Professor Scott A Murray (Scotland); Dr Sébastien Moine (France); Professor Yvonne Engels (the Netherlands); Deirdre Shanagher (Ireland) and Dr Maurizio Cancian (Italy) are Members of the European Association for Palliative Care (EAPC) Primary Care Reference Group executive committee. Here they explain how this is the very moment when the experiences, skills and resources of palliative care enthusiasts must come to the fore…
The Covid-19 pandemic is causing distressing deaths in terrible social isolation to tens of thousands. This is a ‘teachable moment’ for health and social care services in every land. A ‘teachable moment’ is the time at which learning a particular idea becomes possible or easiest. (Wikipedia) There is a compelling case. Palliative care services must be scaled up to help people live and die as well as humanly possible. Nations can learn from their experiences of lack of preparation with personal protective equipment (PPE) and diagnostic testing. As palliative care enthusiasts, we must speak out now so that our countries, and practices, can grasp this moment in history.
In 2019, a group of more than 25 general practitioners (GPs) and researchers from throughout Europe, all members of the EAPC Primary Care Reference Group, produced the EAPC Toolkit for integrating palliative care into primary care at national and clinical level. We also made an infographic and a 90-second video to help us advocate for changes in our countries. This toolkit is intensely relevant and gives us an evidence-based and tested structure to meet the COVID-19 challenge with palliative care.
There are four ways to operationalise this public health approach.
- Speak with national and local policy-makers
Explain that palliative care is necessary to prevent suffering and to support the dying, and that it must be available in the community to reach all people. Do this to gain their support to fast-forward the next three steps. (See our toolkit with the many relevant web links).
2. Support education of health and social care staff
Enable them to gain the required skills, confidence and emotional support. The toolkit details recent initiatives. Also, the REDMAP guide for talking about planning care and dying (see video) has been adapted for the COVID-19 epidemic for telephone interviews with high-risk patients in the community, their family carers, care home residents and their relatives. Symptom control guidelines in the community are now available.
3. Design a new way of working in primary care that is fit for purpose, in and outside the pandemic
An excellent evidence-based guide to telephone and video assessment of suspect cases of COVID-19 in 10 minutes is available, and also information on mobile messaging with patients. All people with an underlying health condition are at risk of dying with COVID-19. Practical guidance on identification and care planning are in the toolkit with links updated for COVID-19. Thus, care planning for at-risk people as well as COVID-19 patients can be done remotely, with home or care home visits as clinically needed. Summaries of care plans should be shared electronically with all other health services.
4. Ensure that essential medicines and equipment (including PPE) are available, and evidence-based interventions (testing, tracing and isolating cases) are deployed in all settings
Rules and regulations are being urgently changed to assist this in nursing care homes and residential care facilities where many deaths will happen. Pharmacies must stock medications to cope with a pandemic. Arranging, as far as is humanly possible, safety measures for relatives to be close to dying patients is essential.
There is a great danger, in the heat of the urgent focus on getting equipment and testing, that we will fail to plan to meet the great need for individual care planning and person-centred care that is a necessity around dying. Care planning for all at risk of getting COVID-19, and for those actually with COVID-19, is essential, as well as palliative care for the dying.
Now is the time to take primary palliative care forward. This is the hour. We are the people. We have the tools! Let’s go!
Links and resources (including specific guidelines produced in Africa and India for palliative care in the COVID pandemic)
- EAPC Primary Care Reference Group (with many resources).
- RED-MAP video.
- Summary of UK NICE guidelines for symptom control in the community: http://doi.org/10.1136/bmj.m1461
- Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ 2020; 368: m1182.
- Martinengo L, Spinazze P, Car J. Mobile messaging with patients. BMJ; 368. Epub ahead of print 16 March 2020. DOI: 10.1136/BMJ.M884.
- COVID-19 resources for palliative care across Africa.
- Palliative care guidelines for COVID-19 pandemic in India.
- 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.
More about the authors…
Professor Scott A Murray is Emeritus Professor in Palliative Medicine University of Edinburgh, Primary Palliative Care Research Group, Scotland. Follow Scott on Twitter @scottamurrayed
Dr Maurizio Cancian is a general practitioner in Conegliano, Treviso, Italy. He is a member of the Italian Society of General Medicine ‘Società Italiana di Medicina Generale’ (Frailty and Palliative Care) and the National Palliative Care Association ‘Società Italiana di Cure Palliative’.
Read more posts about Coronavirus and the Palliative Care Response on the EAPC blog. There are more to come…
Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog in the first six months of 2020.