Understanding and addressing challenges for Advance Care Planning in the COVID-19 pandemic


Today, our guest writer is Andy Bradshaw, Research Fellow in Palliative Care at the Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK, who contributes on behalf of the CovPall study team, led by Professor Irene Higginson.

Andy Bradshaw.

In March, when the first national lockdown occurred, we all witnessed (and continue to witness) the tireless and selfless ways in which frontline workers adapted quickly and innovatively in responding to the pandemic. Having no clinical experience to offer, I felt like a spare part in the palliative care response to COVID-19.

Against this backdrop, I was extremely fortunate to be invited to contribute to the CovPall project. CovPall is a collaborative project with colleagues from King’s College London, University of Hull, Lancaster University, and the University of York. It aims to understand the multinational specialist palliative care response to COVID-19. To do this, we conducted an online survey of hospice and specialist palliative care providers. At the University of Hull, we focused specifically on the challenges experienced, and changes made to support, Advance Care Planning (ACP) during the COVID-19 pandemic.

ACP refers to ongoing discussions that take place between healthcare professionals and patients (and sometimes their trusted family members/friends) regarding the preferences that a person has on their future care. These are important to have because, when conducted well, ACP helps to facilitate a comprehensive and person/family-centred approach to a person’s care. Given that understandings of ACP during COVID-19 are dependent on the cultural and policy contexts in which they are conducted, we focused our analysis on the survey responses of 277 UK palliative and hospice care services.

The results of our study showed that the pandemic intensified some of the already-existing challenges to conducting ACP. These included:

  • Sharing information between services who used different electronic systems
  • Maintaining a personalised approach (particularly when discussing choices related to place of care/death).

Further contributing to these difficulties were COVID-specific challenges to ACP that were directly attributable to the pandemic, such as:

  • Conducting ACP in a national context of fear and uncertainty
  • National policies on social/physical distancing
  • Making complex decisions in the face of a novel disease
  • Communication difficulties (surrounding PPE and social/physical distancing)
  • An abrupt increase in workload and pressure.

In adapting to these challenges, services made changes to the ways in which they conducted ACP. Organisational/structural changes were also made to support ACP. These included:

  • Prioritising specific components of ACP conversations
  • Integrating ACP into everyday practice
  • Having discussions as early as possible
  • Using technology
  • Shifting resources to adapt to an increase in demand
  • Adapting fast through shared learning/collaboration.

In reflecting on these findings, the COVID-19 pandemic has brought into sharp focus the importance of having ACP discussions. Whatever adaptations are made, kept, or dropped as the pandemic continues and eventually passes, it is important that they facilitate high quality, person-centred ACP. This is by ensuring that the starting point of discussions is always the values and priorities of patients themselves, and tailoring ACP to a person’s ethnic, cultural, and religious needs.

The results of this study make the case for policymakers and service providers to urgently consider how these types of ACP discussions can be supported as part of standard care ahead of future or recurrent pandemic waves, and in routine care more generally.

View the full article in pre-print

This post relates to the longer article, ‘Understanding and addressing challenges for Advance Care Planning in the COVID-19 pandemic: An analysis of the UK CovPall survey data from specialist palliative care services’ (https://doi.org/10.1101/2020.10.28.20200725) by A Bradshaw, L Dunleavy, C Walshe, N Preston, R Cripps, MB Hocaoglu, S Bajwah,  M Maddocks,  A Oluyase,  KE Sleeman,  IJ Higginson,  LK Fraser,  FEM Murtagh.

Links and resources

Read more posts on the EAPC blog about Covid-19 and palliative care. Next in our line-up of Guest Writers to this series will be Adejoke O OluyaseResearch Associate at the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, UK. Please email us if you too would like to contribute to the series. 

SUBMIT YOUR ABSTRACT TO 17 TH EAPC WORLD CONGRESS ONLINE – Abstract Submissions deadline: 28 February 2021.


This entry was posted in Advance care planning, Coronavirus and palliative care and tagged . Bookmark the permalink.

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