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Collingridge Moore D, Garner A, Cotterell N, Harding AJE, Preston N. Long term care facilities in England during the COVID-19 pandemic-a scoping review of guidelines, policy and recommendations. BMC Geriatr 2024; 24:394. [PMID: 38702669 PMCID: PMC11069159 DOI: 10.1186/s12877-024-04867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. AIMS To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. METHOD A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. RESULTS Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. DISCUSSION LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.
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Affiliation(s)
| | - Alex Garner
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
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Shibata M, Otsuka Y, Hagiya H, Koyama T, Kashiwagi H, Otsuka F. Changes in the place of death before and during the COVID-19 pandemic in Japan. PLoS One 2024; 19:e0299700. [PMID: 38416759 PMCID: PMC10901324 DOI: 10.1371/journal.pone.0299700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/13/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND In the global aging, the coronavirus disease 2019 (COVID-19) pandemic may have affected the place of death (PoD) in Japan, where hospital deaths have dominated for decades. We analyzed the PoD trends before and during the COVID-19 pandemic in Japan. METHODS This nationwide observational study used vital statistics based on death certificates from Japan between 1951 and 2021. The proportion of PoD; deaths at home, hospitals, and nursing homes; and annual percentage change (APC) were estimated using joinpoint regression analysis. Analyses were stratified by age groups and causes of death. RESULTS After 2019, home deaths exhibited upward trends, while hospital death turned into downward trends. By age, no significant trend change was seen in the 0-19 age group, while hospital deaths decreased in the 20-64 age group in 2019. The trend change in home death in the ≥65 age group significantly increased since 2019 with an APC of 12.3% (95% confidence interval [CI]: 9.0 to 15.7), while their hospital death trends decreased by -4.0% (95% CI: -4.9 to -3.1) in 2019-2021. By cause of death, home death due to cancer and the old age increased since 2019 with an APC of 29.3% (95% CI: 25.4 to 33.2) and 8.8% (95% CI: 5.5 to 12.2), respectively. CONCLUSION PoD has shifted from hospital to home during the COVID-19 pandemic in Japan. The majority of whom were older population with cancer or old age.
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Affiliation(s)
- Masashi Shibata
- Department of General Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshihiro Koyama
- Department of Pharmaceutical Biomedicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideyuki Kashiwagi
- Department of Transitional and Palliative Care, Iizuka Hospital, Iizuka, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Hockley J, Watson J, Johnston L, Shenkin SD. Practicalities of promoting practice-based learning in end of life care for care home staff: Lessons from "online" supportive conversations and reflection sessions. Int J Older People Nurs 2024; 19:e12598. [PMID: 38268311 DOI: 10.1111/opn.12598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Deaths in care homes and "at home" are anticipated to account for a third of UK deaths by 2040. Currently, palliative and end of life care are not part of statutory training in care homes. Reflective practice is a tool that can facilitate practice-based learning and support. Following a feasibly study to test "online" supportive conversations and reflection sessions (OSCaRS) to support care home staff in relation to death/dying during the first months of the COVID pandemic, a one-year practice development follow-up project was undertaken with the aim to create a team of NHS/specialist palliative care (SPC)-based facilitators to lead and support OSCaRS provision in up to 50 care homes in one region in Scotland-the focus of this paper. METHODS Forty care home managers attended an on-line session explaining the project, with a similar session held for 19 NHS/SPC-based nurses external to care homes. Those interested in facilitating OSCaRS then attended three education sessions. DATA COLLECTED records of all activities; reflective notes on OSCaRS organised/delivered; a summary of each OSCaRS reflection/learning points; final interviews with NHS/SPC trainee facilitators. RESULTS A total of 19 NHS/SPC facilitators delivered one or more OSCaRS in 22 participating care homes. However, as of January 2022 only six trained facilitators remained active. Out of the 158 OSCaRS arranged, 96 took place with a total of 262 staff attending. There were three important aspects that emerged: the role, remit, and resources of NHS/SPC supporting OSCaRS; requirements within care homes for establishing OSCaRS; and, the practice-based learning topics discussed at each OSCaRS. CONCLUSION Attempts to establish a team of NHS/SPC facilitators to lead OSCaRS highlights that end of life care education in care homes does not clearly fall within the contractual remit of either group or risks being missed due to more pressing priorities.
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Affiliation(s)
- Jo Hockley
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Julie Watson
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Lucy Johnston
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Susan D Shenkin
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
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Snijders RAH, Brom L, Simons SO, Langenberg SMCH, van der Linden YM, Raijmakers NJH. Referrals to Palliative Care Services for Hospitalised COVID-19 Patients: A Systematic Literature Review. Am J Hosp Palliat Care 2023:10499091231215797. [PMID: 37975523 DOI: 10.1177/10499091231215797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The increase in the incidence of the coronavirus disease 2019 (COVID-19) led to more hospital admissions and deaths, and coincided with an increased need for palliative care. The new circumstances required palliative care services to be flexible and to develop response strategies. AIM To synthesise studies including COVID-19 patients to gain insight into how many patients were referred to hospital-based palliative care services, the characteristics and palliative care needs of these patients and the reasons for referral. DESIGN A systematic literature search was conducted in January 2022 using the PubMed, Embase, CINAHL, and PsycInfo databases. RESULTS Twenty-seven studies were identified. The results show that in 16% of all COVID-19 inpatients and 55% of all deceased COVID-19 inpatients were referred to a palliative care service. The median time from hospital admission to referral was 4 days and from referral to death was 2 days. COVID-19 inpatients were frequently referred for end-of-life care management (52%), had ≥1 comorbidities (84%), and suffered from shortness of breath/dyspnea (45%). CONCLUSIONS The care provided was generally acute, with a high proportion of end-of-life care referrals and a short time period from hospital admission to referral and from referral to death. This highlights the importance of early integration of palliative care into emergency department (ED) care of critically ill patients.
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Affiliation(s)
- Rolf A H Snijders
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Simone M C H Langenberg
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yvette M van der Linden
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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Bailey C, Guo P, MacArtney J, Finucane A, Meade R, Swan S, Wagstaff E. "Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic. Front Public Health 2023; 11:1139313. [PMID: 38026434 PMCID: PMC10662348 DOI: 10.3389/fpubh.2023.1139313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. Methods A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. Findings A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. Conclusion The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.
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Affiliation(s)
- Cara Bailey
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - Ping Guo
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - John MacArtney
- Unit of Primary Care, University of Warwick, Coventry, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice, Edinburgh, United Kingdom
| | - Richard Meade
- Clinical Psychology, Carers UK, Edinburgh, United Kingdom
| | - Susan Swan
- Maggie's Glasgow, Glasgow, United Kingdom
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Leniz J, Davies JM, Bone AE, Hocaoglu M, Verne J, Barclay S, Murtagh FEM, Fraser LK, Higginson IJ, Sleeman KE. Deaths at home, area-based deprivation and the effect of the Covid-19 pandemic: An analysis of mortality data across four nations. Palliat Med 2023; 37:1034-1039. [PMID: 37088955 PMCID: PMC10125882 DOI: 10.1177/02692163231167212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The number and proportion of home deaths in the UK increased during the Covid-19 pandemic. It is not known whether these changes were experienced disproportionately by people from different socioeconomic groups. AIM To examine the association between home death and socioeconomic position during the Covid-19 pandemic, and how this changed between 2019 and 2020. DESIGN Retrospective cohort study using population-based individual-level mortality data. SETTING/PARTICIPANTS All registered deaths in England, Wales, Scotland and Northern Ireland. The proportion of home deaths between 28th March and 31st December 2020 was compared with the same period in 2019. We used Poisson regression models to evaluate the association between decedent's area-based level of deprivation and risk of home death, as well as the interaction between deprivation and year of death, for each nation separately. RESULTS Between the 28th March and 31st December 2020, 409,718 deaths were recorded in England, 46,372 in Scotland, 26,410 in Wales and 13,404 in Northern Ireland. All four nations showed an increase in the adjusted proportion of home deaths between 2019 and 2020, ranging from 21 to 28%. This increase was lowest for people living in the most deprived areas in all nations, with evidence of a deprivation gradient in England. CONCLUSIONS The Covid-19 pandemic exacerbated a previously described socioeconomic inequality in place of death in the UK. Further research to understand the reasons for this change and if this inequality has been sustained is needed.
