Abstract Watch: Palliative and end-of-life care in the context of the COVID-19 pandemic

CATCH UP WITH SOME OF OUR ‘PAST POSTS’ – We know you’re super busy and don’t always have the chance to read all our posts. As, sadly, we enter the second wave of the pandemic we hope that this post may be useful to you.

Barry R Ashpole is a Communications Consultant, Educator and Media Specialist from Ontario, Canada, who contributes a bi-annual post for the blog. Here, he presents a selection of articles that focus on the provision and delivery of palliative and end-of-life care in the context of the COVID-19 pandemic – all with links to full-text articles to view or download.


Statue of Guanyin

Kong Meng San Ohor Kark See Buddhist Monastery, Singapore – Barry is in front of the statue of Guanyin, revered by Buddhists as the Goddess of Mercy.

‘Recommendations to leverage the palliative nursing role during COVID-19 and future public health crises,’ Journal of Hospice & Palliative Nursing| Online – 5 June 2020 –Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. The authors provide recommendations for palliative nurses and other healthcare stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19. Full text (click on pdf icon) 

‘Integration of palliative care into COVID-19 pandemic planning,’ BMJ Supportive & Palliative Care| Online – 9 June 2020 – The COVID-19 pandemic is expected to surpass the healthcare system’s capacity to provide intensive care to all patients who deteriorate as a result of the disease. In this review, the authors describe some of the important palliative care (PC) considerations that need to be incorporated into COVID-19 pandemic planning. The main aspects to be considered include decision algorithms for rationing care, training on effective symptoms management, alternative delivery methods of PC services such as telemedicine and finally death and bereavement support for surviving family members who are likely to be isolated from their loved one at the moment of death. Full text.

‘Clinical uncertainty and Covid-19: Embrace the questions and find solutions,’ Palliative Medicine| Online – 10 June 2020 –The one thing we know with certainty about the Covid-19 pandemic, which has arrived in all our lives with devastating force, is how troubling uncertainty associated with this disease can be. A non-exhaustive list of the uncertainties associated with Covid-19 includes uncertainty at the level of the disease and its management, including its prognosis; how health and social care systems and professionals who work within them should respond; how best to communicate with the public and impart information about the illness; and, of central importance, how patients and their families live alongside the “known unknowns” and “unknown unknowns.” Full text

‘The role and response of palliative care and hospice services in epidemics and pandemics: A rapid review to inform practice during the COVID-19 pandemic,’ Journal of Pain & Symptom Management| Online – 8 April 2020 – Hospice and palliative care services have an essential role in the response to COVID-19 by: 1) Responding rapidly and flexibly; 2) Ensuring protocols for symptom management are available, and training non-specialists in their use; 3) Being involved in triage; 4) Considering shifting resources into the community; 5) Considering redeploying volunteers to provide psychosocial and bereavement care; 6) Facilitating camaraderie among staff and adopt measures to deal with stress; 7) Using technology to communicate with patients and carers; and, 8) Adopting standardised data collection systems to inform operational changes and improve care. Full text

‘Pandemic palliative care: Beyond ventilators and saving lives’
Canadian Medical Association Journal, 2020;192(15):E400-E404. Previous mass casualty events have taught us much about how best to triage patients requiring care, and some of this work can be adapted to palliative care (PC); but little has been written on how to manage those who are not offered life-sustaining measures. The authors advise acting now to stockpile medications and supplies used in PC, train staff to meet PC needs, optimize our space, refine our systems, alleviate the effects of separation, have critical conversations and focus on marginalized populations to ensure that all patients are cared for equitably. The SARS-CoV-2 pandemic has been tragic for many people worldwide. Full text.

‘What should palliative care’s response be to the COVID-19 epidemic?’ Journal of Pain & Symptom Management| Online – 27 March 2020 –Widespread transmission of COVID-19 in the U.S. could translate into large numbers of people needing medical care at the same time. This will push many health systems to the point of rationing limited resources such as ICU beds and life sustaining machinery, as has occurred in Italy. Patients and their families at the peak of the pandemic will face symptoms, emotional distress, and decision-making in the face of uncertainty and limited options. No one is more prepared to handle these needs than providers on palliative care (PC) consult teams. However, PC consult teams are themselves a limited resource. Full text.

Clinical Practice/Toolkits

‘Development of a palliative care toolkit for the COVID-19 pandemic,’ Journal of Pain & Symptom Management, published online 23 May 2020. A workgroup of interdisciplinary palliative care clinicians developed the toolkit, consisting of a detailed chapter in a COVID-19 online resource, a mobile and desktop web application, one-page guides, pocket cards and communication skills training videos. Full text

‘Development and implementation of a clinician-facing prognostic communication tool for patients with COVID-19 and critical illness,’ Journal of Pain & Symptom Management, published online 10 May 2020. The authors have developed and implemented a point-of-care prognostic communication tool for clinicians caring for critically ill patients with COVID-19. Full text.

