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Zee MS, Onwuteaka-Philipsen BD, Witkamp E, Heessels B, Goossensen A, Korfage IJ, Becqué YN, Nierop-van Baalen C, van der Heide A, Pasman HR. Distress among healthcare providers who provided end-of-life care during the COVID-19 pandemic: a longitudinal survey study (the CO-LIVE study). BMC Palliat Care 2024; 23:134. [PMID: 38802776 DOI: 10.1186/s12904-024-01446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic had a significant impact on care at the end-of-life due to restrictions and other circumstances such as high workload and uncertainty about the disease. The objective of this study is to describe the degree of various signs experienced by healthcare providers throughout the first 18 months of the pandemic and to assess what provider's characteristics and care circumstances related to COVID-19 are associated with distress. METHODS A longitudinal survey study among healthcare providers from different healthcare settings who provided end-of-life care during the pandemic's first 18 months. Data of four time periods were analyzed using descriptive statistics, logistic regression analysis and Generalized Estimating Equation. RESULTS Of the respondents (n=302) the majority had a nursing background (71.8%) and most worked in a hospital (30.3%). Although reported distress was highest in the first period, during the first wave of COVID-19 pandemic, healthcare providers reported signs of distress in all four time periods. Being more stressed than usual and being regularly exhausted were the most common signs of distress. Healthcare providers working in nursing homes and hospitals were more likely to experience signs of distress, compared to healthcare providers working in hospice facilities, during the whole period of 1.5 years. When HCPs were restricted in providing post-death care, they were more likely to feel more stressed than usual and find their work more often emotionally demanding. CONCLUSION A substantial amount of healthcare providers reported signs of distress during the first 1.5 years of the COVID-19 pandemic. A cause of distress appears to be that healthcare providers cannot provide the care they desire due the pandemic. Even though the pandemic is over, this remains an important and relevant finding, as high workload can sometimes force healthcare providers to make choices about how they provide care. Given that this can cause prolonged stress and this can lead to burnout (and HCPs leaving their current positions), it is now especially important to continue observing the long term developments of the well-being of our healthcare providers in palliative care and provide timely and adequate support where needed.
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Affiliation(s)
- Masha S Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, 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
| | - Benthe Heessels
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | | | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yvonne N Becqué
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Corine Nierop-van Baalen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Stavropoulou A, Daniil M, Gerogianni G, Vasilopoulos G, Fasoi G, Papageorgiou D, Dafogianni C, Kelesi M. Nurses' Views on Caring for Lonely Patients During the Pandemic: A Qualitative Study. Cureus 2024; 16:e57639. [PMID: 38707112 PMCID: PMC11070056 DOI: 10.7759/cureus.57639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND The implementation of safety measures in hospitals due to the COVID-19 pandemic, including family visitation restrictions, forced the family to be absent during the patient's hospitalization. Nurses were confronted with new roles and responsibilities, as caring for lonely patients was a new phenomenon that emerged during the pandemic. PURPOSE The purpose of this study was to explore the nurses' views on caring for lonely patients during the COVID-19 pandemic. METHODS A qualitative research method based on an inductive content analysis approach was used. Data collection was carried out using semi-structured interviews. The sample consisted of 11 nurses who worked in COVID-19 wards and units. Content analysis was used to analyze the interview data. RESULTS The analysis of the data revealed three main themes: 1) caring for the patient and the family; 2) extending conventional care; and 3) developing supportive mechanisms for better care. Caring for lonely patients brought about changes in patients's management and care and significantly affected communication patterns as well as nurses' roles and responsibilities. Providing care beyond limits, supporting care through the utilization of new technologies, and transforming organization and care were mentioned as areas of challenge for nursing practice. Conclusions: Maintaining communication and supporting the family's involvement in patient care are considered to be equal to healing for the lonely patient. Reshaping working conditions and caring practices to meet the needs of the nurses, the patients, and their families during health crises may contribute positively to the provision of holistic care for patients and their families.
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Affiliation(s)
| | | | | | | | - Georgia Fasoi
- Department of Nursing, University of West Attica, Athens, GRC
| | | | | | - Martha Kelesi
- Department of Nursing, University of West Attica, Athens, GRC
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Slotman E, Fransen HP, van Laarhoven HWM, van den Beuken-van Everdingen MHJ, Tjan-Heijnen VCG, Huijben AMT, Jager A, van Zuylen L, Kuip EJM, van der Linden YM, Raijmakers NJH, Siesling S. Reduction in potentially inappropriate end-of-life hospital care for cancer patients during the COVID-19 pandemic: A retrospective population-based study. Palliat Med 2024; 38:140-149. [PMID: 38142283 PMCID: PMC10798006 DOI: 10.1177/02692163231217373] [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: 12/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic. AIM To investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic. DESIGN Retrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019. PARTICIPANTS A total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included. RESULTS Fewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74-0.88 and OR 0.92; 95% CI 0.87-0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic. CONCLUSIONS Cancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources.
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Affiliation(s)
- Ellis Slotman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Vivianne CG Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Auke MT Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien JM Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, The Netherlands
| | - Yvette M van der Linden
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Natasja JH Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
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Nierop-van Baalen CA, Witkamp FE, Korfage IJ, Pasman HR, Becqué YN, Zee MS, van der Heide A, Onwuteaka-Hilipsen BD, Goossensen A. Relatives' grief at three moments after death of a loved one during COVID-19 pandemic (the CO-LIVE study). DEATH STUDIES 2023:1-10. [PMID: 38145418 DOI: 10.1080/07481187.2023.2297055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
COVID-19 has complicated grieving experiences. Rich qualitative description of these experiences is lacking. We interviewed 10 bereaved relatives (mainly daughters) 2-3 times each: shortly after their relative died in the first wave of COVID-19 pandemic, and after 12 and 18 months (29 interviews in total). Analyses took place according to inductive content analysis. Losses were threefold: the loss of the loved one; of the (desired) way to say farewell, and of social support. We identified five ways in which the three COVID-19 related loss experiences interacted: overshadowed grief, cumulative grief, triggered grief, derailed grief, and conciliatory grief. This study demonstrated that pre-COVID-19 diagnoses and understandings of grief are not sufficient to picture grief during and after the COVID-19 pandemic. These grief experiences are more complex and deserve further exploration.
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Affiliation(s)
- Corine A Nierop-van Baalen
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - F Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Masha S Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bregje D Onwuteaka-Hilipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Carroll HK, Broderick A, McCarthy O, Bambury RM, Power DG, Collins DC, Connolly RM, Noonan SA, Collins D, Cunningham E, Kennedy M, O'Driscoll K, Nuzum D, Twomey K, O'Riordan A, O'Sullivan F, Roe C, Lowney AC, O'Leary MJ, O'Reilly S. Room to Improve: An Audit of In-Hospital End-of-Life Care for Oncology Patients in a Tertiary Cancer Centre in Ireland During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231196620. [PMID: 37670454 DOI: 10.1177/00302228231196620] [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: 09/07/2023]
Abstract
The COVID-19 pandemic compounded isolation for patients through social distancing measures and staff shortages. We were concerned about the impact of COVID-19 on the quality of care provided at end-of-life in 2021 in a national cancer centre, and instigated the first ever review of the care of the dying. Quality of care was assessed retrospectively using a validated instrument developed by the United Kingdom's National Quality Board. Sixty-six patient deaths occurred in our cancer centre in 2021. The 'risk of dying' was documented in 65.2% of records. Palliative care services were involved in 77%, and pastoral care in 10.6%. What was important to the patient was documented in 24.2%. The 'quality-of-death' score was satisfactory for most but poor in 21.2%. Our study prompted change, including appointment of an end-of-life coordinator, development of a checklist to ensure comprehensive communication, expansion of the end-of-life committee to include junior doctors, and regular audit.
