How specialist palliative care services across the world innovated frugally in response to COVID-19


Writing on this blog in May 2020, Catherine Walshe and Nancy Preston introduced the CovPall study, led by Professor Irene Higginson, and invited clinical leads across the globe to take part in a survey to map the response of specialist palliative care providers and hospices to COVID-19. Here, Lesley Dunleavy, Senior Research Associate at the International Observatory on End of Life Care at Lancaster University, UK discusses some of the results from the recently published CovPall study.

Lesley Dunleavy, Senior Research Associate at the International Observatory on End of Life Care at Lancaster University, UK.

I am a researcher who works with Professor Catherine Walshe and Professor Nancy Preston at the International Observatory on End of Life Care at Lancaster University. I worked for many years as a nurse in a hospital and community specialist palliative care team. I had heard from friends and colleagues working in specialist palliative care services how difficult it has been for them working on the ‘front line’ during the pandemic. I was offered the opportunity to work on the CovPall study earlier this year with colleagues from the Cicely Saunders Institute at King’s College London, Hull York Medical School and the University of York. I was keen to be involved in the CovPall study as it has allowed me to combine my skills as a researcher with my previous experience as a specialist palliative care clinician. It has also offered me the opportunity to work with a team of internationally renowned palliative care researchers. 

The overall aims of the CovPall study are to understand the multinational specialist palliative care response to COVID-19. The CovPall study involved an online survey of hospice and specialist palliative care providers. The team at the International Observatory on End of Life care led on mapping and analysing the types of innovations and practice changes developed and implemented by specialist palliative care services in response to COVID-19.

We found that specialist palliative care services have been flexible, highly adaptive and have adopted a low cost ‘frugal innovation’ model when responding to the pandemic.

This included:

  • Being creative by using, adjusting and recombining existing resources, structures, and processes to manage the impact of the crisis.
  • Pooling resources and working collaboratively with other specialist palliative care services, with some services creating a single point of access for patients, family carers and generalist palliative care providers.
  • Hospital specialist palliative care teams implemented a proactive model of care that included developing COVID-19 symptom control guidelines and providing end-of-life care training, such as how to communicate with relatives over the telephone.
  • Services implemented staff wellbeing innovations to help address the fear and anxiety caused by the pandemic. One service reported repurposing a clinic room as a wellbeing space for staff to unwind.
  • Services adopted the use of communication technology so they could continue to provide clinical care. This included raising funds to buy iPads to facilitate ‘virtual visiting’.

Challenges to implementing these innovations included a lack of IT infrastructure and concerns about sustaining out-of-hours cover without adequate funding. It was challenging for services to keep abreast of the ever-changing situation, but there was evidence that services sometimes duplicated guideline, procedure and policy development.

The results of the survey highlighted the need for better financial support but also the need to build organisational resilience and drive forward innovation through greater collaboration. I hope the study findings will be useful for clinicians, service leads and policy makers going forward in the pandemic.

View the full article in pre-print

This post relates to the longer article, ‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multi-national survey (CovPall)’ by L Dunleavy, N Preston, S Bajwah, A Bradshaw, R Cripps, L K Fraser, M Maddocks, M Hocaoglu, F E M Murtagh, A Oluyase, K E Sleeman, I Higginson, C Walshe doi:

Links and resources

Read more posts on the EAPC blog about Covid-19 and palliative care. Next week our guest writer is Dr Wiebke Nehls with a clinician’s view of working on the frontline, and the emotional challenges of the team, in a  specialised lung disease hospital in Berlin, Germany.

SUBMIT YOUR ABSTRACT FOR #EAPC 2021. Have you adopted new ways of working during the pandemic that you’re willing to share with others working in palliative care? Then submit an abstract for the 17th EAPC World  Congress Online. Find out more and Submit an AbstractApply for a 2021 EAPC Researcher Award.

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

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