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Palliative Care in Times of the COVID-19 Pandemic
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Palliative Care in Times of the COVID-19 Pandemic

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (25 August 2022) | Viewed by 9073

Special Issue Editors

Prof. Dr. Lukas Radbruch

E-Mail Website1 Website2
Guest Editor
Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
Interests: quality of life; end-of-life care; symptom assessment; ethical decisions; pain management; fatigue
Prof. Dr. Claudia Bausewein

E-Mail Website1 Website2
Guest Editor
Department of Palliative Medicine, LMU University Hospital Munich, Munich, Germany
Interests: palliative care; outcome measurement; complexity; breathlessness; palliative pharmacy; terminal care

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic has made a huge impact on the health care systems in all countries and regions of the world. Palliative care has been impacted as well, and has sometimes even been marginalized with the focus on the overwhelming need for pulmonary and intensive care.

Palliative care is able to contribute significantly to the management of the pandemic, with its expertise on ethical decision making, symptom control for patients not able to or not willing to access intensive care and/or mechanical ventilation, and psychosocial and spiritual care for patients and family caregivers suffering from the lack of emotional support with isolation and quarantine.

Inclusion of palliative care has been recommended for humanitarian emergencies in general by the World Health Organization and human rights advocates.

Selected publications from research in the first wave of the pandemic in Italy and UK have shown the need for palliative care and the effectiveness of the palliative care approach.

Original papers and reviews will be solicited on the palliative care perspective on the COVID-19 pandemic. This includes the impact of the pandemic on the provision of palliative care, palliative care interventions for patients with COVID-19 infections, and contributions of palliative care expertise to the pandemic management.

Prof. Dr. Lukas Radbruch
Prof. Dr. Claudia Bausewein
Guest Editors

Manuscript Submission Information

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Keywords

  • palliative care
  • palliative medicine
  • hospice care
  • dyspnoea
  • symptom control
  • triage
  • psychosocial suffering
  • isolation
  • emotional support
  • spiritual support
  • pandemic
  • humanitarian crisis

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Published Papers (5 papers)