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Affiliation(s)
| | | | - Orfhlaith McCarthy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Richard M Bambury
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Derek G Power
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Dearbhaile C Collins
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Roisin M Connolly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Sinead A Noonan
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | | | - Elaine Cunningham
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Kennedy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | - Daniel Nuzum
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | | | | | | | - Aoife C Lowney
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Jane O'Leary
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Seamus O'Reilly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Plagg B, Ballmann J, Ewers M. Hospice and Palliative Care during Disasters: A Systematic Review. Healthcare (Basel) 2023; 11:2382. [PMID: 37685416 PMCID: PMC10486474 DOI: 10.3390/healthcare11172382] [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: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Providing and maintaining hospice and palliative care during disasters poses significant challenges. To understand the impact of disasters on the provision of hospice and palliative care and the disaster preparedness initiatives in the field, a systematic review was undertaken. Eligibility criteria for the selection of studies were: peer-reviewed original research papers addressing HPC during disasters published between January 2001 and February 2023 in English. The databases CINAHL, MEDLINE, APA PsycInfo, APA PsycArticles, and SocINDEX were searched with textword and MeSh-terms between October 2022 and February 2023. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies. Content analysis was performed. The results are presented in the form of a narrative synthesis. Of 2581 studies identified, 57 met the inclusion criteria. Most studies were published recently on the impact of the COVID-19 pandemic. Four main themes were identified in the literature: disruption of the system, setting-specific differences, emotional challenges, and system adaptation. Overall, strategies to tackle hospice and palliative care needs have been poorly integrated in disaster preparedness planning. Our findings highlight the need to strengthen the resilience of hospice and palliative care providers to all types of disasters to maintain care standards.
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Affiliation(s)
- Barbara Plagg
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
- Institute of General Practice and Public Health, College of Health Care Professions–Claudiana, Lorenz-Böhler-Straße 13, 39100 Bolzano, Italy
| | - Julia Ballmann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
| | - Michael Ewers
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
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Dobríková P, Scheitel R, Roulston A. Challenges and Innovations in Hospice Care during the COVID-19 Pandemic: A Scoping Review. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:252-274. [PMID: 37389898 DOI: 10.1080/15524256.2023.2229036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
In addition to addressing nursing and medical needs, the social needs of patients within hospice care require assessment (i.e., relationships, isolation, loneliness, societal inclusion or exclusion, negotiating adequate formal and informal support, or living with a life-limiting condition). The objectives of this scoping review are to examine the challenges of adult patients in receipt of hospice care during the COVID-19 pandemic and to identify innovative changes to care during the pandemic. The methodology of the scoping review follows the Joanna Briggs Institute framework developed in 2015. The context included hospice services (inpatient, outpatient and community). In August 2022, PubMed and SAGE journals were searched from 2020 onwards for studies published in English, which focused on COVID-19, hospice, social, support and challenges. Titles and abstracts were independently screened by two reviewers against agreed criteria. Fourteen studies were included. Data were independently extracted by authors. Emerging themes were loss due to COVID-19 restrictions, challenges for staff, barriers to communication and transition to Telemedicine, and positive effects of the pandemic. Pivoting to Tele-medicine and restricting visitors reduced the risk of spreading coronavirus but resulted in patients being socially isolated from loved ones, and a reliance on technology to have sensitive conversations.
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Affiliation(s)
- Patricia Dobríková
- Faculty of Health Care and Social Work, Trnava University, Trnava, Slovakia
| | - Regina Scheitel
- Faculty of Health Care and Social Work, Trnava University, Trnava, Slovakia
| | - Audrey Roulston
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland
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Tong E, Nissim R, Selby D, Bean S, Isenberg-Grzeda E, Thangarasa T, Rodin G, Li M, Hales S. The impact of COVID-19 on the experiences of patients and their family caregivers with medical assistance in dying in hospital. BMC Palliat Care 2023; 22:70. [PMID: 37312178 DOI: 10.1186/s12904-023-01191-8] [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: 08/03/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and its containment measures have drastically impacted end-of-life and grief experiences globally, including those related to medical assistance in dying (MAiD). No known qualitative studies to date have examined the MAiD experience during the pandemic. This qualitative study aimed to understand how the pandemic impacted the MAiD experience in hospital of persons requesting MAiD (patients) and their loved ones (caregivers) in Canada. METHODS Semi-structured interviews were conducted with patients who requested MAiD and their caregivers between April 2020 and May 2021. Participants were recruited during the first year of the pandemic from the University Health Network and Sunnybrook Health Sciences Centre in Toronto, Canada. Patients and caregivers were interviewed about their experience following the MAiD request. Six months following patient death, bereaved caregivers were interviewed to explore their bereavement experience. Interviews were audio-recorded, transcribed verbatim, and de-identified. Transcripts were analyzed using reflexive thematic analysis. RESULTS Interviews were conducted with 7 patients (mean [SD] age, 73 [12] years; 5 [63%] women) and 23 caregivers (mean [SD] age, 59 [11] years; 14 [61%] women). Fourteen caregivers were interviewed at the time of MAiD request and 13 bereaved caregivers were interviewed post-MAiD. Four themes were generated with respect to the impact of COVID-19 and its containment measures on the MAiD experience in hospital: (1) accelerating the MAiD decision; (2) compromising family understanding and coping; (3) disrupting MAiD delivery; and (4) appreciating rule flexibility. CONCLUSIONS Findings highlight the tension between respecting pandemic restrictions and prioritizing control over the dying circumstances central to MAiD, and the resulting impact on patient and family suffering. There is a need for healthcare institutions to recognize the relational dimensions of the MAiD experience, particularly in the isolating context of the pandemic. Findings may inform strategies to better support those requesting MAiD and their families during the pandemic and beyond.
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Affiliation(s)
- Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Debbie Selby
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elie Isenberg-Grzeda
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tharshika Thangarasa
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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10
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van Zuylen ML, de Snoo-Trimp JC, Metselaar S, Dongelmans DA, Molewijk B. Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned. BMC Med Ethics 2023; 24:40. [PMID: 37291555 PMCID: PMC10249541 DOI: 10.1186/s12910-023-00919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. METHODS A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. RESULTS All 178 respondents (response rate: 25-32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to 'team cooperation', 'team solidarity' and 'work ethic'. Lessons learned were mostly related to 'quality of care' and 'professional qualities'. CONCLUSIONS Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals' dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. TRIAL REGISTRATION The trial was registered on The Netherlands Trial Register, number NL9177.
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Affiliation(s)
- Mark L. van Zuylen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Janine C. de Snoo-Trimp
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care, Amsterdam, UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Bert Molewijk
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
- Center of Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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11
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Guraya SS, Menezes P, Lawrence IN, Guraya SY, Rashid-Doubell F. Evaluating the impact of COVID-19 pandemic on the physicians' psychological health: A systematic scoping review. Front Med (Lausanne) 2023; 10:1071537. [PMID: 37056734 PMCID: PMC10086257 DOI: 10.3389/fmed.2023.1071537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundCOVID-19 has endangered healthcare systems at multiple levels worldwide. Published data suggests that moral dilemmas faced during these unprecedented times have placed physicians at the intersections of ethical and unethical considerations. This phenomenon has questioned the physicians' morality and how that has affected their conduct. The purpose of our review is to tap into the spectrum of the transforming optics of patient care during the pandemic and its impact on psychological wellbeing of physicians.MethodsWe adopted the Arksey and O'Malley's framework, defining research questions, identifying relevant studies, selecting the studies using agreed inclusion and exclusion criteria, charting the data, and summarizing and reporting results. Databases of PubMed/Medline, Web of Science, Scopus, Science Direct, CINAHL, and PsycInfo were searched using a predefined search string. The retrieved titles and abstracts were reviewed. Later, a detailed full-text analysis of the studies which matched our inclusion criteria was performed.ResultsOur first search identified 875 titles and abstracts. After excluding duplicates, irrelevant, and incomplete titles, we selected 28 studies for further analysis. The sample size in 28 studies was 15,509 with an average size of 637 per study. Both quantitative and qualitative approaches were used, with cross-sectional surveys being utilized in all 16 quantitative studies. Using the data from semi-structured interviews, several discrete codes were generated, which led to the identification of five main themes; mental health, individual challenges, decision-making, change in patient care, and support services.ConclusionThis scoping review reports an alarming rise in psychological distress, moral injury, cynicism, uncertainty, burnout, and grief among physicians during the pandemic. Decision-making and patient care were mostly regulated by rationing, triaging, age, gender, and life expectancy. Poor professional controls and institutional services potentially led to physicians' crumbling wellbeing. This research calls for the remediation of the deteriorating mental health and a restoration of medical profession's advocacy and equity.
