WE’RE DELIGHTED TO PRESENT THIS MONTH’S ‘EDITOR’S CHOICE’ FROM PALLIATIVE MEDICINE, THE OFFICIAL RESEARCH JOURNAL OF THE EAPC
Each month, Professor Catherine Walshe, Editor-in-Chief of ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’, which is Open Access, or EAPC members can access a free copy from the EAPC website.
Today, Claude Chidiac, Lead Nurse Palliative Care, Homerton University Hospital NHS Foundation Trust, London, and Visiting Lecturer, City, University of London, UK, gives the background to his longer article selected as Editor’s Choice in the October issue of ‘Palliative Medicine’.
We are delighted that our paper has been selected as ‘Editor’s choice’, for the October 2020 issue of Palliative Medicine.
During the first peak of the COVID-19 pandemic in the UK, we had to make significant changes to how our hospital-based palliative care service in East London was operating. Our service, like many others, faced a lot of challenges in trying to adapt and respond to the surge of COVID-19 cases. We were still learning form colleagues in Italy and Switzerland about the gravity of the situation and we knew that palliative care was going to be a core aspect of the wider COVID-19 planning. We did not have time to plan, and we had to learn and develop new skills every day as we were experiencing the surge of COVID-19 cases. Our palliative care planning focused on the following domains: developing service capacity, educating the generalist workforce, care of family caregivers, collaborating with community partners, and supporting the workforce.1
We realised that the clinical characteristics of patients referred to us had changed, and that they were deteriorating and dying quickly when compared to before the pandemic. It was from this stance that we decided to evaluate the impact of COVID-19 on clinical characteristics, symptoms, and outcomes of patients referred to our service. This was an important step to inform a responsive and equitable service planning and future research initiatives.
We found that patients with COVID-19 had lower comorbidity scores, with diabetes and hypertension being the most common. They had higher prevalence of symptoms, lower performance status, and deteriorated and died quicker. Although palliative care is often overlooked in humanitarian responses to emergencies and crises, our findings indicate the importance of early referral to palliative care and ensuring that it is visible and embedded within wider COVID-19 planning and response.
We found that patients from Black, Asian and minority ethnic groups, especially women, tended to be referred later to palliative care compared to White ethnic patients, especially during the pandemic. This suggests that COVID-19 may create compounding experiences of inequality for a structurally disadvantaged group or community. While global ethnic health inequalities are widely documented, we need to understand why this is happening in the context of COVID-19. Health inequalities tend to be related to wider societal and structural issues; however, we all have a role to play as researchers, clinicians, services, and organisations.
In order to find solutions to setting up responsive and equitable palliative care services, we need further research on gender bias and palliative care from an intersectional lens. This means that our research approaches in palliative care need to consider the interlocking of social categories such as ethnicity and gender as organising structures of society. They also need to recognise their significance as key components that influence oppression, identity, equality, and the potential for any form of social justice.
- Chidiac C, Feuer D, Naismith J, et al. Emergency Palliative Care Planning and Support in a COVID-19 Pandemic. Journal of palliative medicine. Epub ahead of print 20 April 2020. DOI: 10.1089/jpm.2020.0195.
This post relates to the longer article, ‘The need for early referral to palliative care especially for Black, Asian and minority ethnic groups in a COVID-19 pandemic: Findings from a service evaluation’ by C Chidiac, D Feuer, M Flatley, A Rodgerson, K Grayson and N Preston; published in Palliative Medicine 2020, Vol. 34 (9), pages: 1241–1248. First Published July 31, 2020. Issue published October 1, 2020. https://doi.org/10.1177/0269216320946688
- Read earlier Palliative Medicine ‘Editor’s choice’ posts on the EAPC blog.
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Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog in the second six months of 2020.