‘Rapid de-escalation and triaging patients in community-based palliative care,’ Journal of Pain & Symptom Management, published online 7 April 2020. This article details recommendations by the Palo Alto Medical Foundation Palliative Care & Support Services team to help triage and coordinate for timely, safe, and effective palliative care in the community and outpatient setting during the ongoing COVID-19 pandemic. Full text.

ICU/Emergency Department

‘Proactive identification of palliative care needs among patients with COVID-19 in the ICU,’ Journal of Pain & Symptom Management, published online 13 June 2020. Given the potentially prolonged duration of the pandemic and the possibility of future patient surges, PC teams should consider implementing a process of proactive screening and outreach to settings in their hospital with high need. Full text.

‘Compassionate communication and end-of-life care for critically ill patients with SARS-Cov-2 infectio,’ Journal of Clinical Ethics, 2020;31(2):RP97-RP-99. This article describes the experiences of clinicians in ICUs in the south of Spain in the hope it will serve to improve the conditions in which these patients die, and to help their families who suffer when they cannot say goodbye to their loved ones. Full text

‘Best case/Worst case: ICU (COVID-19) – A tool to communicate with families of critically ill patients with COVID-19,’ Palliative Medicine Reports, published online 30 April 2020. Palliative care clinicians were asked to bridge a gap in communication between patients’ families and critical care teams, as bedside demands overwhelmed the critical care team’s capacity to provide consistent communication with family. Full text.

Telehealth/Telemedicine

‘Webside manner during the COVID-19 pandemic: Maintaining human connection during virtual visits,’ Journal of Palliative Medicine, published online 11 June 2020. As the death rate numbers related to COVID-19 are in the tens of thousands, clinicians are increasingly tasked with having serious illness conversations.. The authors identify key elements of webside manner helpful when conducting such conversations by virtual visit. Full text

‘Feasibility and acceptability of inpatient palliative care e-family meetings during COVID-19 pandemic,’ Journal of Pain & Symptom Management, published online 4 June 2020. Family meetings likely happened sooner and with far more participants than would have been possible without the use of the technology. While providers expressed limitations in the use of technology, they reported key benefits. Full text

‘National outreach of telepalliative medicine volunteers for a New York City safety net system COVID-19 pandemic response,’ Journal of Pain & Symptom Management, published online 29 May 2020. To the authors’ knowledge, this is the first model to leverage external telepalliative medicine volunteers from across the country for an institutional COVID-19 pandemic response. Full text.  

‘Can video consultations replace face-to-face interviews? Palliative medicine and the COVID-19 pandemic: Rapid review,’ BMJ Supportive & Palliative Care, published online 26 May 2020. While video consultations for palliative care in the U.K. will be a radical change in service delivery, the international evidence appears to support it as effective, accessible, acceptable and cost-effective. Full text. 

‘Rapid implementation of inpatient telepalliative medicine consultations during COVID-19 pandemic,’ Journal of Pain & Symptom Management, published online 10 April 2020. As we plan for decreased provider availability due to quarantine and redeployment and seek to reach increasingly isolated hospitalized patients in the face of COVID-19, the need for telepalliative medicine in the inpatient setting is now clear. Full text.  

Long-Term Care, Nursing & Residential Homes

‘International COVID-19 palliative care guidance for nursing homes leaves key themes unaddressed,’ Journal of Pain & Symptom Management, published online 10 May 202. Essential aspects not fully addressed include: holistic symptom assessment and management at end of life, staff training regarding communication, decision-making and comfort for dying residents, referral to specialist palliative care or hospice, etc., etc. Full text

Paediatric Palliative Care

‘Talking to children about illness and death of a loved one during the COVID-19 pandemic,’ The Lancet Child & Adolescence Health, published online 4 June 2020. In the midst of the devastating death toll and hospitalisations from COVID-19, the psychological effect of this unfolding pandemic on children has been unconscionably overlooked, magnified when someone in the family is hospitalised for or dies from COVID-19. Full text

‘Pediatric palliative care in a pandemic: Role obligations, moral distress, and the care you can give,’ Pediatrics, published online 26 May 2020. The authors present two cases that highlight two different sorts of ethical issues. Both raise challenges for caregivers who are trying to be honest, to deal with their own moral distress, and to provide compassionate palliative care. Full text (click on pdf icon). 

‘A virtual children’s hospice in response to COVID-19: The Scottish experience,’ Journal of Pain & Symptom Management, published online 13 May 2020. Although Children’s Hospices Across Scotland was strategically planning to implement telehospice, COVID-19 accelerated the process. Senior leadership team systematically evaluated its clinical and wrap-around services and rapidly migrated them to a virtual environment. Full text.  

‘Applying palliative care principles to communicate with children about COVID-19,’ Journal of Pain & Symptom Management, published online 31 March 2020. Palliative care teams are wise to encourage families to ground their communication with children on key values: honesty and trust, self-compassion, safety, sensitivity, connection, preparedness, community-building, recognition of death as a part of the lifecycle, and legacy. Full text

Vulnerable Populations

‘The crucial role of nurses and social workers in initiating end-of-life communication to reduce overtreatment in the midst of the COVID-19 pandemic,’ Gerontology, published online 9 June 2020. The COVID-19 epidemic has placed an extraordinary burden on health systems worldwide and reignited awareness of the need for hastier decision-making near the end of life. Full text

‘LGBTQ+ inclusive palliative care in the context of COVID-19: Pragmatic recommendations for clinicians,’ Journal of Pain & Symptom Management, published online 10 May 2020. Although care for LGBTQ+ individuals is no different and requires careful consideration, there is a concerning literature gap related to the health and palliative care of these populations in this context. Full text.

‘The family caregiving crisis meets an actual pandemic,’ Journal of Pain & Symptom Management, published online 10 April 2020. The unprecedented growth in numbers and needs of older adults with serious illness has already necessitated widespread changes in the healthcare system to support caregiving families. The COVID-19 pandemic brings to light how reliant we are on families to support each other during illness. Full text

Advance Care Planning, Advance Medical Directives & Goals-of-Care

‘Reassessing advance care planning in the light of COVID-19,’ British Medical Journal, published on 18 May 2020. Older people and those with frailty are more likely to die from acute infections, such as COVID-19. This has prompted calls internationally for advance care planning in these vulnerable populations, focusing on documenting individuals’ preferences for resuscitation and hospital admission. Full text

‘COVID-19: Don’t apply advance care plans to groups of people, doctors’ leaders warn,’ British Medical Journal, published online 6 April 2020. The joint statement from the Royal College of General Practitioners, British Medical Association, Care Provider Alliance, and Care Quality Commission comes amid concern that GPs are feeling under pressure not to admit their older vulnerable patients to hospital if they contract COVID-19.1Full text

  1. ‘Joint Statement on Advance Care Planning,’ Royal College of General Practitioners, 1 April 2020. Download/view here

‘Goals-of-care in a pandemic: Our experience and recommendations,’ Journal of Pain & Symptom Management, published online 31 March 2020. The authors propose the palliative care team response will occur in two waves: first communication, and second symptom management. Their experience with discussing goals-of-care with the family of a COVID positive patient highlights some expected and unexpected challenges. Full text

Grief & Bereavement

‘Bereavement in the time of Coronavirus: Unprecedented challenges demand novel interventions,’ Journal of Aging & Social Policy, published online 18 May 2020. Persons dying of the virus spend their final days in hospitals and nursing facilities, separated from their families. Their bereaved kin must mourn the loss without the comforting embrace of loved ones. Full text

‘Caring for bereaved family members during the COVID-19 pandemic: Before and after the death of a patient,’ Journal of Pain & Symptom Management, published online 7 May 2020. Given the current COVID-19 pandemic, there is an urgency from a public health perspective to expand bereavement services in an attempt to mitigate poor bereavement outcomes, including prolonged grief disorder, other psychiatric disorders. Full text

‘Bereavement support on the frontline of COVID-19: Recommendations for hospital clinicians,’ Journal of Pain & Symptom Management, published online 3 May 2020. The authors provide evidence-based recommendations and resources for hospital clinicians to mitigate poor bereavement outcomes and support staff. They recommend an organisational and systemic approach, accessing informal and professional support. Full text

‘Grief during the COVID-19 pandemic: Considerations for palliative care providers,’ Journal of Pain & Symptom Management, published online 13 April 2020. The COVID-19 pandemic is anticipated to continue spreading widely across the globe throughout 2020. The authors describe the relationship of the COVID-19 pandemic to anticipatory grief, disenfranchised grief, and complicated grief for individuals, families, and their providers. Full text


Barry Ashpole

Barry R Ashpole.

More about the author
Barry R Ashpole is a Communications Consultant, Educator and Media Specialist. He publishes Media Watch, a weekly compilation of international articles and reports in the fields of healthcare, social services, ethics and law. Barry also teaches frontline care providers about different aspects of palliative care and facilitates workshops on care planning. You can access Media Watch on the International Palliative Care Resources Center website.

Links and resources

Read earlier editions of Abstract Watch on the EAPC blog.

More resources about Coronavirus and the Palliative Care Response on the EAPC website  and our special series on the EAPC blog.

Note: Since publication of this post in July 2020, there have been many more articles published on COVID-19, which are included in Media Watch on the International Palliative Care Resources Center website.

 

This entry was posted in ABSTRACT WATCH, Coronavirus and palliative care, PATIENT & FAMILY CARE and tagged , , . Bookmark the permalink.

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