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Affiliation(s)
- Shaista S. Guraya
- School of Medicine, Royal College of Surgeons Ireland – Medical University Bahrain, Muharraq, Bahrain
| | - Prianna Menezes
- School of Medicine, Royal College of Surgeons Ireland – Medical University Bahrain, Muharraq, Bahrain
| | | | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Salman Yousuf Guraya
| | - Fiza Rashid-Doubell
- School of Medicine, Royal College of Surgeons Ireland – Medical University Bahrain, Muharraq, Bahrain
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12
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Vieveen MJM, Yildiz B, Korfage IJ, Witkamp FE, Becqué YN, van Lent LGG, Pasman HR, Zee MS, Onwuteaka-Philipsen BD, van der Heide A, Goossensen A. Meaning-making following loss among bereaved spouses during the COVID-19 pandemic (the CO-LIVE study). DEATH STUDIES 2023:1-9. [PMID: 36892091 DOI: 10.1080/07481187.2023.2186979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study investigates how individuals construe, understand, and make sense of experiences during the first wave of the COVID-19 pandemic. Seventeen semi-structured interviews were conducted with bereaved spouses focusing on meaning attribution to the death of their partner. The interviewees were lacking adequate information, personalized care, and physical or emotional proximity; these challenges complicated their experience of a meaningful death of their partner. Concomitantly, many interviewees appreciated the exchange of experiences with others and any last moments together with their partner. Bereaved spouses actively sought valuable moments, during and after bereavement, that contributed to the perceived meaning.
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Affiliation(s)
- M J M Vieveen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
- Master Vitality and Ageing, LUMC, Leiden University Medical Center, The Netherlands
| | - B Yildiz
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - F E Witkamp
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
- Research Center Innovations in Care, University of Applied Sciences, Rotterdam, The Netherlands
| | - Y N Becqué
- Research Center Innovations in Care, University of Applied Sciences, Rotterdam, The Netherlands
| | - L G G van Lent
- Department of Internal Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - H R Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute and Expertise center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - M S Zee
- Department of Public and Occupational Health, Amsterdam Public Health research institute and Expertise center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute and Expertise center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - A Goossensen
- University of Humanistic Studies, Universiteit voor Humanistiek, Utrecht, The Netherlands
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Podgorica N, Rungg C, Bertini B, Perkhofer S, Zenzmaier C. End of life care during the COVID-19 pandemic: A qualitative study on the perspectives of nurses and nurse assistants. Nurs Open 2023; 10:3881-3891. [PMID: 36890617 PMCID: PMC10170946 DOI: 10.1002/nop2.1646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/07/2022] [Accepted: 02/04/2023] [Indexed: 03/10/2023] Open
Abstract
AIM To explore nurses' and nurse assistants' experiences of providing end-of-life care during the COVID-19 pandemic in Austria, Germany and Northern Italy. DESIGN A qualitative explorative interview study. METHOD Data were collected between August and December 2020 and analysed using content analysis. Healthcare professionals (nurses (n = 30), nurse coordinators (n = 6) and nurse assistants (n = 5)) from hospitals (n = 32) and long-term care facilities (n = 9) in Austria, Germany and Northern Italy were interviewed for this study. RESULTS Five main categories were identified as follows: (i) end-of-life care involves love and duty, (ii) last wishes and dignity of the patient, (iii) communication with the family, (iv) organizational and religious aspects and (v) personal emotions. Results indicate that more training and guidelines are needed to prepare nurses and nurse assistants for end-of-life care during pandemics. PUBLIC CONTRIBUTION This research can help prepare nurses and nurse assistants for end-of-life care in pandemics and will be of value for improving the institutional and government health policies. Furthermore, it can be of value in preparing training for healthcare professionals patient-relatives.
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Affiliation(s)
- Nertila Podgorica
- Department of Nursing, Health University of Applied Sciences Tyrol, Innsbruck, Austria
| | - Christine Rungg
- Department of Nursing, Health University of Applied Sciences Tyrol, Innsbruck, Austria
| | | | - Susanne Perkhofer
- Research and Innovation Unit, Health University of Applied Sciences Tyrol, Innsbruck, Austria
| | - Christoph Zenzmaier
- Department of Nursing, Health University of Applied Sciences Tyrol, Innsbruck, Austria
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14
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Zee MS, Bagchus L, Becqué YN, Witkamp E, van der Heide A, van Lent LGG, Goossensen A, Korfage IJ, Onwuteaka-Philipsen BD, Pasman HR. Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study). BMJ Open 2023; 13:e063267. [PMID: 36878652 PMCID: PMC9990162 DOI: 10.1136/bmjopen-2022-063267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands. METHODS An in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis. RESULTS Several aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains. CONCLUSION The palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.
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Affiliation(s)
- Masha S Zee
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
| | - Lotje Bagchus
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
| | - Yvonne N Becqué
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Erica Witkamp
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Liza G G van Lent
- Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands
| | | | - Ida J Korfage
- Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
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Kim Y, Shin JM, Yoo SH, Keam B. Challenges in Care for Non-COVID-19 Patients with Severe Chronic Illnesses during COVID-19 Pandemic: A Qualitative Study of Healthcare Providers Working around Acute Care Hospitals in South Korea. Healthcare (Basel) 2023; 11:healthcare11040611. [PMID: 36833145 PMCID: PMC9957023 DOI: 10.3390/healthcare11040611] [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: 01/03/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The COVID-19 epidemic has afflicted patients with severe chronic illnesses who need continuous care between home and hospitals. This qualitative study examines the experiences and challenges of healthcare providers around acute care hospitals who have cared for patients with severe chronic illness in non-COVID-19 situations during the pandemic. METHODS Eight healthcare providers, who work in various healthcare settings around acute care hospitals and frequently care for non-COVID-19 patients with severe chronic illnesses, were recruited using purposive sampling from September to October 2021 in South Korea. The interviews were subjected to thematic analysis. RESULTS Four overarching themes were identified: (1) deterioration in the quality of care at various settings; (2) new emerging systemic problems; (3) healthcare providers holding on but reaching their limit; and (4) a decline in the quality of life of patients at the end of their lives, and their caregivers. CONCLUSION Healthcare providers of non-COVID-19 patients with severe chronic illnesses reported that the quality of care was declining due to the structural problems of the healthcare system and policies centered solely on the prevention and control of COVID-19. Systematic solutions are needed for appropriate and seamless care for non-infected patients with severe chronic illness in the pandemic.
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Affiliation(s)
- Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Jeong Mi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Correspondence: (S.H.Y.); (B.K.); Tel.: +82-2-2072-1589 (S.H.Y.); +82-2-2072-7215 (B.K.); Fax: +82-2-2072-0754 (S.H.Y.); +82-2-2072-7379 (B.K.)
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Correspondence: (S.H.Y.); (B.K.); Tel.: +82-2-2072-1589 (S.H.Y.); +82-2-2072-7215 (B.K.); Fax: +82-2-2072-0754 (S.H.Y.); +82-2-2072-7379 (B.K.)
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16
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Nishimura M, Toyama M, Mori H, Sano M, Imura H, Kuriyama A, Nakayama T. Providing End-of-Life Care for Patients Dying of COVID-19 and Their Families in Isolated Death During the Pandemic in Japan: The Providing End-of-life Care for COVID-19 Project. Chest 2023; 163:383-395. [PMID: 36257473 PMCID: PMC9576251 DOI: 10.1016/j.chest.2022.10.009] [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: 04/07/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Death resulting from COVID-19 in a hospital during the pandemic has meant death in isolation. Although many health care providers (HCPs) have struggled with end-of-life (EOL) care for these patients, the various strategies across hospitals are not well known. RESEARCH QUESTION What EOL care did HCPs give patients dying of COVID-19 and their families in hospitals during the COVID-19 pandemic? What were the key themes in care? STUDY DESIGN AND METHODS This qualitative study used individual, semistructured, internet, and face-to-face interviews. We recruited HCPs who provided EOL care to patients with COVID-19 dying in hospitals and their families. Purposive sampling was used through the academic networks at the School of Public Health, Kyoto University. Anonymized verbatim transcripts were analyzed thematically. RESULTS Fifteen doctors and 18 nurses from 23 hospitals in 13 regions across Japan participated; 16 participants (48%) were women, with an age range of 20 to 59 years (most were 30-39 years of age). Participants described 51 strategies, including providing physical and psychological-spiritual care, making connections, providing death care, and arranging care environments and bereavement care for patients and their families. Four themes emerged as prominent efforts in COVID-19 EOL care: maintaining relationships with isolated patients, connecting patients and families, sharing decision-making in isolation, and creating humanistic episodes. INTERPRETATION Proper application and awareness of the four themes may help HCPs to implement better EOL care. To compensate for limited memories resulting from isolation and rapid progression of the disease, communicating and creating humanistic episodes are emphasized. ICU diaries and the HCPs' arrangements based on cultural funerary procedures could be provided as grief care for the family and to build trust. EOL education and building partnerships among palliative care staff and nonmedical personnel on a regular basis may enhance the capacity to deliver the necessary support for EOL care.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University.
| | - Mayumi Toyama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| | - Hiroko Mori
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Section of Epidemiology, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Makiko Sano
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Department of Nursing, School of Health Sciences, Bukkyo University
| | - Haruki Imura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Department of Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto
| | - Akira Kuriyama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
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Mary Pappiya E, Mubarak Al Baalharith I, Arulappan J, Missiriya Jalal S, Venkatesan K, Salem Al Grad H, Baraik S. Alawad A. Stress and Burnout Among Frontline Nurses During COVID-19 Pandemic in a Middle Eastern Country. SAGE Open Nurs 2023; 9:23779608231185918. [PMID: 37457617 PMCID: PMC10345911 DOI: 10.1177/23779608231185918] [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: 02/28/2023] [Revised: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in an unanticipated shift in nursing practice to meet the sudden increase in demand for pandemic-related care, leaving nurses unable to provide acceptable services to patients in the way they were taught and expected to do. It put the nurses under more stress and most of them were dissatisfied with their work due to excessive burnout. Objectives The study determined the level of stress and burnout among front-line nurses working at the Ministry of Health Hospitals in Najran, Saudi Arabia during the COVID-19 pandemic. Methods A total of 1594 nurses were chosen using a convenience sampling approach. Google Forms were used to collect data from the nurses. COVID-19 stressors questionnaire and an abbreviated Maslach Burnout Inventory were used to assess stress and burnout among nurses. Results Our study reported that the majority of nurses experienced extreme levels of stress as their colleagues became ill; that they would spread COVID-19 infection to their family and friends; upsetting to see COVID-19 patients dying in front of them; not knowing when the COVID-19 pandemic will be under control; and emotional exhaustion and physical fatigue. A vast majority of nurses felt there were not adequate protective measures; there was a shortage of staff at times; were nervous and scared and thought of quitting their job; and they would quit their job if a COVID-19 outbreak recur and they would fall sick. Likewise, 41.9% of the nurses experienced a high level of burnout. A significant association was found between the area of working and the level of burnout among nurses. Conclusion As nurses experienced extreme levels of stress and severe burnout, it is vital to design regular programs to assist frontline nurses in maintaining their mental health.
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Affiliation(s)
- Ester Mary Pappiya
- Department of Nursing, Regional Nursing Administration, Directorate of General Health Affair, Ministry of Health, Najran, Kingdom of Saudi Arabia
| | - Ibrahim Mubarak Al Baalharith
- Department of Nursing, Regional Nursing Administration, Directorate of General Health Affair, Ministry of Health, Najran, Kingdom of Saudi Arabia
| | - Judie Arulappan
- Department of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Al Khoudh, Muscat, Sultanate of Oman
| | - Sahbanathul Missiriya Jalal
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | - Krishnaraju Venkatesan
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Asir Province, Kingdom of Saudi Arabia
| | - Hamad Salem Al Grad
- Department of Nursing, Regional Nursing Administration, Directorate of General Health Affair, Ministry of Health, Najran, Kingdom of Saudi Arabia
| | - Abdullaah Baraik S. Alawad
- Department of Nursing, Regional Nursing Administration, Directorate of General Health Affair, Ministry of Health, Najran, Kingdom of Saudi Arabia
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Hedman C, Fürst CJ, Rasmussen BH, van der Heide A, Schelin MEC. Dying during the COVID-19 Pandemic in Sweden: Relatives' Experiences of End-of-Life Care (the CO-LIVE Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16146. [PMID: 36498221 PMCID: PMC9740982 DOI: 10.3390/ijerph192316146] [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: 10/19/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Background: The COVID-19 pandemic has seen many deaths, but the majority were for causes other than COVID-19. However, end-of-life care in all settings has been affected by measures limiting the spread of the virus, for patients with and without COVID-19. The Swedish coronavirus strategy was different compared to many other countries, which might have affected end-of-life care. The aim was to describe the experiences of end-of-life care for bereaved relatives in Sweden during the “first wave” and to compare the experiences for deaths due to COVID-19 with the experiences for deaths for other reasons. Methods: A random sample of addresses for 2400 people who died during March−September 2020 was retrieved from the Swedish Person Address Registry. Relatives were contacted with a questionnaire regarding their experience of end-of-life care, with a focus on communication, participation, and trust. Results: In total, 587 relatives (25% response rate) answered the questionnaire (14% COVID-19-deaths, 65% non-COVID-19-deaths, 21% uncertain). In the COVID-19 group 28% of the relatives were allowed visits without restrictions compared to 60% in the non-COVID-19 group (p < 0.01). Only 28% of the relatives in the COVID-19 group reported that the person received “enough care from physicians”, significantly fewer than the non-COVID group (65%, p < 0.01). Conclusion: Relatives’ experience of end-of-life care for persons with COVID-19 was significantly worse than relatives of persons without COVID-19, but relatives for persons without COVID-19 were also negatively affected.
