health status needed to be addressed by devising an integrated approach towards improving patients' wellbeing at the post-COVID period.
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Seibel K, Couné B, Mueller M, Boehlke C, Simon ST, Bausewein C, Becker G. Implementation of an acute palliative care unit for COVID-19 patients in a tertiary hospital: Qualitative data on clinician perspectives. Palliat Med 2022; 36:332-341. [PMID: 35176931 DOI: 10.1177/02692163211059690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, it has become apparent that palliative care has dynamically adapted to the care of dying patients with and without COVID-19 and has developed new forms of collaboration. Evaluation is needed to assess which innovations should be integrated into future pandemic management. AIM To explore the experiences of stakeholders and staff in implementing and operating an ad hoc unit delivering acute palliative care. What lessons were learned? DESIGN Qualitative interview study (German Clinical Trials Register; identifier 22,473) with qualitative content analysis. SETTING/PARTICIPANTS During the first wave of the pandemic, the University Medical Center Freiburg (Germany) established an ad hoc unit delivering acute palliative care for COVID-19 patients likely to die. Nurses from non-palliative areas and the specialist palliative care team formed a new team working together there. Twenty-nine individuals from management and staff of this unit were interviewed. RESULTS Patient care and teamwork were rated positively. Joint familiarization, bedside teaching, and team/management support were evaluated as core elements for success. Challenges for the nurses from non-palliative settings included adapting to palliative care routines and culture of care. The palliative care team had to adjust the high standards of palliative care to pandemic conditions. Due to sufficient hospital-wide capacity, only three COVID-19 patients were treated, significantly fewer than anticipated at planning. CONCLUSIONS Results show the feasibility of an ad hoc COVID-19 acute palliative care unit. In the event of capacity constraints, such a unit can be a viable part of future pandemic management.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Couné
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Mueller
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hohl CM, Rosychuk RJ, Archambault PM, O'Sullivan F, Leeies M, Mercier É, Clark G, Innes GD, Brooks SC, Hayward J, Ho V, Jelic T, Welsford M, Sivilotti MLA, Morrison LJ, Perry JJ. The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study. CMAJ Open 2022; 10:E90-E99. [PMID: 35135824 PMCID: PMC9259439 DOI: 10.9778/cmajo.20210243] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Predicting mortality from COVID-19 using information available when patients present to the emergency department can inform goals-of-care decisions and assist with ethical allocation of critical care resources. The study objective was to develop and validate a clinical score to predict emergency department and in-hospital mortality among consecutive nonpalliative patients with COVID-19; in this study, we define palliative patients as those who do not want resuscitative measures, such as intubation, intensive care unit care or cardiopulmonary resuscitation. METHODS This derivation and validation study used observational cohort data recruited from 46 hospitals in 8 Canadian provinces participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included adult (age ≥ 18 yr) nonpalliative patients with confirmed COVID-19 who presented to the emergency department of a participating site between Mar. 1, 2020, and Jan. 31, 2021. We randomly assigned hospitals to derivation or validation, and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting emergency department and in-hospital mortality in a validation cohort. RESULTS Of 8761 eligible patients, 618 (7.0%) died. The CCEDRRN COVID-19 Mortality Score included age, sex, type of residence, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support. The area under the curve was 0.92 (95% confidence interval [CI] 0.90-0.93) in derivation and 0.92 (95% CI 0.90-0.93) in validation. The score had excellent calibration. These results suggest that scores of 6 or less would categorize patients as being at low risk for in-hospital death, with a negative predictive value of 99.9%. Patients in the low-risk group had an in-hospital mortality rate of 0.1%. Patients with a score of 15 or higher had an observed mortality rate of 81.0%. INTERPRETATION The CCEDRRN COVID-19 Mortality Score is a simple score that can be used for level-of-care discussions with patients and in situations of critical care resource constraints to accurately predict death using variables available on emergency department arrival. The score was derived and validated mostly in unvaccinated patients, and before variants of concern were circulating widely and newer treatment regimens implemented in Canada. STUDY REGISTRATION ClinicalTrials.gov, no. NCT04702945.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont.
| | - Rhonda J Rosychuk
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Patrick M Archambault
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Murdoch Leeies
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Éric Mercier
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Gregory Clark
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Grant D Innes
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Steven C Brooks
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Jake Hayward
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Vi Ho
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Tomislav Jelic
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Michelle Welsford
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Marco L A Sivilotti
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Laurie J Morrison
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Jeffrey J Perry
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
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COVID-19 palliative care toolkit development and military health system deployment. Nurs Outlook 2022; 70:S161-S171. [PMID: 36585063 PMCID: PMC9794907 DOI: 10.1016/j.outlook.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND During the initial phase of the pandemic, we identified a critical gap in the Military Health System's access to palliative care. Our team of nurse scientists and evidence-based practice (EBP) facilitators aimed to develop and implement an evidence-based point of care palliative care toolkit for frontline workers in inpatient settings lacking established palliative care specialists. METHODOLOGY We utilized Melnyk and Fineout-Overholt's (2018) seven-step EBP process. Six central themes were derived from 17 publications providing an evidence-base for toolkit resource selection and development. Our practice change implementation was piloted at a large West Coast military treatment facility. We included iPads in the toolkit for patient communication and palliative mobile application use. RESULTS The most significant finding was the critical and continued need for basic palliative care education and training. Integrating the palliative care toolkit into daily practice was promising yet challenging due to the high volume of deployed medical staff.
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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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Connolly M, Bell M, Lawler F, Timmins F, Ryder M. Hospital-Based Palliative and End-of-Life Care in the COVID-19 Pandemic: A Scoping Review. Am J Hosp Palliat Care 2021; 39:1105-1120. [PMID: 34894772 PMCID: PMC9386368 DOI: 10.1177/10499091211057049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim: To identify the nature of the evidence reporting hospital-based palliative and end-of-life care during the COVID-19 pandemic. Background: The COVID-19 pandemic has seen an increase in the numbers of seriously ill people being cared for across all health services worldwide. Due to the rapid progression of severe symptoms, the majority of staff working in hospitals and other healthcare centres were providing end-of-life care. Little is known about the level of hospital-based palliative care service provided during the COVID-19 pandemic, particularly during surges in admission rates with an increased number of deaths accruing. Methods: A scoping review was conducted to search and select potential studies. The scoping review was guided by the framework of Arskey and O’Malley and advanced by the use of the methodology of the Joanna Briggs Institute. Results: Eighteen studies published between March 2020 and July 2021 were identified. Three broad categories included overall management strategy and logistics, symptom prevalence and management of patients with COVID-19 and end-of-life care needs within the current pandemic. Conclusions: This review highlights increased awareness and knowledge of palliative and end-of-life care provided in hospitals. The review also highlights the response of hospital-based palliative care teams to an evolving crisis, within the context of developed health systems under sustained and overwhelming pressure. Implications: Newly established clinical links and referral pathways developed during the initial COVID-19 surge between hospital-based palliative care and other healthcare teams, be continued and further enhanced. Understanding of the role of specialist palliative care providers in supporting palliative and end-of-life care within the hospital setting needs further investigation.
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Affiliation(s)
- Michael Connolly
- Clinical Nursing, School of Nursing, Midwifery & Health Systems, 8797University College Dublin, Ireland.,8870Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Mary Bell
- 8870Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Fiona Lawler
- 8870Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Fiona Timmins
- Nursing and Head of School, School of Nursing, Midwifery & Health Systems, 8797University College Dublin, Dublin, Ireland
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, 8797University College Dublin, Dublin, Ireland
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Shapiro GK, Tong E, Nissim R, Zimmermann C, Allin S, Gibson J, Li M, Rodin G. Exploring key stakeholders' attitudes and opinions on medical assistance in dying and palliative care in Canada: a qualitative study protocol. BMJ Open 2021; 11:e055789. [PMID: 34862301 PMCID: PMC8646969 DOI: 10.1136/bmjopen-2021-055789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services. METHODS AND ANALYSIS A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25-30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels. ETHICS AND DISSEMINATION This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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de Lasa C, Brown EE, Colman R, Rajji TK, Colman S. Invited letter: Integrated palliative care in a geriatric mental health setting during the COVID-19 pandemic. Int J Geriatr Psychiatry 2021; 37:10.1002/gps.5654. [PMID: 34792225 PMCID: PMC8646403 DOI: 10.1002/gps.5654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Cristina de Lasa
- Division of Medicine in PsychiatryCentre for Addiction and Mental HealthTorontoCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoCanada
| | - Eric E. Brown
- Division of Adult Neurodevelopment and Geriatric PsychiatryCentre for Addiction and Mental HealthTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Rebecca Colman
- Divisions of Respirology and Division of Palliative MedicineDepartment of MedicineUniversity of TorontoTorontoCanada
- Temmy Latner Centre for Palliative CareSinai Health SystemTorontoCanada
| | - Tarek K. Rajji
- Division of Adult Neurodevelopment and Geriatric PsychiatryCentre for Addiction and Mental HealthTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
- Toronto Dementia Research AllianceUniversity of TorontoTorontoCanada
| | - Sarah Colman
- Division of Adult Neurodevelopment and Geriatric PsychiatryCentre for Addiction and Mental HealthTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
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de Boer M, Coghlan RJ, Russell B, Philip JAM. The underrepresentation of palliative care in global guidelines for responding to infectious disease outbreaks: a systematic narrative review. Int Health 2021; 14:453-467. [PMID: 34750636 PMCID: PMC9450641 DOI: 10.1093/inthealth/ihab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/11/2021] [Accepted: 10/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The importance of palliative care provision has been highlighted in previous humanitarian emergencies. This review aimed to examine the breadth and depth of palliative care inclusion within global guidelines for responding to infectious disease outbreaks. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic searches of MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, PsychInfo and grey literature were performed. Inclusion criteria were guidelines (recommendations for clinical practice or public health policy) for responding to infectious disease outbreaks in the general adult population. Results were limited to the English language, between 1 January 2010 and 17 August 2020. Analysis of the included articles involved assessing the breadth (number of palliative care domains covered) and depth (detail with which the domains were addressed) of palliative care inclusion. RESULTS A total of 584 articles were retrieved and 43 met the inclusion criteria. Two additional articles were identified through handsearching. There was limited inclusion of palliative care in the guidelines examined. CONCLUSIONS There is an opportunity for the development of guidelines that include information on palliative care implementation in the context of infectious disease outbreaks in order to reduce the suffering of key vulnerable populations worldwide.
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Affiliation(s)
- Meghan de Boer
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Building 181, University of Melbourne, Grattan St, Melbourne, Victoria, Australia, 3010
| | - Rachel J Coghlan
- Centre for Humanitarian Leadership, Deakin University, 221 Burwood Highway, Burwood Victoria, Australia, 3125
| | - Bethany Russell
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065.,Department of Palliative Care, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065
| | - Jennifer A M Philip
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065.,Department of Palliative Care, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065.,Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, Victoria, Australia, 3000.,Department of Palliative Care, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
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Rosa WE, Buck HG, Squires AP, Kozachik SL, Huijer HAS, Bakitas M, Boit JM, Bradley PK, Cacchione PZ, Chan GK, Crisp N, Dahlin C, Daoust P, Davidson PM, Davis S, Doumit MAA, Fink RM, Herr KA, Hinds PS, Hughes TL, Karanja V, Kenny DJ, King CR, Klopper HC, Knebel AR, Kurth AE, Madigan EA, Malloy P, Matzo M, Mazanec P, Meghani SH, Monroe TB, Moreland PJ, Paice JA, Phillips JC, Rushton CH, Shamian J, Shattell M, Snethen JA, Ulrich CM, Wholihan D, Wocial LD, Ferrell BR. American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access. Nurs Outlook 2021; 69:961-968. [PMID: 34711419 PMCID: PMC8717680 DOI: 10.1016/j.outlook.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 01/19/2023]
Abstract
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.
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Affiliation(s)
- William E Rosa
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel; Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel.
| | - Harleah G Buck
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | | | | | - Huda Abu-Saad Huijer
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | | | | | | | | | | | | | | | - Patricia M Davidson
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | | | | | - Keela A Herr
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | | | - Tonda L Hughes
- Global Nursing & Health Expert Panel; Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel
| | | | | | | | | | | | | | | | | | | | | | | | - Todd B Monroe
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | - Patricia J Moreland
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | - J Craig Phillips
- Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel
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Rao SR, Rao KS, Singhai P, Gupta M, Rao S, Shanbhag V, Balakrishnan JM, Acharya RV, Varma M, Saravu K, Munikrishna R, Thomas J, Muthanna CG, Shetty A, Rao SK, Salins N. COVID-19 Palliative and End-of-Life Care Plan: Development and Audit of Outcomes. Indian J Palliat Care 2021; 28:272-279. [PMID: 36072250 PMCID: PMC9443125 DOI: 10.25259/ijpc_59_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/17/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Palliative care (PC) referral in serious and critical COVID-19 improves decision-making, health resource utilisation, end-of-life symptom management and family support. In this study, we explored developing a systematic decision-making matrix for PC referral in COVID-19 and audited its outcomes. Materials and Methods: A team of interdisciplinary experts developed a hospital COVID-19 PC plan. PC referral and outcomes of PC referral in hospitalised COVID-19 patients were audited. Results: Out of 1575 inpatients, 1066 (67.7%) had mild and 509 (32.3%) had serious and critical COVID-19 illness. Among 50 (3.1%) referred to PC, 5 (0.4%) had mild and 45 (8.8%) had serious and critical COVID-19 illness. Out of 45 serious and critical COVID-19 patients referred to PC, 38 (84%) received end-of-life care (EOLC), 4 (9%) self-discharged against medical advice and 3 (7%) recovered. Forty-seven (94%) were referred for goals-of-care discussion. About 78% received opioids, 70% benzodiazepines and 42% haloperidol for symptom management. Among 45 serious and critical COVID-19 patients referred to PC, foregoing life-sustaining treatment was documented in 43 (96%) but implemented only in 23 (53%). Out of 38 who received EOLC, ICU was the place of death in 31 (82%) and ward in 7 (18%). Conclusion: Despite interdisciplinary experts developing a hospital COVID-19 PC, low referral of serious and critical COVID-19 patients to PC was observed. PC referral enabled access to management of end-of-life symptoms and facilitated limitation of life-sustaining treatment in some COVID-19 patients with serious illness. Educating critical care physicians about the scope of PC in the COVID-19 setting might improve PC referral.