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Affiliation(s)
- Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Pontificia Universidad Católica de Chile, Escuela de Medicina, Departamento de Salud Pública, Santiago, Chile
| | - Joanna M Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Harvard Medical School, Blavatnik Institute, Global Health and Social Medicine, Boston, MA, USA
| | - Julia Verne
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Stephen Barclay
- Martin House Research Centre, Department of Health Sciences, University of York, Heslington, York, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Lorna K Fraser
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Aldea-Ramos N, Le Strat Y, Fouillet A. Place of death in France: impact of the first wave (March-May 2020) of the Covid-19 epidemic. BMC Public Health 2023; 23:776. [PMID: 37118715 PMCID: PMC10140713 DOI: 10.1186/s12889-023-15651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The Covid-19 epidemic entailed a major public health issue in France challenging the efficiency of the public health system. The distribution of deaths by place in France may have been affected by the epidemic and mitigation actions. This article presents mortality rate ratios by place of death in France during the first lockdown (17 March - 10 May, 2020) of the Covid-19 epidemic. METHODS We considered five places of death recorded in death certificates. Deaths in 2020 were compared to deaths from 2015 to 2019. We employed quasi-Poisson regressions in order to stablish mortality rate ratios (MRR) during the Covid-19 epidemic, for all-cause and non-Covid-19 deaths. Analysis was conducted in Metropolitan France, and for three groups of regions defined according to the intensity of the first COVID-19 epidemic wave. RESULTS A significant increase in all-cause and non-COVID-19 mortality at home was observed for all age groups. Also, an increase in mortality was observed in nursing homes, mostly due to Covid-19. Non-covid-19 mortality in public hospitals decreased significantly in all the country. These trends were mainly observed for cancers. CONCLUSIONS Overall mortality increased during the first wave of the Covid-19 epidemic. Most Covid-19 deaths took place in public hospitals and nursing homes at old ages. There was a displacement of non-Covid-19 mortality from public hospitals to home and nursing homes, particularly in the most highly exposed area. Among hypotheses to explain such a displacement, population avoidance of hospital care, or redeployment of hospital activity in this emergent context can be cited. Further analysis is needed to understand the reasons of the increase in non-Covid-19 mortality in nursing homes and at home.
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Affiliation(s)
- Néstor Aldea-Ramos
- Division of Data Science, Santé Publique France, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France
| | - Yann Le Strat
- Division of Data Science, Santé Publique France, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France
| | - Anne Fouillet
- Division of Data Science, Santé Publique France, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France.
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Dixon J, Lorenz-Dant K, Stubbs E, Harrison Dening K, Mostaghim M, Casson D. Registered care home managers' experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study. BMC Geriatr 2023; 23:236. [PMID: 37076808 PMCID: PMC10113990 DOI: 10.1186/s12877-023-03935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/26/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Visiting restrictions in care homes in England and many comparable countries during the Covid-19 pandemic were extensive and prolonged. We examined how care home managers experienced, understood and responded to the national care home visiting guidance in England in developing their visiting policies. METHODS A diverse sample of 121 care home managers across England, recruited through varied sources including the NIHR ENRICH network of care homes, completed a 10-item qualitative survey. Follow-up, in-depth qualitative interviews were conducted with a purposive sub-sample of 40 managers. Data were analysed thematically using Framework, a theoretically and methodologically flexible tool for data analysis in multiple researcher teams. FINDINGS Some viewed the national guidance positively; as supporting the restrictive measures they felt necessary to protect residents and staff from infection, or as setting a broad policy framework while allowing local discretion. More commonly, however, managers experienced challenges. These included the guidance being issued late; the initial document and frequent, media-led updates not being user-friendly; important gaps, particularly in relation to dementia and the risks and harms associated with restrictions; guidance being unhelpfully open to interpretation while restrictive interpretations by regulators limited apparent scope for discretion; fragmented systems of local governance and poor central-local coordination; inconsistent access and quality of support from local regulators wider sources of information, advice and support that, while often valued, were experienced as uncoordinated, duplicative and sometimes confusing; and insufficient account taken of workforce challenges. CONCLUSIONS Underlying many of the challenges experienced were structural issues, for which there have been longstanding calls for investment and strategic reform. For increasing sector resilience, these should be are urgently addressed. Future guidance would also be significantly strengthened by gathering better data, supporting well-facilitated peer exchange, engaging the sector more fully and dynamically in policy-making and learning from care home managers' and staff's experiences, particularly of assessing, managing and mitigating the wider risks and harms associated with visiting restrictions.
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Affiliation(s)
- Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Klara Lorenz-Dant
- University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Edmund Stubbs
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Karen Harrison Dening
- De Montfort University, The Gateway, Leicester, LE1 9BH, UK
- Dementia UK, 7th Floor, One Aldgate, London, EC3N 1RE, UK
| | - Manna Mostaghim
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Daniel Casson
- Care England, 2nd Floor, 2 Devonshire Square, London, EC2M 4UJ, UK
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Kirby E, MacArtney JI. Pandemic delay: social implications and challenges for palliative
care. Palliat Care Soc Pract 2023; 17:26323524231159146. [PMID: 36970304 PMCID: PMC10034307 DOI: 10.1177/26323524231159146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
| | - John I MacArtney
- Unit of Academic Primary Care, Division of
Health Sciences, Warwick Medical School, University of Warwick, Coventry,
UK
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Bradshaw A, Ostler S, Goodman C, Batkovskyte I, Ellis-Smith C, Tunnard I, Bone AE, Barclay S, Vernon M, Higginson IJ, Evans CJ, Sleeman KE. Provision of palliative and end-of-life care in UK care homes during the COVID-19 pandemic: A mixed methods observational study with implications for policy. Front Public Health 2023; 11:1058736. [PMID: 36998280 PMCID: PMC10043445 DOI: 10.3389/fpubh.2023.1058736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Little consideration has been given to how the provision of palliative and end-of-life care in care homes was affected by COVID-19. The aims of this study were to: (i) investigate the response of UK care homes in meeting the rapidly increasing need for palliative and end-of-life care during the COVID-19 pandemic and (ii) propose policy recommendations for strengthening the provision of palliative and end-of-life care within care homes. Materials and methods A mixed methods observational study was conducted, which incorporated (i) an online cross-sectional survey of UK care homes and (ii) qualitative interviews with care home practitioners. Participants for the survey were recruited between April and September 2021. Survey participants indicating availability to participate in an interview were recruited using a purposive sampling approach between June and October 2021. Data were integrated through analytic triangulation in which we sought areas of convergence, divergence, and complementarity. Results There were 107 responses to the survey and 27 interviews. We found that (i) relationship-centered care is crucial to high-quality palliative and end-of-life care within care homes, but this was disrupted during the pandemic. (ii) Care homes' ability to maintain high-quality relationship-centered care required key "pillars" being in place: integration with external healthcare systems, digital inclusion, and a supported workforce. Inequities within the care home sector meant that in some services these pillars were compromised, and relationship-centered care suffered. (iii) The provision of relationship-centered care was undermined by care home staff feeling that their efforts and expertise in delivering palliative and end-of-life care often went unrecognized/undervalued. Conclusion Relationship-centered care is a key component of high-quality palliative and end-of-life care in care homes, but this was disrupted during the COVID-19 pandemic. We identify key policy priorities to equip care homes with the resources, capacity, and expertise needed to deliver palliative and end-of-life care: (i) integration within health and social care systems, (ii) digital inclusivity, (iii) workforce development, (iv) support for care home managers, and (v) addressing (dis)parities of esteem. These policy recommendations inform, extend, and align with policies and initiatives within the UK and internationally.