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Affiliation(s)
- Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Anna Steckséns gata 53, SE-17176 Stockholm, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE-11219 Stockholm, Sweden
- Department of Clinical Sciences Lund, Lund University, BMC, Sölvegatan 19, SE-22362 Lund, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Scheelevägen 2, Medicon Village, SE-22381 Lund, Sweden
| | - Carl Johan Fürst
- Department of Clinical Sciences Lund, Lund University, BMC, Sölvegatan 19, SE-22362 Lund, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Scheelevägen 2, Medicon Village, SE-22381 Lund, Sweden
| | - Birgit H. Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Scheelevägen 2, Medicon Village, SE-22381 Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1B, SE-22240 Lund, Sweden
| | - Agnes van der Heide
- Institute for Palliative Care, Lund University and Region Skåne, Scheelevägen 2, Medicon Village, SE-22381 Lund, Sweden
- Department of Public Health, Erasmus MC, Dr. Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands
| | - Maria E. C. Schelin
- Department of Clinical Sciences Lund, Lund University, BMC, Sölvegatan 19, SE-22362 Lund, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Scheelevägen 2, Medicon Village, SE-22381 Lund, Sweden
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Delgado MXL, González ÁRA, Reyes LAB, Campos LFR, Ángel LFV, Rodríguez LIH, Granados MAL, Salazar LVG. [Grief and palliative home-care services for patients at the end of life during the COVID-19 pandemic in Colombia. Analysis from the relatives´ perspective]. REVISTA COLOMBIANA DE PSIQUIATRIA 2022:S0034-7450(22)00116-0. [PMID: 36311343 PMCID: PMC9595366 DOI: 10.1016/j.rcp.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION End-of-life care is one of the most crucial experiences for both the patient and their loved ones. However, as a result of the changes generated by the COVID 19 pandemic, the dynamics of the end-of-life process has undergone changes at both the family, social and health levels. In turn, this has altered the perception and development of the grief of relatives of patients who died during the pandemic regardless of the cause of death. Then, the aim of this study is to analyze the perceptions and some aspects of bereavement of died patients` relatives during the pandemic of Covid 19. METHODS Through the admission evaluation and follow-up of the relatives with an adapted version of the international Care Of the Dying Evaluation (iCODE) questionnaire. RESULTS 239 relatives were surveyed, of which 112 completed the follow-up questionnaire. Most of the patients died at home and their family members were highly involved in their care. Medical attention was considered adequate and the symptom with the highest perception was pain. 87% of those surveyed participated in funeral rites, and 42% rated them as very sober. Regarding grief, the scale of personal growth predominates, however, in the negative aspects, the feeling of pressure in the chest and frequent crying predominates. CONCLUSIONS The end of life of home-care patients during the pandemic was perceived as adequate, allowing family support and symptom control. The grieving process shows no complications. The training of health professionals in these fundamental aspects of patient care is important.
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Affiliation(s)
- Marta Ximena León Delgado
- Médica Anestesióloga, especialista en Dolor y Cuidados Paliativos, Jefe del Departamento de Anestesia, Dolor y Cuidados Paliativos, Profesora Titular Facultad de Medicina Universidad de la Sabana, Chía, Colombia
| | - Ángela Rocío Acero González
- Médica Psiquiatra, MMF, PhD, Profesora asistente, Grupo de Investigación Psiquiatría y Salud Mental, Departamento de Psiquiatría, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Lina Angélica Buitrago Reyes
- Estadística, MSc en Epidemiología Clínica, PhD(c) en Ciencias-Estadística. Universidad Nacional de Colombia. Facultad de Ciencias. Departamento de Estadística, Colombia
| | - Luisa Fernanda Rodríguez Campos
- Médica Familiar y Comunitaria, especialista en Dolor y Cuidados Paliativos, profesora asistente Departamento de Anestesia, Dolor y Cuidados Paliativos, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
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20
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Iness AN, Abaricia JO, Sawadogo W, Iness CM, Duesberg M, Cyrus J, Prasad V. The Effect of Hospital Visitor Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review. Am J Med 2022; 135:1158-1167.e3. [PMID: 35472383 PMCID: PMC9035621 DOI: 10.1016/j.amjmed.2022.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
Health care policymaking during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and health care provider well-being. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported 1 or more prespecified main or secondary outcome (coronavirus disease 2019 [COVID-19] disease transmission, global well-being, mortality, morbidity, or health care resource utilization). Two authors independently extracted data into a standardized form with a third author resolving discrepancies. A total of 1153 abstracts were screened, and 26 final full-text articles were included. Ten studies were qualitative, with 7 cohort studies, and no randomized controlled trials. Critically ill patients were the most represented (12 out of 26 studies). Blanket hospital visitor policies were associated with failure to address the unique needs of patients, their visitors, and health care providers in various clinical environments. Overall, a patient-centered, thoughtful, and nuanced approach to hospital visitor policies is likely to benefit all stakeholders while minimizing potential harms.
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Affiliation(s)
- Audra N Iness
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, Va; Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Jefferson O Abaricia
- Department of Bioengineering, College of Engineering, Virginia Commonwealth University, Richmond, Va
| | - Wendemi Sawadogo
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Va
| | - Caleb M Iness
- School of Medicine, California Northstate University, Elk Grove, Calif
| | - Max Duesberg
- School of Medicine, California Northstate University, Elk Grove, Calif
| | - John Cyrus
- Health Sciences Library, Research and Education Department, Virginia Commonwealth University, Richmond, Va
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
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21
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Fordjour GA, Chow AYM. Global Research Trend and Bibliometric Analysis of Current Studies on End-of-Life Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11176. [PMID: 36141446 PMCID: PMC9517393 DOI: 10.3390/ijerph191811176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
The growing emphasis on evidence-based practice has led to a need for more research on healthcare disciplines, and for the synthesis and translation of that research into practice. This study explored the global research trend in regard to End-of-Life Care (EoLC), and assessed the impact and influence, on the scientific community, of relevant EoLC publications EoLC. Over 350,000 related publications on EoLC were retrieved from three databases (PubMed, Scopus, and Web of Science). Our analysis of the global research trend revealed an exponential rise in the number of related publications on EoLC since the year 1837. This study assessed the bibliometric information of 547 current journal publications on EoLC, sorted by relevance, from the three databases. The USA (47.3%) and the UK (16.1%) were the most productive countries, in terms of the number of relevant publications. The bibliometric analysis also revealed which EoLC research was most impactful and influential, from different parameters including documents, authors, sources, and organisations. The keyword analysis further suggested the growing importance of advance care planning and decision-making in regard to EoLC, as well as an episodic upsurge of EoLC publications related to the COVID-19 pandemic. There were few collaborations among the prolific research on EoLC. This study recommends increased research collaboration across the globe, for wider wisdom-sharing on EoLC issues.
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Affiliation(s)
| | - Amy Yin Man Chow
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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22
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Levoy K, Foxwell A, Rosa WE. Palliative care delivery changes during COVID-19 and enduring implications in oncology nursing: a rapid review. Curr Opin Support Palliat Care 2022; 16:94-101. [PMID: 35929556 PMCID: PMC9364779 DOI: 10.1097/spc.0000000000000603] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW A rapid review was conducted to synthesize evidence of palliative care delivery changes during the COVID-19 pandemic. Changes were synthesized according to the eight domains of high-quality palliative care and enduring implications for oncology nurses beyond the pandemic discussed. RECENT FINDINGS The most significant changes occurred in the structure and processes of palliative care (Domain 1), where increased utilization of telehealth was critical in circumventing barriers imposed by COVID-19 mitigation. The suboptimal availability of community-based psychosocial supports for patients and caregivers and inadequate health system-based psychosocial supports for healthcare providers were highlighted (Domains 3-5). The pandemic also ushered in an increased emphasis on the need for advance care planning (ACP), where integrating its delivery earlier in the outpatient setting and shifting policy to promote subsequent virtual documentation (Domain 8) were essential to ensure care preferences were clarified and accessible before health crises occurred. SUMMARY Continuing to embrace and sustain systems-level changes with respect to telehealth, psychosocial supports, and ACP are critical to bridging gaps in palliative care delivery underscored by the pandemic. Oncology nurses are well positioned to fill these gaps in care beyond the pandemic by providing evidence-based, palliative care throughout the cancer continuum.
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Affiliation(s)
- Kristin Levoy
- Department of Community and Health Systems, Indiana University School of Nursing
- Indiana University Center for Aging Research, Regenstrief Institute
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Anessa Foxwell
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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23
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Felser S, Sewtz C, Kriesen U, Kragl B, Hamann T, Bock F, Strüder DF, Schafmayer C, Dräger DL, Junghanss C. Relatives Experience More Psychological Distress Due to COVID-19 Pandemic-Related Visitation Restrictions Than In-Patients. Front Public Health 2022; 10:862978. [PMID: 35910882 PMCID: PMC9326244 DOI: 10.3389/fpubh.2022.862978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic led to visiting restrictions (VRs) of patients in hospitals. Social contacts between patients' relatives play an important role in convalescence. Isolation may cause new psychological comorbidity. The present study investigated the psychological distress of VR in in-patients and their relatives. Methods From April 1, 2020 to May 20, 2020, 313 in-patients (≥14 years) of the University Medical Center Rostock were interviewed by questionnaires and 51 relatives by phone. Subjective psychological distress was assessed by a distress thermometer [0 (not at all)−100 (extreme)]. The study also investigated stressors due to VR, psychological distress in dependence on demographic or disease-related data, currently used communication channels and desired alternatives and support. Results Relatives were more psychologically distressed by VR than in-patients (59 ± 34 vs. 38 ± 30, p = 0.002). Loss of direct physical contact and facial expressions/gestures resulted in the most distress. Psychological distress due to VR was independent of demographics and indicates small positive correlations with the severity of physical restriction and the general psychological distress of in-patients. The most frequent ways of communication were via phone and social media. Frequently requested alternatives for patients were other interlocutors and free phone/tablet use, for relatives visiting rooms with partitions. Conclusion VRs are a stressor for patients and their relatives. The establishment of visiting rooms with partitions and the free use of phones/tablets could reduce the additional distress.
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Affiliation(s)
- Sabine Felser
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
- *Correspondence: Sabine Felser
| | - Corinna Sewtz
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
| | - Ursula Kriesen
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
| | - Brigitte Kragl
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
| | - Till Hamann
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Felix Bock
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Daniel Fabian Strüder
- Head and Neck Surgery “Otto Koerner”, Department of Otorhinolaryngology, University Hospital Rostock, Rostock, Germany
| | - Clemens Schafmayer
- Department of General Surgery, University Hospital Rostock, Rostock, Germany
| | | | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
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24
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Desjardins CM, Muehlhausen BL, Galchutt P, Tata-Mbeng BS, Fitchett G. American health care chaplains' narrative experiences serving during the COVID-19 pandemic: a phenomenological hermeneutical study. J Health Care Chaplain 2022; 29:229-244. [PMID: 35820036 DOI: 10.1080/08854726.2022.2087964] [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: 10/17/2022]
Abstract
The COVID-19 pandemic significantly impacted North American health care chaplains' modes of work and emotions. To capture the experiences of health care chaplains across the United States, 30 Board Certified (or eligible) chaplains were asked to keep a weekly narrative journal of their experiences and emotions during the pandemic from April of 2020 through June of 2020. Twenty-one chaplains submitted their journals for qualitative analysis, amounting to over 90,000 words of chaplain reflection containing rich, descriptive, and often personal stories of health care chaplains. Journals were analyzed using hermeneutic phenomenological methodology. The overarching patterns identified included: The World of Chaplaincy, Policies/Procedures/Visitation, Staff Care, Rituals, Chaplain Emotional Responses, Coping, and Racism. A significant finding was the resiliency and creativity of chaplains despite the rapid changes, uncertainty, and fear brought on by the pandemic. The results further suggest that journaling is a feasible and acceptable method in chaplaincy research.
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Affiliation(s)
- Cate Michelle Desjardins
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA.,Mennonite Healthcare Fellowship, Philadelphia, PA, USA
| | | | - Paul Galchutt
- Spiritual Health Services, University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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25
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Yildiz B, Korfage IJ, Witkamp EF, Goossensen A, van Lent LG, Pasman HR, Onwuteaka-Philipsen BD, Zee M, van der Heide A. Dying in times of COVID-19: Experiences in different care settings - An online questionnaire study among bereaved relatives (the CO-LIVE study). Palliat Med 2022; 36:751-761. [PMID: 35264024 PMCID: PMC9006387 DOI: 10.1177/02692163221079698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic and restricting measures have affected end-of-life care across different settings. AIM To compare experiences of bereaved relatives with end-of-life care for a family member or friend who died at home, in a hospital, nursing home or hospice during the pandemic. DESIGN An open observational online survey was developed and disseminated via social media and public fora (March-July 2020). Data were analyzed using descriptive statistics and logistic regression analyses. PARTICIPANTS Individuals who lost a family member or friend in the Netherlands during the COVID-19 pandemic. RESULTS The questionnaire was filled out by 393 bereaved relatives who lost a family member or friend at home (n = 68), in a hospital (n = 114), nursing home (n = 176) or hospice (n = 35). Bereaved relatives of patients who died in a hospital most often evaluated medical care (79%) as sufficient, whereas medical care (54.5%) was least often evaluated as sufficient in nursing homes. Emotional support for relatives was most often evaluated as sufficient at home (67.7%) and least often in nursing homes (40.3%). Sufficient emotional support for relatives was associated with a higher likelihood to rate the place of death as appropriate. Bereaved relatives of patients who died at a place other than home and whose care was restricted due to COVID-19 were less likely to evaluate the place of death as appropriate. CONCLUSION End-of-life care during the COVID-19 pandemic was evaluated least favourably in nursing homes. The quality of emotional support for relatives and whether care was restricted or not were important for assessing the place of death as appropriate.
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Affiliation(s)
- Berivan Yildiz
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Fe Witkamp
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Research Centre Innovations in Care, University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Masha Zee
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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26
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[Making decisions in times of a pandemic : A qualitative study on perspectives of managers of long-term care facilities]. Z Gerontol Geriatr 2022; 55:143-149. [PMID: 35201395 PMCID: PMC8867686 DOI: 10.1007/s00391-022-02034-6] [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: 08/05/2021] [Accepted: 01/25/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the spring of 2020 during the first wave of the pandemic an above-average number of residents and staff in nursing homes fell ill and accounted for the highest number of incidences. Due to the pandemic, managers in nursing homes had to make new decisions on a daily basis as well as interpret and integrate decisions made by higher level authorities. AIM OF THE STUDY The aim was to describe the decisions that had to be made by the managers of nursing homes in dealing with the COVID-19 pandemic and related consequences. MATERIAL AND METHODS A qualitative multicentre cross-sectional design was chosen. Data collection was conducted with semi-structured telephone interviews. The recorded audio data were transcribed, analyzed using the framework analysis method and reflected in peer debriefings. RESULTS A total of 78 interviews were conducted in 43 nursing homes and 3 main themes with 10 subthemes emerged: decisions about social participation, decisions on quarantine and isolation and staff adjustments. DISCUSSION Clearer information and directives for the implementation of measures are needed, e.g. through standardized guidelines nationwide. Additionally, public health departments should play a stronger and more responsible role in a pandemic situation. The consequences of their decisions were hardly foreseeable for the managers and were marked by uncertainty. Responsibilities for and consequences of pandemic-related decisions should be further evaluated to empower managers in times of crises.
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Seibel K, Couné B, Mueller M, Boehlke C, Simon ST, Bausewein C, Becker G. Implementation of an acute palliative care unit for COVID-19 patients in a tertiary hospital: Qualitative data on clinician perspectives. Palliat Med 2022; 36:332-341. [PMID: 35176931 DOI: 10.1177/02692163211059690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, it has become apparent that palliative care has dynamically adapted to the care of dying patients with and without COVID-19 and has developed new forms of collaboration. Evaluation is needed to assess which innovations should be integrated into future pandemic management. AIM To explore the experiences of stakeholders and staff in implementing and operating an ad hoc unit delivering acute palliative care. What lessons were learned? DESIGN Qualitative interview study (German Clinical Trials Register; identifier 22,473) with qualitative content analysis. SETTING/PARTICIPANTS During the first wave of the pandemic, the University Medical Center Freiburg (Germany) established an ad hoc unit delivering acute palliative care for COVID-19 patients likely to die. Nurses from non-palliative areas and the specialist palliative care team formed a new team working together there. Twenty-nine individuals from management and staff of this unit were interviewed. RESULTS Patient care and teamwork were rated positively. Joint familiarization, bedside teaching, and team/management support were evaluated as core elements for success. Challenges for the nurses from non-palliative settings included adapting to palliative care routines and culture of care. The palliative care team had to adjust the high standards of palliative care to pandemic conditions. Due to sufficient hospital-wide capacity, only three COVID-19 patients were treated, significantly fewer than anticipated at planning. CONCLUSIONS Results show the feasibility of an ad hoc COVID-19 acute palliative care unit. In the event of capacity constraints, such a unit can be a viable part of future pandemic management.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Couné
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Mueller
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Dennis B, Vanstone M, Swinton M, Brandt Vegas D, Dionne JC, Cheung A, Clarke FJ, Hoad N, Boyle A, Huynh J, Toledo F, Soth M, Neville TH, Fiest K, Cook DJ. Sacrifice and solidarity: a qualitative study of family experiences of death and bereavement in critical care settings during the pandemic. BMJ Open 2022; 12:e058768. [PMID: 35046010 PMCID: PMC8771806 DOI: 10.1136/bmjopen-2021-058768] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pandemic-related restrictions are expected to continue to shape end-of-life care and impact the experiences of dying hospitalised patients and their families. OBJECTIVE To understand families' experiences of loss and bereavement during and after the death of their loved one amidst the SARS-CoV-2 (COVID-19) pandemic. DESIGN Qualitative descriptive study. SETTING Three acute care units in a Canadian tertiary care hospital. PARTICIPANTS Family members of 28 hospitalised patients who died from March-July 2020. MAIN OUTCOME MEASURES Qualitative semistructured interviews conducted 6-16 months after patient death inquired about family experiences before and beyond the death of their loved one and garnered suggestions to improve end-of-life care. RESULTS Pandemic restrictions had consequences for families of dying hospitalised patients. Most family members described an attitude of acquiescence, some framing their experience as a sacrifice made for the public good. Families appreciated how clinicians engendered trust in the name of social solidarity while trying to mitigate the negative impact of family separation. However, fears about the patient's experience of isolation and changes to postmortem rituals also created despair and contributed to long-lasting grief. CONCLUSION Profound loss and enduring grief were described by family members whose final connections to their loved one were constrained by pandemic circumstances. Families observed solidarity among clinical staff and experienced a sense of unity with staff, which alleviated some distress. Their suggestions to improve end-of-life care given pandemic restrictions included frequent, flexible communication, exceptions for family presence when safe, and targeted efforts to connect patients whose isolation is intensified by functional impairment or limited technological access. TRIAL REGISTRATION NUMBER NCT04602520; Results.
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Affiliation(s)
- Brittany Dennis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Joanna C Dionne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Cheung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - France J Clarke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Neala Hoad
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Anne Boyle
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Huynh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Feli Toledo
- Department of Spiritual Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mark Soth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Thanh H Neville
- University of California Los Angeles, Los Angeles, California, USA
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Abstract
Supplemental Digital Content is available in the text. Patient- and family-centered end-of-life care can be difficult to achieve in light of visitation restrictions and infection-prevention measures. We evaluated how the 3 Wishes Program evolved to allow continued provision of compassionate end-of-life care for critically ill patients during the coronavirus disease 2019 pandemic.
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30
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Becqué YN, van der Geugten W, van der Heide A, Korfage IJ, Pasman HRW, Onwuteaka-Philipsen BD, Zee M, Witkamp E, Goossensen A. Dignity reflections based on experiences of end-of-life care during the first wave of the COVID-19 pandemic: A qualitative inquiry among bereaved relatives in the Netherlands (the CO-LIVE study). Scand J Caring Sci 2021; 36:769-781. [PMID: 34625992 PMCID: PMC8661881 DOI: 10.1111/scs.13038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/26/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic affects care practices for critically ill patients, with or without a COVID-19 infection, and may have affected the experience of dying for patients and their relatives in the physical, psychological, social and spiritual domains. AIM To give insight into aspects of end-of-life care practices that might have jeopardised or supported the dignity of the patients and their family members during the first wave of the COVID-19 pandemic in the Netherlands. METHODOLOGY A qualitative study involving 25 in-depth interviews with purposively sampled bereaved relatives of patients who died during the COVID-19 pandemic between March and July 2020 in the Netherlands. We created a dignity-inspired framework for analysis, and used the models of Chochinov et al. and Van Gennip et al. as sensitising concepts. These focus on illness-related aspects and the individual, relational and societal/organisational level of dignity. RESULTS Four themes concerning aspects of end-of-life care practices were identified as possibly jeopardising the dignity of patients or relatives: 'Dealing with an unknown illness', 'Being isolated', 'Restricted farewells' and 'Lack of attentiveness and communication'. The analysis showed that 'Meaningful end-of-life moments' and 'Compassionate professional support' contributed to the dignity of patients and their relatives. CONCLUSION This study illuminates possible aspects of end-of-life care practices that jeopardised or supported dignity. Experienced dignity of bereaved relatives was associated with the unfamiliarity of the virus and issues associated with preventive measures. However, most aspects that had an impact on the dignity experiences of relatives were based in human action and relationships. Relatives experienced that preventive measures could be mitigated by health care professionals to make them less devastating.
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Masha Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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31
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Schloesser K, Simon ST, Pauli B, Voltz R, Jung N, Leisse C, van der Heide A, Korfage IJ, Pralong A, Bausewein C, Joshi M, Strupp J. "Saying goodbye all alone with no close support was difficult"- Dying during the COVID-19 pandemic: an online survey among bereaved relatives about end-of-life care for patients with or without SARS-CoV2 infection. BMC Health Serv Res 2021; 21:998. [PMID: 34551766 PMCID: PMC8455806 DOI: 10.1186/s12913-021-06987-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND During the SARS-CoV2 pandemic, protection measures, as well as visiting restrictions, had a severe impact on seriously ill and dying patients and their relatives. The study aims to describe the experiences of bereaved relatives of patients who died during the SARS-CoV2 pandemic, regardless of whether patients were infected with SARS-CoV2 or not. As part of this, experiences related to patients' end-of-life care, saying goodbye, visiting restrictions and communication with the healthcare team were assessed. METHODS An open observational post-bereavement online survey with free text options was conducted with 81 bereaved relatives from people who died during the pandemic in Germany, with and without SARS-CoV2 diagnosis. RESULTS 67/81 of the bereaved relatives were female, with a mean age of 57.2 years. 50/81 decedents were women, with a mean age of 82.4 years. The main underlying diseases causing death were cardiovascular diseases or cancer. Only 7/81 of the patients were infected with SARS-CoV2. 58/81 of the relatives felt burdened by the visiting restrictions and 60/81 suffered from pandemic-related stress. 10 of the patients died alone due to visiting restrictions. The burden for relatives in the hospital setting was higher compared to relatives of patients who died at home. 45/81 and 44/81 relatives respectively reported that physicians and nurses had time to discuss the patient's condition. Nevertheless, relatives reported a lack of proactive communication from the healthcare professionals. CONCLUSIONS Visits of relatives play a major role in the care of the dying and have an impact on the bereavement of relatives. Visits must be facilitated, allowing physical contact. Additionally, virtual contact with the patients and open, empathetic communication on the part of healthcare professionals is needed. TRIAL REGISTRATION German Clinical Trials Register (DRKS00023552).
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Affiliation(s)
- Karlotta Schloesser
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Steffen T Simon
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Berenike Pauli
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research. Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Agnes van der Heide
- Department of Public Health, University Medical Center Rotterdam, Erasmus, MC, the Netherlands
| | - Ida J Korfage
- Department of Public Health, University Medical Center Rotterdam, Erasmus, MC, the Netherlands
| | - Anne Pralong
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital Munich, Munich, Germany
- Comprehensive Cancer Centre Munich (CCCM), Munich, Germany
| | - Melanie Joshi
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, Litwin T, Kreutz C, Boger AH, Lindner S, Verboom B, Voss S, Movsisyan A. Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Cochrane Database Syst Rev 2021; 9:CD015085. [PMID: 34523727 PMCID: PMC8442144 DOI: 10.1002/14651858.cd015085.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Starting in late 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2, spread around the world. Long-term care facilities are at particularly high risk of outbreaks, and the burden of morbidity and mortality is very high among residents living in these facilities. OBJECTIVES To assess the effects of non-pharmacological measures implemented in long-term care facilities to prevent or reduce the transmission of SARS-CoV-2 infection among residents, staff, and visitors. SEARCH METHODS On 22 January 2021, we searched the Cochrane COVID-19 Study Register, WHO COVID-19 Global literature on coronavirus disease, Web of Science, and CINAHL. We also conducted backward citation searches of existing reviews. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies that assessed the effects of the measures implemented in long-term care facilities to protect residents and staff against SARS-CoV-2 infection. Primary outcomes were infections, hospitalisations and deaths due to COVID-19, contaminations of and outbreaks in long-term care facilities, and adverse health effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts. One review author performed data extractions, risk of bias assessments and quality appraisals, and at least one other author checked their accuracy. Risk of bias and quality assessments were conducted using the ROBINS-I tool for cohort and interrupted-time-series studies, the Joanna Briggs Institute (JBI) checklist for case-control studies, and a bespoke tool for modelling studies. We synthesised findings narratively, focusing on the direction of effect. One review author assessed certainty of evidence with GRADE, with the author team critically discussing the ratings. MAIN RESULTS We included 11 observational studies and 11 modelling studies in the analysis. All studies were conducted in high-income countries. Most studies compared outcomes in long-term care facilities that implemented the measures with predicted or observed control scenarios without the measure (but often with baseline infection control measures also in place). Several modelling studies assessed additional comparator scenarios, such as comparing higher with lower rates of testing. There were serious concerns regarding risk of bias in almost all observational studies and major or critical concerns regarding the quality of many modelling studies. Most observational studies did not adequately control for confounding. Many modelling studies used inappropriate assumptions about the structure and input parameters of the models, and failed to adequately assess uncertainty. Overall, we identified five intervention domains, each including a number of specific measures. Entry regulation measures (4 observational studies; 4 modelling studies) Self-confinement of staff with residents may reduce the number of infections, probability of facility contamination, and number of deaths. Quarantine for new admissions may reduce the number of infections. Testing of new admissions and intensified testing of residents and of staff after holidays may reduce the number of infections, but the evidence is very uncertain. The evidence is very uncertain regarding whether restricting admissions of new residents reduces the number of infections, but the measure may reduce the probability of facility contamination. Visiting restrictions may reduce the number of infections and deaths. Furthermore, it may increase the probability of facility contamination, but the evidence is very uncertain. It is very uncertain how visiting restrictions may adversely affect the mental health of residents. Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies) Barrier nursing may increase the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent cleaning and environmental hygiene measures may reduce the number of infections, but the evidence is very uncertain. It is unclear how contact reduction measures affect the probability of outbreaks. These measures may reduce the number of infections, but the evidence is very uncertain. Personal hygiene measures may reduce the probability of outbreaks, but the evidence is very uncertain. Mask and personal protective equipment usage may reduce the number of infections, the probability of outbreaks, and the number of deaths, but the evidence is very uncertain. Cohorting residents and staff may reduce the number of infections, although evidence is very uncertain. Multicomponent contact -regulating and transmission -reducing measures may reduce the probability of outbreaks, but the evidence is very uncertain. Surveillance measures (2 observational studies; 6 modelling studies) Routine testing of residents and staff independent of symptoms may reduce the number of infections. It may reduce the probability of outbreaks, but the evidence is very uncertain. Evidence from one observational study suggests that the measure may reduce, while the evidence from one modelling study suggests that it probably reduces hospitalisations. The measure may reduce the number of deaths among residents, but the evidence on deaths among staff is unclear. Symptom-based surveillance testing may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Outbreak control measures (4 observational studies; 3 modelling studies) Separating infected and non-infected residents or staff caring for them may reduce the number of infections. The measure may reduce the probability of outbreaks and may reduce the number of deaths, but the evidence for the latter is very uncertain. Isolation of cases may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent measures (2 observational studies; 1 modelling study) A combination of multiple infection-control measures, including various combinations of the above categories, may reduce the number of infections and may reduce the number of deaths, but the evidence for the latter is very uncertain. AUTHORS' CONCLUSIONS This review provides a comprehensive framework and synthesis of a range of non-pharmacological measures implemented in long-term care facilities. These may prevent SARS-CoV-2 infections and their consequences. However, the certainty of evidence is predominantly low to very low, due to the limited availability of evidence and the design and quality of available studies. Therefore, true effects may be substantially different from those reported here. Overall, more studies producing stronger evidence on the effects of non-pharmacological measures are needed, especially in low- and middle-income countries and on possible unintended consequences of these measures. Future research should explore the reasons behind the paucity of evidence to guide pandemic research priority setting in the future.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Laura Arnold
- Academy of Public Health Services, Duesseldorf, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Saskia Lindner
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Pouwels BDC, Simons SO, Theunissen M, Peters ML, Schoenmaekers JJ, Bekkers SC, van den Beuken-van Everdingen MHJ. Healthcare use during COVID-19 and the effect on psychological distress in patients with chronic cardiopulmonary disorders in the Netherlands: a cross-sectional study. BMJ Open 2021; 11:e046883. [PMID: 34193494 PMCID: PMC8249168 DOI: 10.1136/bmjopen-2020-046883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic caused a massive shift in the focus of healthcare. Such changes could have affected health status and mental health in vulnerable patient groups. We aimed to investigate whether patients with chronic pulmonary and cardiac diseases had experienced high levels of psychological distress during the COVID-19 pandemic in the Netherlands. DESIGN A cross-sectional study. SETTING COVID-19 pandemic-related changes in healthcare use, health status and psychological distress were investigated among patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF) and congestive heart failure (CHF), using an online nationwide survey. PARTICIPANTS 680 patients completed the survey. COPD was the most often reported diagnosis 334 (49%), followed by congestive heart failure 219 (32%) and PF 44 (7%). There were 79 (12%) patients with primary diagnosis 'other' than chronic cardiopulmonary disease, who also completed this survey. INTERVENTIONS Psychological distress was assessed via the DASS-21 score (Depression Anxiety Stress Scale). Moreover, specific worries and anxieties regarding COVID-19 were explored. RESULTS The frequency of contact with healthcare professionals changed in 52%. Changes in treatment were reported in 52%. Deterioration in health status was self-reported in 39%. Moderate to extremely severe levels of depression, anxiety and stress was observed in 25.8%, 28.5% and 14%, respectively. Over 70% reported specific worries and anxieties, such as about their own health and fear of being alone. Both the deterioration in health status and increased levels of anxiety were significantly (p<0.001, p<0.006) associated with changes in treatment. Exploratory analyses indicated that lack of social support may further increase anxiety. CONCLUSION Healthcare use changed during the COVID-19 pandemic in the Netherlands. It was associated with a decrease in health status, and increased psychological stress among patients with chronic cardiopulmonary disorders. Provision of healthcare should be more sensitive to the mental health needs of these patients during subsequent COVID-19 waves.
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Affiliation(s)
- Beau D C Pouwels
- Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Madelon L Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Janna J Schoenmaekers
- Respiratory Medicine and Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
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