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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.


Adejoke O. Oluyase

Mevhibe Hocaoglu

Rachel L. Cripps

Matthew Maddocks

Catherine Walshe

Lorna K. Fraser

Nancy Preston

Lesley Dunleavy

Andy Bradshaw

Sabrina Bajwah

Katherine E. Sleeman

Irene J. Higginson


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.


Oluyase, A. O., Hocaoglu, M., Cripps, R. L., Maddocks, M., Walshe, C., Fraser, L. K., …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,

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
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Keywords Palliative care; COVID-19; Pandemics; Severe acute respiratory syndrome coronavirus 2; End of life care; Hospices
Public URL
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Article in press (1 Mb)

Copyright Statement
© 2021 The Authors. Published by Elsevier Inc. on behalf of<br /> American Academy of Hospice and Palliative Medicine. This is an<br /> open access article under the CC BY license<br /> (

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