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Affiliation(s)
- Andy Bradshaw
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Sophia Ostler
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Claire Goodman
- Center for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, United Kingdom
| | - Izabele Batkovskyte
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Clare Ellis-Smith
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - India Tunnard
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Anna E. Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Martin Vernon
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
| | - Irene J. Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Catherine J. Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | - Katherine E. Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
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O'Reilly S, Kathryn Carroll H, Murray D, Burke L, McCarthy T, O'Connor R, Kilty C, Lynch S, Feighan J, Cloherty M, Fitzpatrick P, Falvey K, Murphy V, Jane O'Leary M, Gregg S, Young L, McAuliffe E, Hegarty J, Gavin A, Lawler M, Kavanagh P, Spillane S, McWade T, Heffron M, Ryan K, Kelly PJ, Murphy A, Corrigan M, Redmond HP, Redmond P, Walsh PM, Tierney P, Zhang M, Bennett K, Mullooly M. Impact of the COVID-19 pandemic on cancer care in Ireland - Perspectives from a COVID-19 and Cancer Working Group. J Cancer Policy 2023; 36:100414. [PMID: 36841473 PMCID: PMC9951610 DOI: 10.1016/j.jcpo.2023.100414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
Upon the COVID-19 pandemic onset in Ireland, cancer service disruptions occurred due to prioritisation of COVID-19 related care, redeployment of staff, initial pausing of screening, diagnostic, medical and surgical oncology procedures, staff shortages due to COVID-19 infection and impacts on the physical and mental health of cancer healthcare workers. This was coupled with reluctance among people with symptoms suspicious for cancer to attend for clinical evaluation, due to concerns of contracting the virus. This was further compounded by a cyber-attack on national health service IT systems on May 14th 2021. The Irish Cancer Society, a national cancer charity with a role in advocacy, research and patient supports, convened a multi-disciplinary stakeholder group (COVID-19 and Cancer Working Group) to reflect on and understand the impact of the pandemic on cancer patients and services in Ireland, and discuss potential mitigation strategies. Perspectives on experiences were gathered across domains including timeliness of data acquisition and its conversion into intelligence, and the resourcing of cancer care to address cancer service impacts. The group highlighted aspects for future research to understand the long-term pandemic impact on cancer outcomes, while also highlighting potential strategies to support cancer services, build resilience and address delayed diagnosis. Additional measures include the need for cancer workforce recruitment and retention, increased mental health supports for both patients and oncology professionals, improvements to public health messaging, a near real-time multimodal national cancer database, and robust digital and physical infrastructure to mitigate impacts of the current pandemic and future challenges to cancer care systems.
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Affiliation(s)
- Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland; Cancer Trials Ireland, Dublin, Ireland.
| | - Hailey Kathryn Carroll
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Deirdre Murray
- School of Public Health, University College Cork, Cork, Ireland; National Cancer Registry Ireland, Cork, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital and University College Cork, Cork, Ireland
| | | | | | | | - Sonya Lynch
- PPI Contributor c/o Cancer Research, UCC University College Cork, T12 DCA4 Cork, Ireland
| | - Jennifer Feighan
- Irish Nutrition & Dietetic Institute, Airfield Estate, Overend Ave, Dundrum, Dublin, Ireland
| | - Maeve Cloherty
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; National Screening Service, Dublin, Ireland
| | | | | | - Mary Jane O'Leary
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Sophie Gregg
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Leonie Young
- Endocrine Oncology Research Group, Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eilish McAuliffe
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | | | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Mark Lawler
- Faculty of Medicine, Health and Life Sciences, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland, UK; DATA-CAN, the UK's Health Data Research Hub for Cancer, UK
| | - Paul Kavanagh
- National Health Intelligence Unit, Strategy and Research, Jervis House, Jervis St, Health Service Executive, Dublin 1, Ireland
| | - Susan Spillane
- Health Information and Quality Authority, Dublin, Ireland
| | - Terry McWade
- Royal College of Physicians of Ireland, Dublin, Ireland
| | | | - Karen Ryan
- Department of Palliative Medicine, Mater Misericordiae University Hospital and St Francis Hospice Dublin, Ireland
| | - Paul J Kelly
- Bon Secours Radiotherapy Centre, Bon Secours, Cork, Ireland; UPMC Hillman Cancer Centre, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Mark Corrigan
- Department of Breast Surgery, Cork University Hospital, Cork, Ireland
| | - H Paul Redmond
- Department of Breast Surgery, Cork University Hospital, Cork, Ireland
| | - Patrick Redmond
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Mengyang Zhang
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Shin J, Kim Y, Yoo SH, Sim JA, Keam B. Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:150-158. [PMID: 37674665 PMCID: PMC10179996 DOI: 10.14475/jhpc.2022.25.4.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 09/08/2023]
Abstract
Purpose Social distancing and strict visitor restrictions at hospitals have been national policies since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This has challenged the concept of a good death in comfort with the opportunity to say goodbye. Little is known about how these measures have influenced end-of-life (EOL) care among cancer patients who die in acute care hospitals. This study examined changes in the EOL care of cancer patients during the COVID-19 pandemic. Methods We retrospectively analyzed 1,456 adult cancer patients who died in 2019 (n=752) and 2020 (n=704) at a tertiary hospital. Data on EOL care-symptom control and comfort care in an imminently dying state, preparation for death, place of death, and aggressive care in the last month-were reviewed. Results The 1,456 patients had a median age of 67 years, and 62.5% were men. Patients who died in 2020 were more likely to experience agitation or delirium before death (17.2% vs. 10.9%), to use inotropes/vasopressors near death (59.2% vs. 52.3%), and to receive cardiopulmonary resuscitation in their last months (16.3% vs. 12.5%) than those who died in 2019. Additionally, the number of deaths in the emergency room doubled in 2020 compared to 2019 (from 7.1% to 14.1%). Conclusion This study suggests that EOL care for cancer patients who died in a tertiary hospital deteriorated during the COVID-19 pandemic. The implementation of medical care at the EOL and the preferred place of death should be discussed carefully in advance for high-quality EOL care.
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Affiliation(s)
- Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Spacey A, Porter S. Understanding advance care planning in care homes throughout the COVID-19 pandemic: A critical realist review and synthesis. Palliat Med 2022; 37:663-676. [PMID: 36373288 PMCID: PMC9659704 DOI: 10.1177/02692163221137103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted advance care planning discussions in care homes, particularly discussions involving relatives and surrogate decision makers. There is a need to collate and examine current evidence to assess the extent of the problem. AIM To examine the processes and experiences involved in advance care planning in care homes throughout the COVID-19 pandemic. DESIGN A critical realist review and synthesis. DATA SOURCES MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and May 2022. RESULTS Eleven studies were included. Communication difficulties associated with remote technologies meant that care home staff's concerns about engaging effectively with relatives further exacerbated the emotional toll of dealing with high death rates in circumstances where staff shortages stretched the capacity of those remaining to provide timely advance care planning discussions. The threat of the pandemic tended to encourage earlier and more frequent advance care planning discussions, though this tendency was partially countervailed by the difficulties that some residents and relatives had in engaging with remote communication modes. There was evidence that education and training in advance care planning increased staff's confidence and readiness to engage in care planning during pandemic conditions. CONCLUSION Results highlight part of the new context facing staff, relatives and residents in care homes, thus providing valuable insight for future intervention development required to maintain and improve the effectiveness of advance care planning in care homes during and beyond the pandemic.
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Affiliation(s)
- Adam Spacey
- School of Health and Society, University of Salford, Salford, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK
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Sanmarchi F, Esposito F, Adorno E, De Dominicis F, Fantini MP, Golinelli D. The impact of the SARS-CoV-2 pandemic on cause-specific mortality patterns: a systematic literature review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-19. [PMID: 36188447 PMCID: PMC9510758 DOI: 10.1007/s10389-022-01755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022]
Abstract
Background Understanding the effects of the COVID-19 pandemic on cause-specific mortality should be a priority, as this metric allows for a detailed analysis of the true burden of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon. Methods We searched MEDLINE, Scopus, and ProQuest for studies that reported cause-specific mortality during the COVID-19 pandemic, extracting relevant data. Results A total of 2413 articles were retrieved, and after screening 22 were selected for data extraction. Cause-specific mortality results were reported using different units of measurement. The most frequently analyzed cause of death was cardiovascular diseases (n = 16), followed by cancer (n = 14) and diabetes (n = 11). We reported heterogeneous patterns of cause-specific mortality, except for suicide and road accident. Conclusions Evidence on non-COVID-19 cause-specific deaths is not exhaustive. Reliable scientific evidence is needed by policymakers to make the best decisions in an unprecedented and extremely uncertain historical period. We advocate for the urgent need to find an international consensus to define reliable methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01755-7.