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Research

10 pages, 588 KiB  
Article
Impact of COVID-19 on Head and Neck Cancer Advancement Measured by Increasing Numbers of Urgent Dyspnea Cases—What Could Be Improved in the Event of Subsequent Pandemics?
by Wioletta Pietruszewska, Paweł Burduk, Oskar Rosiak, Paulina Podlawska, Bartosz Zakrzewski, Magda Barańska, Magdalena Kowalczyk, Jakub Piątkowski, Grzegorz Śmigielski, Paweł Solarz, Marta Staszak, Małgorzata Wierzbicka and Bogusław Mikaszewski
J. Clin. Med. 2022, 11(21), 6385; https://doi.org/10.3390/jcm11216385 - 28 Oct 2022
Cited by 4 | Viewed by 1528
Abstract
The COVID-19 pandemic has altered all aspects of the healthcare system’s organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for [...] Read more.
The COVID-19 pandemic has altered all aspects of the healthcare system’s organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. This study’s objective was to evaluate the clinical characteristics of two multi-center cohorts, “pre-COVID-19” and “COVID-19”, of HNC patients admitted as emergencies for dyspnea. The therapeutic activity of HNC patients in four University Departments of Otolaryngology was studied over two time periods: September–February 2019/2020 and 2020/2021. A group of 136 HNC patients who underwent a tracheotomy in two-time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), was analyzed. The mean tracheotomies incidence proportion was 1.82 (SD: 1.12) for the pre-COVID-19 and 3.79 (SD: 2.76) for COVID-19 period. A rise in the occurrence of emergency dyspnea was observed in the COVID-19 cohort, and the greatest increase was seen in the centers with the highest limitations on planned surgeries. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in the COVID-19 period (p = 0.04). There was a higher incidence of laryngeal and laryngopharyngeal cancer in the COVID-19 period (63% vs. 75%, respectively). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56%, respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) in comparison to the pre-COVID-19 period (N = 14, 24%). Reorganization of the referral system, adjustment of treatment capacity for an increased number of HNC, and a reserve for more extensive resection and reconstruction surgeries should be made in the profile of otorhinolaryngological departments, ensuring future HNC treatment is not hampered in case of a new pandemic wave. Full article
(This article belongs to the Special Issue Palliative Care in Times of the COVID-19 Pandemic)
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9 pages, 240 KiB  
Article
Prepared to Accompany the End of Life during Pandemics in Nursing Homes
by Norbert Krumm, Cordula Gebel, Lars Kloppenburg, Roman Rolke and Ulrich Wedding
J. Clin. Med. 2022, 11(20), 6075; https://doi.org/10.3390/jcm11206075 - 14 Oct 2022
Viewed by 1140
Abstract
Background: The COVID-19 pandemic confronted nursing homes with a variety of challenges to ensure the provision of palliative care for residents. PallPan-Implement aimed to adapt the recommendations of the National Strategy for the Care of Seriously Ill, Dying Adults and their Families in [...] Read more.
Background: The COVID-19 pandemic confronted nursing homes with a variety of challenges to ensure the provision of palliative care for residents. PallPan-Implement aimed to adapt the recommendations of the National Strategy for the Care of Seriously Ill, Dying Adults and their Families in Times of Pandemic (PALLPAN) in such a way that nursing facilities can use and implement them. Methods: Based on 33 PALLPAN recommendations, we developed a questionnaire, conducted a pilot implementation for selected nursing homes, and asked for qualitative feedback. Results: The developed questionnaire contains 22 main questions. A three-stage pilot implementation with an introductory event, processing phase, and evaluation event took place in seven facilities. The facilities evaluated the developed questionnaire as helpful. Feedback from the facilities identified three major categories: (a) requirements for facilities should be realistic to avoid frustration, (b) the creation of a pandemic plan for palliative care only is impractical, (c) measures for the psychosocial support of staff is particularly necessary, but was perceived as difficult to implement. Conclusions: The practical implementation of recommendations requires a concept and material tailored to facilities and areas. The strategy of PallPan Implement developed in this project appears to be target-oriented, well-received, and can be recommended for further implementation. Full article
(This article belongs to the Special Issue Palliative Care in Times of the COVID-19 Pandemic)
12 pages, 950 KiB  
Article
Specialist Palliative Care Consultations in COVID-19 Patients in the ICU—A Retrospective Analysis of Patient Characteristics and Symptoms at a German University Hospital
by Theresa Tenge, Sebastian Brimah, Daniel Schlieper, Antje Roesel, Jacqueline Schwartz, Manuela Schallenburger, Stefan Meier, Timo Brandenburger, Detlef Kindgen-Milles, Peter Kienbaum and Martin Neukirchen
J. Clin. Med. 2022, 11(19), 5925; https://doi.org/10.3390/jcm11195925 - 7 Oct 2022
Cited by 6 | Viewed by 1619
Abstract
COVID-19 patients who may require invasive therapeutic procedures such as extracorporeal membrane oxygenation (ECMO) have high symptom burden and in-hospital mortality. In addition, awake patients on ECMO are new in the intensive care unit (ICU) setting. Inpatient specialist palliative care (sPC) provides support [...] Read more.
COVID-19 patients who may require invasive therapeutic procedures such as extracorporeal membrane oxygenation (ECMO) have high symptom burden and in-hospital mortality. In addition, awake patients on ECMO are new in the intensive care unit (ICU) setting. Inpatient specialist palliative care (sPC) provides support such as symptom control on a physical, psychosocial and spiritual level. The field of sPC in COVID-19 patients is still new and important to investigate. We aim to analyze sPC of COVID-19 patients in the ICU with regard to patient characteristics and symptoms from a palliative care perspective. We conducted a retrospective analysis (03/2020–04/2021) and identified 51 ICU patients receiving sPC. The statistical analysis included descriptive statistics and comparisons of symptoms. The first sPC contact of patients (mean age 69.5 years, 62.7% male) was around 14 days after COVID-19 confirmation, and 43% were treated with ECMO therapy. The baseline symptom burden was high with a focus on weakness (100%), tiredness (98%), dyspnea (96%) and family burden (92%). The symptom intensity significantly decreased during the time period of sPC and COVID-19 treatment (t(99) = 3.119, p = 0.003, d = 0.437). These results help intensivists and sPC clinicians to identify symptoms and the need for sPC in COVID-19 patients. However, studies with prospective and controlled designs need to follow. Full article
(This article belongs to the Special Issue Palliative Care in Times of the COVID-19 Pandemic)
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16 pages, 303 KiB  
Article
Impact of the COVID-19 Pandemic on the Perceived Quality of Palliative Care in Nursing Homes
by Emilio Mota-Romero, Concepcion Petra Campos-Calderon, Daniel Puente-Fernandez, Cesar Hueso-Montoro, Ana A. Esteban-Burgos and Rafael Montoya-Juarez
J. Clin. Med. 2022, 11(19), 5906; https://doi.org/10.3390/jcm11195906 - 6 Oct 2022
Cited by 5 | Viewed by 2040
Abstract
The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. Objectives: To describe perceptions among staff at nursing homes and primary [...] Read more.
The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. Objectives: To describe perceptions among staff at nursing homes and primary health care (PHC) centres regarding the relevance, feasibility, and degree of achievement of quality standards for palliative care in nursing homes and to determine the differences in these perceptions before and after the pandemic. Methodology: Cross-sectional descriptive study. Professionals at eight nursing homes and related PHC centres who participated in NUHELP development assessed 42 palliative care standards at two time points (2018 and 2022). The Mann–Whitney U test was applied to analyse differences in the scores between these two times and between perceptions at nursing homes and at PHC centres. Results: The study population consisted of 58 professionals in 2018 and 50 in 2022. The standard regarding communication with persons affected by the death of a family member was considered less relevant (p = 0.05), and that concerning the culturally sensitive and dignified treatment of the body was less fully achieved (p = 0.03) in 2022 than in 2018. Social support (p = 0.04), sharing information among the care team (p = 0.04), patient participation (p = 0.04) and information about the treatment provided (p = 0.03) were all more poorly achieved in 2022 than in 2018. The perceptions of nursing home and PHC workers differed in several respects. Conclusions: Professional intercommunication and social support should be reinforced, and residents should be more actively involved in decision-making. Full article
(This article belongs to the Special Issue Palliative Care in Times of the COVID-19 Pandemic)
14 pages, 788 KiB  
Article
The Impact of the SARS-CoV-2 Pandemic on the Needs of Non-Infected Patients and Their Families in Palliative Care—Interviews with Those Concerned
by Christina Gerlach, Anneke Ullrich, Natalie Berges, Claudia Bausewein, