The challenges of caring for people dying from COVID-19: a multinational, observational study (CovPall)

Oluyase, Adejoke O.; Hocaoglu, Mevhibe; Cripps, Rachel L.; Maddocks, Matthew; Walshe, Catherine; Fraser, Lorna K.; Preston, Nancy; Dunleavy, Lesley; Bradshaw, Andy; Murtagh, Fliss E.M.; Bajwah, Sabrina; Sleeman, Katherine E.; Higginson, Irene J.

Abstract

Context: Systematic data on the care of people dying with COVID-19 are scarce. Objectives: To understand the response of and challenges faced by palliative care services during the COVID-19 pandemic, and identify associated factors. Methods: We surveyed palliative care and hospice services, contacted via relevant organizations. Multivariable logistic regression identified associations with challenges. Content analysis explored free text responses. Results: A total of 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world; 81% cared for patients with suspected or confirmed COVID-19, 77% had staff with suspected or confirmed COVID-19; 48% reported shortages of Personal Protective Equipment (PPE), 40% staff shortages, 24% medicines shortages, 14% shortages of other equipment. Services provided direct care and education in symptom management and communication; 91% changed how they worked. Care often shifted to increased community and hospital care, with fewer admissions to inpatient palliative care units. Factors associated with increased odds of PPE shortages were: charity rather than public management (OR 3.07, 95% CI 1.81–5.20), inpatient palliative care unit rather than other settings (OR 2.34, 95% CI 1.46–3.75). Being outside the UK was associated with lower odds of staff shortages (OR 0.44, 95% CI 0.26–0.76). Staff described increased workload, concerns for their colleagues who were ill, whilst expending time struggling to get essential equipment and medicines, perceiving they were not a front-line service. Conclusion: Palliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics.

Citation

Oluyase, A. O., Hocaoglu, M., Cripps, R. L., Maddocks, M., Walshe, C., Fraser, L. K., Preston, N., Dunleavy, L., Bradshaw, A., Murtagh, F. E., Bajwah, S., Sleeman, K. E., & Higginson, I. J. (in press). The challenges of caring for people dying from COVID-19: a multinational, observational study (CovPall). Journal of pain and symptom management, https://doi.org/10.1016/j.jpainsymman.2021.01.138

• Journal Article Type: Article
• Acceptance Date: Jan 30, 2021
• Online Publication Date: Feb 5, 2021
• Deposit Date: Feb 15, 2021
• Publicly Available Date: Apr 1, 2021
• Journal: Journal of Pain and Symptom Management
• Print ISSN: 0885-3924
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.jpainsymman.2021.01.138
• Keywords: Palliative care; COVID-19; Pandemics; Severe acute respiratory syndrome coronavirus 2; End of life care; Hospices
• Public URL: https://hull-repository.worktribe.com/output/3724538
• Publisher URL: https://www.jpsmjournal.com/article/S0885-3924(21)00159-7/fulltext