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Affiliation(s)
- Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Emanuele Adorno
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco De Dominicis
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
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15
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Goodrich J, Tutt L, Firth AM, Evans CJ, Murtagh FE, Harding R. The most important components of out-of-hours community care for patients at the end of life: A Delphi study of healthcare professionals' and patient and family carers' perspectives. Palliat Med 2022; 36:1296-1304. [PMID: 35766525 PMCID: PMC9446430 DOI: 10.1177/02692163221106284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Community services for palliative patients outside normal working hours are variable and the best evidence-based models of care have not been determined. AIM To establish expert consensus on the most important components of out-of-hours community palliative care services. DESIGN Delphi study. The first round listed 68 components generated from systematic literature reviewing, focus groups with healthcare professionals and input from the project's patient and public involvement advisory group. The components deemed 'essential' by over 70% of participants in the first round were refined and carried forward to a second round, asking participants to rank each on a five-point Likert scale (5 highest to 1 lowest). The consensus threshold was median of 4 to 5 and interquartile range of ⩽1. PARTICIPANTS Community specialist palliative care health professionals, generalist community health professionals and patients and family carers with experience of receiving care out-of-hours at home. RESULTS Fifty-four participants completed round 1, and 44 round 2. Forty-five components met the threshold as most important for providing out-of-hours care, with highest consensus for: prescription, delivery and administration of medicines; district and community nurse visits; and shared electronic patient records and advance care plans. CONCLUSIONS The Delphi method identified the most important components to provide community palliative care for patients out-of-hours, which are often provided by non-specialist palliative care professionals. The importance placed on the integration and co-ordination with specialist palliative care through shared electronic records and advance care plans demonstrates the reassurance for patients and families of being known to out-of-hours services.
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Affiliation(s)
- Joanna Goodrich
- Florence Nightingale Faculty of Nursing Midwifery a Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Lydia Tutt
- Florence Nightingale Faculty of Nursing Midwifery a Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Alice M Firth
- Florence Nightingale Faculty of Nursing Midwifery a Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Catherine J Evans
- Florence Nightingale Faculty of Nursing Midwifery a Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery a Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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16
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Behnke J, Arndt PF, Cekay MJ, Berthold D, Herentin B, Dumitrascu R, Sibelius U, Eul B. Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany. BMC Palliat Care 2022; 21:144. [PMID: 35953820 PMCID: PMC9371950 DOI: 10.1186/s12904-022-01035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective. Methods First, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service. Results The analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033). Conclusions Most COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01035-x.
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Affiliation(s)
- Jonas Behnke
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany.
| | - Philipp Friedrich Arndt
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Michael John Cekay
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Daniel Berthold
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Birgit Herentin
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Rio Dumitrascu
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Ulf Sibelius
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Bastian Eul
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
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Klinger I, Heckel M, Shahda S, Kriesen U, Schneider C, Kurkowski S, Junghanss C, Ostgathe C. COVID-19: Challenges and solutions for the provision of care to seriously ill and dying people and their relatives during SARS-CoV-2 pandemic - perspectives of pandemic response team members: A qualitative study on the basis of expert interviews (part of PallPan). Palliat Med 2022; 36:1092-1103. [PMID: 35637612 PMCID: PMC9248004 DOI: 10.1177/02692163221099114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the SARS-CoV-2 pandemic's initial waves, bans on visiting and isolation measures placed limits on providing services for seriously ill and dying people and their relatives. Pandemic response teams at governmental level (macro), at federal state and municipal level (meso) and in healthcare facilities (micro) played their role in pandemic management procedures. AIM To explore pandemic-related challenges and solutions of pandemic response teams regarding the provision of care to seriously ill and dying people and their relatives. Findings were to be integrated into a national strategy (PallPan). DESIGN Semi-structured expert interviews (10/2020-2/2021) analysed via structured content analysis. SETTINGPARTICIPANTS We interviewed 41 members, who discussed the work of 43 German pandemic response teams (micro n = 23; meso n = 20; no members were available at macro level) from 14 German federal states. RESULTS Twenty-nine of 43 teams took account of the needs of seriously ill and dying. Their main challenges resulted from pandemic-related legal requirements in hospitals and long-term care facilities. The implementation of such was in the remits of the meso level. Dysfunctional or non-existent communication between the levels was reported to be challenging. To foster patient-related solutions the micro level pandemic response teams supported individual decisions to enable patient-relative contact for example, visiting and saying goodbye outside, meeting via digital solutions. CONCLUSIONS Pandemic response teams evidently struggled to find appropriate solutions to ease pandemic-related impact on the care of seriously ill and dying patients and their relatives. We recommend bringing palliative care expertise on board.
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Affiliation(s)
- Isabell Klinger
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Maria Heckel, Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, Erlangen, 91054, Germany.
| | - Sophie Shahda
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ursula Kriesen
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Carolin Schneider
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Sandra Kurkowski
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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18
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Peña-Longobardo LM, Oliva-Moreno J, Rodríguez-Sánchez B. The Effects of Severe Acute Respiratory Syndrome Coronavirus 2 on the Reported Mental Health Symptoms of Nonprofessional Carers: An Analysis Across Europe. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:736-743. [PMID: 35500947 PMCID: PMC8665653 DOI: 10.1016/j.jval.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/30/2021] [Accepted: 10/21/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study tries to analyze how the crisis generated by severe acute respiratory syndrome coronavirus 2 has affected the reported mental health symptoms of informal caregivers in different European countries. METHODS The Survey of Health, Ageing and Retirement in Europe-COVID-19 was used, collecting information from the beginning of June 2020 to August 2020 about individuals' state of health and the care they received. Several probit regression models were used to analyze the differences in the probability of (1) being sad or depressed, (2) being anxious or nervous, (3) having difficulty sleeping, and (4) feeling lonely, between individuals who provided informal care and individuals who did not. Several subanalyses by geographic area, mortality rates due to coronavirus disease 2019 (COVID-19), and long-term care expenditure were also performed. RESULTS Since the outbreak of COVID-19, informal caregivers have had a higher probability of being sad or depressed of 8 percentage points (p.p.), a 7.1 p.p. higher probability of being anxious or nervous, and a 5.9 p.p. higher probability of having difficulty sleeping than non-caregivers. Informal caregivers in Southern Europe have had an 8 p.p. higher probability of being sad or depressed than non-caregivers. In Eastern Europe, this difference in probability reaches 9.7 p.p. Finally, in countries with higher mortality rates due to COVID-19, there have been greater differences in terms of being sad or depressed between caregivers and non-caregivers, regardless of expenditure on long-term care. CONCLUSIONS Since the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers.
