The challenges of caring for people dying from COVID-19

CONTINUING OUR NEW SERIES: COVID-19 AND THE PALLIATIVE CARE RESPONSE…

On International Women’s Day 2021, we’re delighted to welcome our guest writer, Adejoke O Oluyase, Research Associate at the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, UK, who discusses some of the findings from the CovPall study led by Professor Irene J Higginson.

Dr Adejoke O Oluyase.

During the first quarter of the year 2020, there was increased attention to the intensive care of people with COVID-19, a new disease, that soon became a pandemic. At the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation (CSI), our clinical colleagues described how wards at the local hospital were increasingly becoming COVID wards and the enormous challenges involved in managing patients dying with or from this disease.

I have a pharmacy background and had worked as a researcher at the CSI for several years at the onset of the pandemic. I was very delighted when offered the opportunity to work on the CovPall study by Professor Irene J Higginson, as it allowed me to contribute my pharmacy knowledge and research skills to understand how to improve care for patients and their families.

CovPall is a collaborative project with colleagues from Lancaster University, University of Hull, and the University of York. It aims to understand the response of and challenges for multinational specialist palliative and hospice care during the COVID-19 pandemic, and to identify factors associated with challenges experienced.

We asked palliative care and hospice services to complete an online survey. Four hundred and fifty-eight services completed the survey. We had a balanced mix of services, including roughly equal numbers of charity managed and publicly managed services. Services worked across hospitals, inpatient palliative care units, home care teams, and some provided home nursing. Most services described being overwhelmed by people with COVID-19 while trying also to look after their existing patients. In general, community and hospital palliative care teams had a large surge in patients to care for. Almost all services changed how they worked.

Eighty-one per cent of services cared for patients with suspected or confirmed (by test) COVID-19. Three groups of patients dying from and/or with severe symptoms due to COVID-19 were observed:

  • patients with underlying conditions and/or multimorbid disease not previously known to palliative care (70 per cent of services);
  • patients already known to palliative care services (47 per cent of services); and
  • patients, previously healthy, now dying from COVID-19 (37 per cent of services).

More than three-quarters of services reported having staff with suspected or confirmed COVID-19. Staff described increased workload, concerns for their colleagues who were ill, while spending time struggling to get essential equipment and medicines, and worrying about the financial viability of their service.

Major challenges included shortages: 48 per cent reported shortages of Personal Protective Equipment (PPE); 40 per cent staff shortages; 24 per cent shortages of medicines (top three being levomepromazine, midazolam and alfentanil); 14 per cent shortages of other equipment. Charity managed services were more likely to experience shortages of PPE compared to publicly managed services. Services in the UK were more likely to experience staff shortages compared with those in the rest of Europe or elsewhere in the world.

Taken together, palliative care services responded actively but felt ignored by many national health systems during the COVID-19 pandemic. The crucial role of palliative care during pandemics must be better recognised and integrated. This is particularly the case for charity managed services and those providing care in people’s homes. Alternatives to first line drugs are needed to address medicines shortages.

View the full article in pre-print

This post relates to the longer article, ‘The challenges of caring for people dying from COVID-19: a multinational, observational study of palliative and hospice services (CovPall)’  by AO Oluyase,  M Hocaoglu,  R Cripps,  M Maddocks,  C Walshe,  LK Fraser, N Preston, L Dunleavy, A Bradshaw,   FEM Murtagh, S Bajwah, KE Sleeman,  IJ Higginson. doi: https://doi.org/10.1101/2020.10.30.20221465.

Links and resources

Read more posts on the EAPC blog about Covid-19 and palliative care. Our next guest writer in the series is Dr Ebun Abarshi who will be sharing her experiences of working in a hospice during the Covid-19 pandemic.


EXPLORE NEW DIMENSIONS  17th EAPC World Congress Online  #EAPC2021 – interactive live sessions 6 to 8 October 2021.

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