CONTINUING OUR NEW SERIES: COVID-19 AND THE PALLIATIVE CARE RESPONSE…
Today’s Guest Writers are Professor Irene J Higginson, OBE, and Dr Mevhibe B Hocaoglu, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, United Kingdom.
Palliative care services have made a tremendous response to help support and care for patients diagnosed with COVID-19.  Patients with COVID-19 often have symptoms that need palliative management.  Palliative care has supported patients, their families as well as healthcare professionals on the frontline  (to read more), although not enough is known about the effectiveness of palliative treatments in controlling symptoms.
As part of the multi-centre cohort study, the ‘Rapid evaluation of the COVID-19 pandemic response in palliative and end of life care: national delivery, workforce and symptom management (CovPall)’, jointly funded by UKRI (UK Research & Innovation) and NIHR (National Institute for Health Research) [COV0011; MR/V012908/1], we collected information about patients seen and supported by palliative care services in England and Wales. Patients had clinically diagnosed and/or test-confirmed COVID-19. Ethical approval was granted from HRA and Health and Care Research Wales (HCRW) Approval (20/NW/0259).
We had a terrific response to this study, which is a tribute to the forethought of palliative care services, their commitment to quality care and to improving care for patients and families. Twenty-nine services stepped forward to take part in the study.
So far, we have information about the symptoms, treatments and symptom severity over time on more than 600 patients. Symptom assessment information is collected using the COVID-19 specific Integrated Palliative Outcome Scale (IPOS)  (POS family of measures can be accessed here, which records common symptoms and other problems as they affect patients on a scale of 0 (no symptom/effect) to 4 (overwhelming symptom).
The data analysis for this study is ongoing; however, we share here some early insights from an interim analysis of a sub-sample of 290 patients, referred to hospital palliative care.
In this group of mostly older patients (mean age 77), there was a median of two comorbidities, hypertension being the most prevalent (41%) (beyond the recent infection of COVID-19). Weakness / lack of energy (72.6%) and breathlessness (60.6%) were the most prevalent severe or moderate symptoms when patients were referred to palliative care. At the first baseline assessment on referral to palliative care, 43% of patients were assessed as being in the dying phase, 29% were deteriorating and 24% were in unstable phases of illness. The group deteriorated very quickly, within 48 hours, following first assessment, more than 50% of the patients referred had died. Preliminary analysis of differences in symptom severity between final and initial assessments shows improvement of symptoms such as breathlessness, pain and anxiety in patients.
These data reveal the rapid way that hospital palliative care both responded to the pandemic, and the speed with which they had to work, caring for a surge in patients who deteriorated quickly. However, the way in which palliative care was overlooked by many governments, led us to develop a detailed action plan for palliative care,  which sets out a seven-point plan to better palliative care.
Making palliative care an integral part of the national health services and pandemic planning, and routinely recording its outcomes, is overdue.
- Ting, R., et al., Palliative care for patients with severe covid-19. BMJ, 2020. 370: p. m2710.
- Lovell, N., et al., Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. Journal of pain and symptom management, 2020. 60(1): p. e77-e81.
- Bajwah, S., et al., Managing the supportive care needs of those affected by COVID-19. European Respiratory Journal, 2020: p. 2000815.
- POS Development Team. Palliative Outcome Scale Family of Measures. April 2021]; Available from: www.pos-pal.org.
- Cicely Saunders International, You Matter Because You Are You: An action plan for better palliative care. 2021. Download a copy here.
Links and resources
- Cicely Saunders Institute
- COVID-19 Resources (Cicely Saunders Institute)
- Coronavirus and the palliative care response: EAPC web page with links to publications and resources.
- Follow us at @CSI_KCL
- ‘Roles and responses of palliative care during the Covid-19 pandemic and beyond’ – video presentation by Prof Irene Higginson at the 11th EAPC World Research Congress Online 2020.
More about the authors…
Professor Irene J Higginson, OBE BMedSci BMBS PhD FMedSci FRCP FFPHM is Executive Dean and Vice Dean for Research (Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care), and Director of Cicely Saunders Institute. Irene has a world leading reputation in the field of palliative care, applied health care and outcomes research. She is active in education and teaching and has extensive experience in leading and delivering national and international multidisciplinary collaborations. Read more.
Dr Mevhibe B Hocaoglu, BSc MSc PhD is a Post-doctoral Research Associate for NIHR SL ARC Palliative and End of Life Care Outcomes Programmed, Rapid evaluation of the COVID-19 pandemic response in palliative and end of life care: national delivery, workforce and symptom management (CovPall), coordinator of the HDR UK Data & Connectivity NCP Project for CovPall-Connect Study and Key CSI Contact of the Palliative care Outcome Scale (POS) Development Team. Read more.
Read more posts on the EAPC blog about Covid-19 and palliative care. We’ve got a great line-up of Guest Writers who will be joining us in the next few weeks.
EXPLORE NEW DIMENSIONS at 17th EAPC World Congress Online with a great line-up of plenary speakers, oral communications, posters and lots of opportunity for online networking, Science Slam, Yoga sessions and much else…