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Affiliation(s)
| | - Juan Oliva-Moreno
- Economic Analysis and Finance Department, University of Castilla-La Mancha, Toledo, Spain
| | - Beatriz Rodríguez-Sánchez
- Department of Applied, Public and Political Economics, Faculty of Law, Complutense University of Madrid, Madrid, Spain
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19
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Selman LE, Farnell D, Longo M, Goss S, Seddon K, Torrens-Burton A, Mayland CR, Wakefield D, Johnston B, Byrne A, Harrop E. Risk factors associated with poorer experiences of end-of-life care and challenges in early bereavement: Results of a national online survey of people bereaved during the COVID-19 pandemic. Palliat Med 2022; 36:717-729. [PMID: 35176927 PMCID: PMC9005832 DOI: 10.1177/02692163221074876] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Experiences of end-of-life care and early bereavement during the COVID-19 pandemic are poorly understood. AIM To identify clinical and demographic risk factors for sub-optimal end-of-life care and pandemic-related challenges prior to death and in early bereavement, to inform clinical practice, policy and bereavement support. DESIGN Online national survey of adults bereaved in the UK (deaths between 16 March 2020 and 2 January 2021), recruited via media, social media, national associations and organisations. SETTING/PARTICIPANTS 711 participants, mean age 49.5 (SD 12.9, range 18-90). 628 (88.6%) were female. Mean age of the deceased was 72.2 (SD 16.1, range miscarriage to 102 years). 311 (43.8%) deaths were from confirmed/suspected COVID-19. RESULTS Deaths in hospital/care home increased the likelihood of poorer experiences at the end of life; for example, being unable to visit or say goodbye as wanted (p < 0.001). COVID-19 was also associated with worse experiences before and after death; for example, feeling unsupported by healthcare professionals (p < 0.001), social isolation/loneliness (OR = 0.439; 95% CI: 0.261-0.739), and limited contact with relatives/friends (OR = 0.465; 95% CI: 0.254-0.852). Expected deaths were associated with a higher likelihood of positive end-of-life care experiences. The deceased being a partner or child also increased the likelihood of positive experiences, however being a bereaved partner strongly increased odds of social isolation/loneliness, for example, OR = 0.092 (95% CI: 0.028-0.297) partner versus distant family member. CONCLUSIONS Four clear risk factors were found for poorer end-of-life care and pandemic-related challenges in bereavement: place, cause and expectedness of death, and relationship to the deceased.
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Affiliation(s)
- Lucy Ellen Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Djj Farnell
- School of Dentistry, Cardiff University, Cardiff, UK
| | - M Longo
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - S Goss
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - K Seddon
- Wales Cancer Research Centre, Cardiff, UK
| | | | - C R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - D Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - B Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - A Byrne
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - E Harrop
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
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20
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Mitchell S, Harrison M, Oliver P, Gardiner C, Chapman H, Khan D, Boyd K, Dale J, Barclay S, Mayland CR. Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey. Palliat Med 2022; 36:161-170. [PMID: 34915759 PMCID: PMC8796165 DOI: 10.1177/02692163211049311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. AIM To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. DESIGN Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. SETTING/PARTICIPANTS United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. RESULTS A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 'other'. Over a third of respondents (n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. CONCLUSION Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.
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Affiliation(s)
| | | | | | | | - Helen Chapman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dena Khan
- Patient and Public Involvement Representative, Birmingham, England, UK
| | | | - Jeremy Dale
- University of Warwick, Coventry, England, UK
| | - Stephen Barclay
- University of Cambridge, Cambridge, UK
- University of East Anglia Norwich Medical School, UK
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21
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Handley M, Parker D, Bunn F, Goodman C. A qualitative comparison of care home staff and palliative care specialists' experiences of providing end of life care to people living and dying with dementia in care homes in two countries: A focus group study. Palliat Med 2022; 36:114-123. [PMID: 34479468 PMCID: PMC8793290 DOI: 10.1177/02692163211043374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palliative care for people with dementia dying in care homes is an important aspect of long-term care. Whilst there is consensus about the principles of palliative care, less is known about how care home staff negotiate and influence decisions around end of life and how organisational context shapes that process. AIM To explore the views and experiences of care home staff and palliative care specialists on end of life care in care homes and understand how care home settings affected palliative care provision in England and Australia. DESIGN/PARTICIPANTS Eight focus groups in Australia and England with care home staff and palliative care specialists (n = 49). Reflexive thematic analysis was undertaken. FINDINGS Australian participants reported collaboration between care home staff, visiting professions and family members though case conferences. English participants discussed resident-focussed involvement from specialists that was less formally organised. Negotiating roles and responsibilities in end of life care; the importance of relationships to overcome deficiencies in formal processes; and the legitimacy and authority of advance care planning at times of crisis were recurring themes. The organisation and embedding of end of life care in processes and practices of care homes differed; this closely linked to care home procedures in Australia but was less apparent in England. CONCLUSION In both countries, partnership working was recognised and valued as key to effective palliative care. Work that enables care home staff to identify challenges with visiting professionals, such as agreeing priorities for care and negotiating their shared responsibilities, may lead to context-sensitive, sustainable solutions.
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Affiliation(s)
- Melanie Handley
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
| | | | - Frances Bunn
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
| | - Claire Goodman
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
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22
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Sleeman KE, Cripps RL, Murtagh FEM, Oluyase AO, Hocaoglu MB, Maddocks M, Walshe C, Preston N, Dunleavy L, Bradshaw A, Bajwah S, Higginson IJ, Fraser LK. Change in Activity of Palliative Care Services during the Covid-19 Pandemic: A Multinational Survey (CovPall). J Palliat Med 2021; 25:465-471. [PMID: 34935477 PMCID: PMC8968830 DOI: 10.1089/jpm.2021.0315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To identify factors associated with palliative care services being busier during Covid-19. Methods: Cross-sectional online survey of UK palliative care services (April to July 2020) (CovPall). Ethical approval was received from King's College London Research Ethics committee (LRS-19/20-18541). The primary outcome was change in busyness (five-point ordinal scale). Ordinal logistic regression investigated factors associated with the primary outcome. Results: Of 277 responses, 71 (26%) reported being a lot more busy, 62 (22%) slightly more, 53 (19%) about the same, 50 (18%) slightly less, and 28 (10%) much less busy. Increased business was associated with homecare services (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.15–3.25), nursing care at home (OR 3.24, 95% CI 1.70–6.19), publicly managed services (OR 2.20, 95% CI 1.11–4.34), Covid-19 cases (OR 1.01, 95% CI 1.00–1.01), and staff shortages (OR 2.71, 95% CI 1.64–4.48). Conclusion: Services providing community care, and publicly managed services, may have been better able to respond to escalating needs during Covid-19. This has potential implications for both service delivery and funding models.
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Affiliation(s)
- Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.,King's College Hospital NHS Foundation Trust, Denmark Hill, United Kingdom
| | - Rachel L Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Mevhibe B Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.,King's College Hospital NHS Foundation Trust, Denmark Hill, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.,King's College Hospital NHS Foundation Trust, Denmark Hill, United Kingdom
| | - Lorna K Fraser
- Health Sciences, University of York, York, United Kingdom
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23
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O'Donnell SB, Bone AE, Finucane AM, McAleese J, Higginson IJ, Barclay S, Sleeman KE, Murtagh FE. Changes in mortality patterns and place of death during the COVID-19 pandemic: A descriptive analysis of mortality data across four nations. Palliat Med 2021; 35:1975-1984. [PMID: 34425717 PMCID: PMC8641034 DOI: 10.1177/02692163211040981] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Understanding patterns of mortality and place of death during the COVID-19 pandemic is important to help provide appropriate services and resources. AIMS To analyse patterns of mortality including place of death in the United Kingdom (UK) (England, Wales, Scotland and Northern Ireland) during the COVID-19 pandemic to date. DESIGN Descriptive analysis of UK mortality data between March 2020 and March 2021. Weekly number of deaths was described by place of death, using the following definitions: (1) expected deaths: average expected deaths estimated using historical data (2015-19); (2) COVID-19 deaths: where COVID-19 is mentioned on the death certificate; (3) additional non-COVID-19 deaths: above expected but not attributed to COVID-19; (4) baseline deaths: up to and including expected deaths but excluding COVID-19 deaths. RESULTS During the analysis period, 798,643 deaths were registered in the UK, of which 147,282 were COVID-19 deaths and 17,672 were additional non-COVID-19 deaths. While numbers of people who died in care homes and hospitals increased above expected only during the pandemic waves, the numbers of people who died at home remained above expected both during and between the pandemic waves, with an overall increase of 41%. CONCLUSIONS Where people died changed during the COVID-19 pandemic, with an increase in deaths at home during and between pandemic waves. This has implications for planning and organisation of palliative care and community services. The extent to which these changes will persist longer term remains unclear. Further research could investigate whether this is reflected in other countries with high COVID-19 mortality.