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Affiliation(s)
- Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Krithika S. Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Pankaj Singhai
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Mayank Gupta
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Shwetapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Jayaraj Mymbilly Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Raviraja V. Acharya
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Muralidhar Varma
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Kavitha Saravu
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
| | - Rahul Munikrishna
- Department of Healthcare Operations, Kasturba Hospital, Manipal, Karnataka, India,
| | - Jibu Thomas
- Department of Healthcare Operations, Kasturba Hospital, Manipal, Karnataka, India,
| | - C. G. Muthanna
- Department of Healthcare Operations, Kasturba Hospital, Manipal, Karnataka, India,
| | - Avinash Shetty
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Sharath Kumar Rao
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India,
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Buchman DZ, Ding P, Lo S, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use substances during communicable disease epidemics and pandemics: a scoping review protocol. BMJ Open 2021; 11:e053124. [PMID: 34706961 PMCID: PMC8551744 DOI: 10.1136/bmjopen-2021-053124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Communicable disease epidemics and pandemics magnify the health inequities experienced by marginalised populations. People who use substances suffer from high rates of morbidity and mortality and should be a priority to receive palliative care, yet they encounter many barriers to palliative care access. Given the pre-existing inequities to palliative care access for people with life-limiting illnesses who use substances, it is important to understand the impact of communicable disease epidemics and pandemics such as COVID-19 on this population. METHODS AND ANALYSIS We will conduct a scoping review and report according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. We conducted a comprehensive literature search in seven bibliographical databases from the inception of each database to August 2020. We also performed a grey literature search to identify the publications not indexed in the bibliographical databases. All the searches will be rerun in April 2021 to retrieve recently published information because the COVID-19 pandemic is ongoing at the time of this writing. We will extract the quantitative data using a standardised data extraction form and summarise it using descriptive statistics. Additionally, we will conduct thematic qualitative analyses and present our findings as narrative summaries. ETHICS AND DISSEMINATION Ethics approval is not required for a scoping review. We will disseminate our findings to healthcare providers and policymakers through professional networks, digital communications through social media platforms, conference presentations and publication in a scientific journal.
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Affiliation(s)
- Daniel Z Buchman
- Bioethics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Philip Ding
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Samantha Lo
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Naheed Dosani
- Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, University Health Network, Toronto, Ontario, Canada
| | - Sarina R Isenberg
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheryl Spithoff
- Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alissa Tedesco
- Inner City Health Associates, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
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Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States. ACTA ACUST UNITED AC 2021; 57:medicina57101123. [PMID: 34684160 PMCID: PMC8540351 DOI: 10.3390/medicina57101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Ambulatory (outpatient) healthcare organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to sustain a continuity of palliative care. Continuance of palliative care during major crises has been previously accomplished; however, the global pandemic presents new challenges to the US healthcare industry. Materials and methods: This systematic review queried four research databases to identify applicable studies related to the provision of palliative care during the pandemic in outpatient organizations within the United States. Results: There are two primary facilitators for the ongoing provision of palliative care for the outpatient segment of the United States healthcare industry: technology and advanced care planning. Researchers also identified two primary barriers in the outpatient setting impacting the continuance of palliative care: lack of resources and accessibility to care. Conclusions: This systematic review identified facilitators and barriers for palliative care initiatives in the United States that can further assist future outpatient (ambulatory care) providers at a global level as the pandemic and associated public health initiatives continue.
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49
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Porter B, Zile A, Peryer G, Farquhar M, Sanderson K. The impact of providing end-of-life care during a pandemic on the mental health and wellbeing of health and social care staff: Systematic review and meta-synthesis. Soc Sci Med 2021; 287:114397. [PMID: 34537656 PMCID: PMC8445829 DOI: 10.1016/j.socscimed.2021.114397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/24/2021] [Accepted: 09/12/2021] [Indexed: 01/10/2023]
Abstract
Background Disease outbreaks and disasters can result in excess deaths and severe disruption of usual end-of-life care processes. We aimed to: i) synthesise evidence describing the experiences of health and social care staff providing end-of-life care during a disease outbreak or humanitarian disaster, ii) understand the impact on their mental health and wellbeing and, iii) identify means of support. Methods A systematic review with meta-synthesis was conducted including studies of health and social care staff providing end-of-life care during disease outbreaks (Ebola, COVID-19, SARs, MERs) or humanitarian disasters (2001–2020). MEDLINE (Ovid), Embase, PsycInfo, Web of Science, and grey literature databases were searched systematically, with forward and backward citation searching of included studies. Any research study designs, in any care settings, were included. Study quality was assessed using an appraisal tool relevant to each study design. Qualitative meta-synthesis was used to analyse the findings, which were then reported narratively. PROSPERO registration: CRD42020181444. Results Nineteen studies were included, including 10 Ebola studies and two COVID-19 studies. The analysis generated two superordinate themes: individual experience and organisational responsibilities. Individual experience comprised four themes: dignity in death, positive experiences, negative experience and support for staff. Organisational responsibilities comprised four themes: preparation, adaption, resources, and Personal Protective Equipment (PPE). Discussion No studies quantitively measured the impact of providing end-of-life care on staff mental health and wellbeing, however qualitative studies described experiences in varied settings. Serious disease outbreaks and disasters can expose care staff to abnormally high levels of mortality and suffering. Health and social care systems need to proactively prepare for future events and enable peer support mechanisms that may help mitigate experiences of psychological distress in humanitarian crises.
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Affiliation(s)
- Bryony Porter
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Amy Zile
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Kristy Sanderson
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
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Pastrana T, De Lima L, Pettus K, Ramsey A, Napier G, Wenk R, Radbruch L. Impact of COVID-19 Pandemic on Palliative Care Workers: An International Cross-sectional Study. Indian J Palliat Care 2021; 27:299-305. [PMID: 34511800 PMCID: PMC8428902 DOI: 10.25259/ijpc_6_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The COVID-19 pandemic and the measures taken to mitigate spread have affected countries in different ways. Healthcare workers, in particular, have been impacted by the pandemic and by these measures. This study aims to explore how COVID-19 has impacted on palliative care (PC) workers around the world. Materials and Methods: Online survey to members of the International Association for Hospice and PC during the initial months of the COVID-19 pandemic. Convenience sampling was used. Statistical descriptive and contingency analyses and Chi-square tests with P < 0.05 were conducted. Results: Seventy-nine participants (RR = 16%) from 41 countries responded. Over 93% of those who provide direct patient care reported feeling very or somewhat competent in PC provision for patients with COVID-19. Eighty-four felt unsafe or somewhat safe when caring for patients with COVID-19. Level of safety was associated with competence (P ≤ 0.000). Over 80% reported being highly or somewhat affected in their ability to continue working in their PC job, providing care to non-COVID patients and in staff availability in their workplace. About 37% reported that availability and access to essential medicines for PC were highly or somewhat affected, more so in low-income countries (P = 0.003). Conclusion: The results from this study highlight the impact of COVID-19 on the provision of PC. It is incumbent on government officials, academia, providers and affected populations, to develop and implement strategies to integrate PC in pandemic response, and preparedness for any similar future events, by providing appropriate and comprehensive education, uninterrupted access to essential medicines and personal protective equipment and ensure access to treatment and care, working together with all levels of society that is invested in care of individuals and populations at large. The long-term effects of the pandemic are still unknown and future research is needed to monitor and report on the appropriateness of measures.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Taxes, United States
| | - Katherine Pettus
- International Association for Hospice and Palliative Care, Houston, Taxes, United States
| | - Alison Ramsey
- International Association for Hospice and Palliative Care, Houston, Taxes, United States
| | - Genevieve Napier
- International Association for Hospice and Palliative Care, Houston, Taxes, United States
| | - Roberto Wenk
- International Association for Hospice and Palliative Care, Houston, Taxes, United States
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, Taxes, United States
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