Rachel Cripps, Simon Etkind, Anna Bone, Adejoke Oluyase, Mevhibe Hocaoglu, Katherine Sleeman and Irene Higginson, King’s College London, Cicely Saunders Institute, London, UK, share the evidence and explain how you can get involved in a new survey.
Clockwise: Katherine Sleeman, Rachel Cripps, Simon Etkind, Mevhibe Hocaoglu, Irene Higginson, Adejoke Oluyase and Anna Bone.
Palliative care and hospice teams are having to make rapid changes in how they deliver care in response to COVID-19. Sound evidence will help guide this response. To this end, we conducted a rapid review of existing evidence evidence on the role and response of palliative care and hospice teams to epidemic/pandemics such as COVID-19.
We included 10 studies from six countries, all but one outside of Europe. The evidence covered Ebola in West Africa, swine flu and SARS in Asia, with one paper reporting the early Italian experience with COVID-19. We drew out the findings and authors’ recommendations, presenting them according to Downar et al’s framework for response to epidemics according to ‘systems’, ‘staff’, ‘space’ and ‘stuff’.
Systems
Pandemics necessitate review and update of clinical policies. In particular, hospital palliative care teams should provide protocols and training for non-specialist staff. Guidelines are required for specific settings, e.g. care homes. To improve communication and coordination, a key decision-maker should be identified, and protocols shared between settings.
Staff
Palliative care staff may need to be re-deployed between palliative care services. Voluntary services may be paused during pandemics, but their skills can still be harnessed, for example by providing psychosocial and bereavement support remotely. Chaplains and psychologists often have skills and experiences in palliative care, and can provide crucial support.
To increase resilience among healthcare professionals, camaraderie should be encouraged to reduce stressors, support staff working outside of their specialist areas and to promote team cohesion. Training in communication and bereavement support should be made available.
Space
Resources should be distributed between healthcare settings according to clinical need. Where new healthcare services emerge, they should include palliative care. Where possible staff should support virtual communication with family members.
Stuff
There needs to be a list of prescribable medications for symptoms such as cough, fever, breathlessness, delirium, anxiety, agitation and pain. There should also be sufficient supply of medications and Personal Protective Equipment.
Understanding the available evidence will not necessarily make the COVID-19 pandemic any less challenging for palliative care. However, having a framework of actions may support palliative and hospice teams to take the best, evidence-based actions to respond, and maintain our crucial specialty in exceptional times.
To learn faster – collaborate…
One of the key findings from our review was that data is vital. The disease is new. We do not know enough about its effects, its symptoms or what treatments work. We recommend that services routinely collect data on: number of patients seen, symptoms, treatments, treatment effectiveness and outcomes. But we believe that more is needed. To learn faster we need to collaborate. For this reason, we are establishing a research collaboration between the Cicely Saunders Institute, the Wolfson Centre for Palliative Care, the International Observatory on End of Life Care, and others, linking with the European Association for Palliative Care.
Hospice and palliative care services survey – get involved…
We want to survey hospices and palliative care services about their response to COVID-19 and, and collect data about the symptoms and treatments used with patients. If you would like to get involved, please contact us at palliativecare@kcl.ac.uk or find more information here.
The rapid review on the role and response of palliative care and hospice services in epidemics and pandemics is available from the Journal of Pain and Symptom Management as a journal pre-proof.
Resources relating to Covid-19 and palliative care in humanitarian emergencies
- Covid-19 resources from Cicely Saunders Institute.
- Coronavirus and the palliative care response: EAPC web page to source and share information, with links to publications and resources including World Health Organization resources, national guidelines, videos, scientific journal collections. Please email us if you have new or updated resources to share.
- Palliative care in humanitarian emergencies – see ‘Integrating palliative care into responses to humanitarian emergencies and crises – a WHO guide’.
- PalCHASE – Palliative Care in Humanitarian Aid Situations and Emergencies network.
- Latest news will continue to be shared on the EAPC Twitter , Facebook, and LinkedIn Join the conversation at #pallicovid
Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog in the first six months of 2020.
Read more posts about Coronavirus and the Palliative Care Response and Palliative Care in Humanitarian Crises on the EAPC blog. There are many more to come, including a follow-up to this post from Professor Catherine Walshe and Professor Nancy Preston of the International Observatory on End of Life Care.
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