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Affiliation(s)
- Sean B O'Donnell
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | - Jenny McAleese
- Patient and Public Involvement Partner, York Hospitals NHS Foundation Trust, Harrogate, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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24
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Chen S, Jones PB, Underwood BR, Fernandez‐Egea E, Qin P, Lewis JR, Cardinal RN. Risk factors for excess deaths during lockdown among older users of secondary care mental health services without confirmed COVID-19: A retrospective cohort study. Int J Geriatr Psychiatry 2021; 36:1899-1907. [PMID: 34382242 PMCID: PMC8420159 DOI: 10.1002/gps.5610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/05/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate factors contributing to excess deaths of older patients during the initial 2020 lockdown beyond those attributable to confirmed COVID-19. METHODS Retrospective cohort study comparing patients treated between 23 March 2020 and 14 June 2020, deemed exposed to the pandemic/lockdown, to patients treated between 18 December 2019 and 10 March 2020, deemed to be unexposed. Data came from electronic clinical records from secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment area population ∼0.86 million). Eligible patients were aged 65 years or over at baseline with at least 14 days' follow-up, excluding patients diagnosed with confirmed or suspected SARS-CoV-2 infection. The primary outcome was all-cause mortality. FINDINGS In the two cohorts, 3,073 subjects were exposed to lockdown and 4,372 subjects were unexposed; the cohorts were followed up for an average of 74 and 78 days, respectively. After controlling for confounding by sociodemographic factors, smoking status, mental comorbidities, and physical comorbidities, patients with dementia suffered an additional 53% risk of death (HR = 1.53, 95% CI = 1.02-2.31), and patients with severe mental illness suffered an additional 123% risk of death (HR = 2.23, 95% CI = 1.42-3.49). No significant additional mortality risks were identified from physical comorbidities, potentially due to low statistical power in that respect. CONCLUSION During lockdown people with dementia or severe mental illness had a higher risk of death without confirmed COVID-19. These data could inform future health service responses and policymaking to help prevent avoidable excess death during future outbreaks of this or a similar infectious disease.
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Affiliation(s)
- Shanquan Chen
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Peter B. Jones
- Department of PsychiatryUniversity of CambridgeCambridgeUK,NIHR Applied Research CollaborationEast of EnglandUK,Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
| | - Benjamin R. Underwood
- Department of PsychiatryUniversity of CambridgeCambridgeUK,Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
| | - Emilio Fernandez‐Egea
- Department of PsychiatryUniversity of CambridgeCambridgeUK,Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
| | - Pei Qin
- Department of Biostatistics and EpidemiologyShenzhen University Health Science CentreShenzhenChina
| | | | - Rudolf N. Cardinal
- Department of PsychiatryUniversity of CambridgeCambridgeUK,Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
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25
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Koirala S, Subedi K, Subedi N. Unnatural Deaths among Autopsy Cases Brought at Tertiary Care Hospital of Western Nepal during COVID-19 Pandemic Period: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1293-1296. [PMID: 35199792 PMCID: PMC9200028 DOI: 10.31729/jnma.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The outbreak of COVID-19 as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. METHODS This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. CONCLUSIONS The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.
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Affiliation(s)
- Santosh Koirala
- Department of Forensic Medicine, Chitwan Medical College, Chitwan, Nepal
| | - Krishna Subedi
- Department of Community Dentistry, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal
| | - Nuwadatta Subedi
- Department of Forensic Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal,Correspondence: Dr. Nuwadatta Subedi, Department of Forensic Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal. , Phone: +977-9855054563
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26
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Runacres F, Steele P, Hudson J, Bills M, Poon P. 'We couldn't have managed without your team': A collaborative palliative care response to the COVID-19 pandemic in residential aged care. Australas J Ageing 2021; 41:147-152. [PMID: 34755441 PMCID: PMC8646512 DOI: 10.1111/ajag.13013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 01/10/2023]
Abstract
The global COVID‐19 pandemic has challenged healthcare, aged care and palliative care provision in ways previously unimaginable. In Australia, this has been felt particularly amongst our most vulnerable members of society, those residing in residential aged care. Currently representing the majority (75%) of COVID‐19 deaths and health‐care worker infections, this vulnerable sector has borne the greatest impact. A collaborative response comprising a tertiary hospital palliative care outreach service, residential InReach geriatric service and a community palliative care service effectively delivered comprehensive and timely specialist care to residents infected with COVID‐19. Daily videoconferencing rounds were efficient, minimised infection risk and facilitated family members attending virtually during patient assessments and care planning discussions. This model was both reactive and proactive and importantly scalable should further infective outbreaks occur in Australasian residential aged care facilities.
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Affiliation(s)
- Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia.,Department of Palliative Care, Calvary Health Care Bethlehem, Parkdale, Vic., Australia.,The University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Patrick Steele
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia.,Palliative Care South East, Cranbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Parkville, Vic., Australia
| | - Jade Hudson
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia
| | - Maryann Bills
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Clayton, Vic., Australia.,School of Medicine, Monash University, Clayton, Vic., Australia
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27
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Yardley S, Francis SA, Chuter A, Hellard S, Abernethy J, Carson-Stevens A. Mixed-methods study protocol: do national reporting and learning system medication incidents in palliative care reflect patient and carer concerns about medication management and safety? BMJ Open 2021; 11:e048696. [PMID: 34518258 PMCID: PMC8438946 DOI: 10.1136/bmjopen-2021-048696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Approximately 20% of serious safety incidents involving palliative patients relate to medication. These are disproportionately reported when patients are in their usual residence when compared with hospital or hospice. While patient safety incident reporting systems can support professional learning, it is unclear whether these reports encompass patient and carer concerns with palliative medications or interpersonal safety. AIM To explore and compare perceptions of (un)safe palliative medication management from patient, carer and professional perspectives in community, hospital and hospice settings. METHODS AND ANALYSIS We will use an innovative mixed-methods study design combining systematic review searching techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative metasynthesis to integrate three elements: (1) Scoping review: multiple database searches for empirical studies and first-hand experiences in English (no other restrictions) to establish how patients and informal carers conceptualise safety in palliative medication management. (2)Medication incidents from the England and Wales National Reporting and Learning System: identifying and characterising reports to understand professional perspectives on suboptimal palliative medication management. (3) Comparison of 1 and 2: contextualising with stakeholder perspectives. PATIENT AND PUBLIC INVOLVEMENT Our team includes a funded patient and public involvement (PPI) collaborator, with experience of promoting patient-centred approaches in patient safety research. Funded discussion and dissemination events with PPI and healthcare (clinical and policy) professionals are planned. ETHICS AND DISSEMINATION Prospective ethical approval granted: Cardiff University School of Medicine Research Ethics Committee (Ref 19/28). Our study will synthesise multivoiced constructions of patient safety in palliative care to identify implications for professional learning and actions that are relevant across health and social care. It will also identify changing or escalating patterns in palliative medication incidents due to the COVID-19 pandemic. Peer-reviewed publications, academic presentations, plain English summaries, press releases and social media will be used to disseminate to the public, researchers, clinicians and policy-makers.
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Affiliation(s)
- Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Sally-Anne Francis
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Antony Chuter
- Patient and Public Involvement Collaborator, Hayward Heaths, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Abernethy
- Patient Safety Team, NHS England and NHS Improvement, London, UK
| | - A Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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28
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Soosaipillai G, Wu A, Dettorre GM, Diamantis N, Chester J, Moss C, Aguilar-Company J, Bower M, Sng CCT, Salazar R, Brunet J, Jones E, Mesia R, Jackson A, Mukherjee U, Sita-Lumsden A, Seguí E, Ottaviani D, Carbó A, Benafif S, Würstlein R, Carmona C, Chopra N, Cruz CA, Swallow J, Saoudi N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Wong YNS, Sureda A, Maluquer C, Ruiz-Camps I, Cabirta A, Prat A, Loizidou A, Gennari A, Ferrante D, Tabernero J, Russell B, Van Hemelrijck M, Dolly S, Hulbert-Williams NJ, Pinato DJ. Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective. Ther Adv Med Oncol 2021; 13:17588359211042224. [PMID: 34497669 PMCID: PMC8419540 DOI: 10.1177/17588359211042224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. METHODS From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT- not referred). RESULTS Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more 'Do not attempt cardio-pulmonary resuscitation' orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. CONCLUSION SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.
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Affiliation(s)
| | - Anjui Wu
- Cancer Division, University College London Hospitals, London, UK
- UCL Cancer Institute, Fitzrovia, London, UK
| | - Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Juan Aguilar-Company
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC. Hospitalet de Llobregat, Spain
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Eleanor Jones
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sarah Benafif
- Cancer Division, University College London Hospitals, London, UK
| | - Rachel Würstlein
- Department of Gynaecology and Obstetrics, Breast Centre and Gynaecological Cancer Centre and CCC Munich, University Hospital Munich, Munich, Germany
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Judith Swallow
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Nadia Saoudi
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Myria Galazi
- Cancer Division, University College London Hospitals, London, UK
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alba Cabirta
- Department of Haematology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, Barcelona, Spain
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Josep Tabernero
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Nicholas J Hulbert-Williams
- Professor of Behavioural Medicine, Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chritchley Building, Parkgate Road, Chester, Cheshire, CH1 4BJ, UK
| | - David J Pinato
- Department of Surgery and Cancer, Clinical Senior Lecturer and Consultant Medical Oncologist, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Oluyase AO, Hocaoglu M, Cripps RL, Maddocks M, Walshe C, Fraser LK, Preston N, Dunleavy L, Bradshaw A, Murtagh FEM, Bajwah S, Sleeman KE, Higginson IJ. The Challenges of Caring for People Dying From COVID-19: A Multinational, Observational Study (CovPall). J Pain Symptom Manage 2021; 62:460-470. [PMID: 33556496 PMCID: PMC7863772 DOI: 10.1016/j.jpainsymman.2021.01.138] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Systematic data on the care of people dying with COVID-19 are scarce. OBJECTIVES To understand the response of and challenges faced by palliative care services during the COVID-19 pandemic, and identify associated factors. METHODS We surveyed palliative care and hospice services, contacted via relevant organizations. Multivariable logistic regression identified associations with challenges. Content analysis explored free text responses. RESULTS A total of 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world; 81% cared for patients with suspected or confirmed COVID-19, 77% had staff with suspected or confirmed COVID-19; 48% reported shortages of Personal Protective Equipment (PPE), 40% staff shortages, 24% medicines shortages, 14% shortages of other equipment. Services provided direct care and education in symptom management and communication; 91% changed how they worked. Care often shifted to increased community and hospital care, with fewer admissions to inpatient palliative care units. Factors associated with increased odds of PPE shortages were: charity rather than public management (OR 3.07, 95% CI 1.81-5.20), inpatient palliative care unit rather than other settings (OR 2.34, 95% CI 1.46-3.75). Being outside the UK was associated with lower odds of staff shortages (OR 0.44, 95% CI 0.26-0.76). Staff described increased workload, concerns for their colleagues who were ill, whilst expending time struggling to get essential equipment and medicines, perceiving they were not a front-line service. CONCLUSION Palliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics.
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Affiliation(s)
- Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Rachel L Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Lorna K Fraser
- Health Sciences, University of York, York, North Yorkshire, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust, Denmark Hill, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust, Denmark Hill, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust, Denmark Hill, UK.
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Spacey A, Porter S, Board M, Scammell J. Impact of the COVID-19 pandemic on end of life care delivery in care homes: A mixed method systematic review. Palliat Med 2021; 35:1468-1479. [PMID: 34328031 DOI: 10.1177/02692163211029806] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current evidence suggests that COVID-19 is having a negative impact on the delivery of end of life care in care homes around the world. There is a need to collate current evidence to provide a comprehensive overview to assess extent of the problem. AIM To describe and evaluate the impact of the COVID-19 pandemic on end of life care delivery in care homes. DESIGN Systematic review and narrative synthesis of studies reporting qualitative and quantitative data. DATA SOURCES The databases MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and March 2021. RESULTS Nine studies were included. For care home staff, challenges included significant increases in responsibility and exposure to death, both of which have taken an emotional toll. Results indicate that staff tended not to be offered adequate emotional support or afforded the time to grieve. For those receiving end of life care, results indicate that the end of life care that they tended to receive, especially in the form of advance planning, was disrupted by the pandemic. CONCLUSION The effect of the pandemic has been to exacerbate existing problems in the provision of end of life care in care homes for both service providers and users, making that which was previously opaque starkly visible. Future research is needed to explore the effects of the pandemic and its management on those receiving end of life care in care homes and their significant others.
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Affiliation(s)
- Adam Spacey
- School of Health and Society, University of Salford, Salford, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK
| | - Michele Board
- Department of Nursing Science, Bournemouth University, Poole, UK
| | - Janet Scammell
- Department of Nursing Science, Bournemouth University, Poole, UK
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31
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Everitt R, Robinson N, Marco D, Weil J, Bryan T. Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit. Palliat Med 2021; 35:1508-1513. [PMID: 34159860 DOI: 10.1177/02692163211026518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19. AIM This study aimed to consider the impact of COVID-19 on utilisation of inpatient palliative care in the context of low community transmission, and low numbers of cases in hospital. DESIGN A retrospective service evaluation examining differences in number of admissions, diagnoses, number of deaths and time from admission to death, across three discrete 8-week time periods spanning the early COVID-19 pandemic. SETTING/PARTICIPANTS All admissions (n = 194) to a metropolitan tertiary hospital inpatient palliative care unit in Melbourne during the study period. RESULTS An initial 16.9% fall in admissions was followed by a return to baseline admission numbers, with a 46.7% increase in number of deaths compared to baseline. The number of deaths within 24 h rose from 10.8% to 37.3% (p < 0.01). The number of patients with non-malignant diagnoses increased from 32.4% to 52%, and those with non-malignant diagnoses were more likely to die rapidly (p < 0.01). There were no patients with COVID-19 infection. CONCLUSION Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.
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Affiliation(s)
- Rachel Everitt
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Neil Robinson
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - David Marco
- Centre for Palliative Care, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Weil
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Tamsin Bryan
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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Mayland CR, Hughes R, Lane S, McGlinchey T, Donnellan W, Bennett K, Hanna J, Rapa E, Dalton L, Mason SR. Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives' experiences during the COVID-19 pandemic. Palliat Med 2021; 35:1480-1491. [PMID: 34053347 DOI: 10.1177/02692163211019885] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. AIM To explore bereaved relatives' experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. DESIGN A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June-September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. PARTICIPANTS Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. RESULTS Respondents (n = 278, mean 53.4 years) tended to be female (n = 216, 78%); over half were 'son/daughter' (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their 'usual place of care' (n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of 'not knowing'; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. CONCLUSION Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.
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Affiliation(s)
- Catriona R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Palliative Care Unit, University of Liverpool, Liverpool, UK
| | - Rosemary Hughes
- Palliative Care Unit, University of Liverpool, Liverpool, UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | - Warren Donnellan
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Kate Bennett
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Jeffrey Hanna
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Stephen R Mason
- Palliative Care Unit, University of Liverpool, Liverpool, UK
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Harding A, Preston N, Doherty J, Cousins E, Varey S, McCann A, Dening KH, Finucane A, Carter G, Mitchell G, Brazil K. Developing and evaluating online COVID-centric advance care planning training and information resources for nursing staff and family members in nursing homes: the necessary discussions study protocol. BMC Geriatr 2021; 21:456. [PMID: 34372794 PMCID: PMC8350283 DOI: 10.1186/s12877-021-02398-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nursing home residents are typically older adults with high levels of chronic illness and impairment. As such, they are particularly susceptible to severe complications and mortality from COVID-19. Since all nursing home residents are at increased risk, nursing home care staff need to know what residents would want to happen should they become infected with COVID-19. This study aims to develop and evaluate advance care planning (ACP) COVID-centric online training and information resources for nursing home staff and family members of residents, to improve care at the end of life during a COVID-19 outbreak. Based on the findings we will develop implementation guidelines for nursing homes to ensure wider impact and application during the pandemic and beyond. Methods The content of the training and information resources will be based on a rapid review of literature and guidance on ACP in the context of COVID-19 and consultation with the study expert reference group. An integrated communications company will then work alongside the research team to design the online training and information resources. To evaluate the resources, we will employ a multiple case study design where a nursing home (defined as an institutional setting in which nursing care is provided to older adults on-site 24 h a day) will be the unit of analysis or ‘case’. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. We will recruit and interview staff and family members from between 6 and 9 nursing homes across Northern Ireland, England and Scotland and gather quantitative data from a feedback survey included in the training and information resources. Discussion The Necessary Discussions study is very timely given the challenging experiences of nursing homes, their staff, residents and their family members during the COVID-19 pandemic. It meets a key need and addresses an important gap in research and practice. The training and information resources will be ‘COVID-centric’, but they will also have a longstanding relevance for future ACP practice in UK care homes. Trial registration ISRCTN registry (ID 18003630) on 19.05.21
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Affiliation(s)
- Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK.
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34
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Affiliation(s)
- Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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35
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Mitchell S, Oliver P, Gardiner C, Chapman H, Khan D, Boyd K, Dale J, Barclay S, R Mayland C. Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey. BJGP Open 2021; 5:BJGPO.2021.0095. [PMID: 34117014 PMCID: PMC8450890 DOI: 10.3399/bjgpo.2021.0095] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. AIM To understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. DESIGN & SETTING A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020. METHOD Responses were analysed using descriptive statistics and an inductive thematic analysis. RESULTS Valid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. CONCLUSION Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.
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Affiliation(s)
- Sarah Mitchell
- Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Phillip Oliver
- Clinical Lecturer, Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Senior Research Fellow, Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Helen Chapman
- Queen's Nurse and Head of Integrated Community Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dena Khan
- Patient and Public Involvement Representative, University of Warwick, Warwick, UK
| | - Kirsty Boyd
- Reader in Palliative Care, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jeremy Dale
- Professor of Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Barclay
- Senior Lecturer in General Practice and Palliative Care, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Catriona R Mayland
- Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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36
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Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey. BJGP Open 2021. [PMID: 34117014 DOI: 10.3399/bjgpo.2021.0095.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
BACKGROUND Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. AIM To understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. DESIGN & SETTING A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020. METHOD Responses were analysed using descriptive statistics and an inductive thematic analysis. RESULTS Valid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. CONCLUSION Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.
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Divanoglou A, Samuelsson APK, Sjödahl PER, Andersson C, Levi PR. Rehabilitation needs and mortality associated with the Covid-19 pandemic: a population-based study of all hospitalised and home-healthcare individuals in a Swedish healthcare region. EClinicalMedicine 2021; 36:100920. [PMID: 34095795 PMCID: PMC8164661 DOI: 10.1016/j.eclinm.2021.100920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This first report of the Linköping Covid-19 Study (LinCoS) aimed at determination of Covid-19-associated mortality, impairments, activity and participation limitations denoting rehabilitation needs four months after discharge from hospital. METHODS An ambidirectional population-based cohort study including all confirmed Covid-19 cases admitted to hospital during 1/03-31/05 and those living in home healthcare settings identified through a regional registry and evaluated through medical records, including WHO Clinical Progression Scale (CPS). All patients discharged from hospital were followed-up by structured telephone interview at 4 months post-discharge. Respondents indicated any new or aggravated persisting problems in any of 25 body functions and 12 activity/participation items and rated them for impact on daily life. FINDINGS Out of 734 hospitalised patients, 149 were excluded, 125 died, and 460 were alive at 4-month follow-up of whom 433 (94.1%) were interviewed. In total, 40% reported impairments and activity/participation limitations affecting daily life and warranted further multi-professional rehabilitation assessment, predominantly those with severe disease and a considerable proportion of those with moderate disease. Cognitive and affective impairments were equally common in all groups and were reported by 20-40% of cases. Limb weakness was reported by 31%, with CPS 7-9 being four times more likely to report this problem as compared to CPS 4-5. 26% of those working or studying reported difficulties returning to these activities, this being 3.5 times more likely in CPS 7-9 as compared to CPS 4-5. 25% reported problems walking >1 km, with CPS 7-9 over three times more likely to report this as compared to the other two sub-groups. 90-day mortality rate of Covid-19 associated deaths was 15.1%. INTERPRETATION Most rehabilitation needs after Covid-19 involved higher cerebral dysfunction both in patients with moderate and severe disease. This should be considered when designing services aiming at minimizing long-term disability. FUNDING ALF grant and Region Östergötland.
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Affiliation(s)
- Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring sciences, Linköping University, S-58185, Linköping, Sweden
| | - Assoc. Prof Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring sciences, Linköping University, S-58185, Linköping, Sweden
| | - Prof. Emer. Rune Sjödahl
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, S-58185, Linköping, Sweden
| | - Christer Andersson
- Department of Orthopedics, Linköping University Hospital, S-58185, Linköping, Sweden
| | - Prof. Richard Levi
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring sciences, Linköping University, S-58185, Linköping, Sweden
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Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095031. [PMID: 34068622 PMCID: PMC8126108 DOI: 10.3390/ijerph18095031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.
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Onwuteaka-Philipsen BD, Pasman HRW, Korfage IJ, Witkamp E, Zee M, van Lent LG, Goossensen A, van der Heide A. Dying in times of the coronavirus: An online survey among healthcare professionals about end-of-life care for patients dying with and without COVID-19 (the CO-LIVE study). Palliat Med 2021; 35:830-842. [PMID: 33825567 PMCID: PMC8114455 DOI: 10.1177/02692163211003778] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND During the COVID-19 outbreak restricting measures may have affected the provision of good end-of-life care for patients with and without COVID-19. AIM To describe characteristics of patients who died and the care they received, and to examine how patient characteristics, setting and visiting restrictions are related to provided care and evaluation of the dying process. DESIGN An open observational online survey among healthcare professionals about their experience of end-of-life care that was provided to a patient with or without COVID-19 who died between March and July 2020. SETTING/PARTICIPANTS Healthcare professionals (nurses, physicians and others) in the Netherlands from all settings: home (n = 163), hospital (n = 249), nursing home (n = 192), hospice (n = 89) or elsewhere (n = 68). RESULTS Of patients reported on, 56% had COVID-19. Among these patients, 358 (84.4%) also had a serious chronic illness. Having COVID-19 was negatively, and having a serious chronic illness was positively associated with healthcare staff's favourable appreciation of end-of-life care. Often there had been visiting restrictions in the last 2 days of life (75.8%). This was negatively associated with appreciation of care at the end of life and the dying process. Finally, care at the end of life was less favourably appreciated in hospitals and especially nursing homes, and more favourably in home settings and especially hospices. CONCLUSIONS Our study suggests that end-of-life care during the COVID-19 pandemic may be further optimised, especially in nursing homes and hospitals. Allowing at least some level of visits of relatives seems a key component.
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Affiliation(s)
- Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Erica Witkamp
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Masha Zee
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Finucane AM, Bone AE, Etkind S, Carr D, Meade R, Munoz-Arroyo R, Moine S, Iyayi-Igbinovia A, Evans CJ, Higginson IJ, Murray SA. How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery. BMJ Open 2021; 11:e041317. [PMID: 33536318 PMCID: PMC7868264 DOI: 10.1136/bmjopen-2020-041317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery. DESIGN We estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need. SETTING Scotland, population of 5.4 million. PARTICIPANTS All decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey. PRIMARY AND SECONDARY OUTCOMES Estimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively. RESULTS We project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred. CONCLUSIONS By 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.
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Affiliation(s)
- Anne M Finucane
- Research, Marie Curie Hospice Edinburgh, Edinburgh, UK
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Simon Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Richard Meade
- Policy and Public Affairs, Marie Curie, Edinburgh, UK
| | | | - Sébastien Moine
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Education, Université Paris, Paris, UK
| | | | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
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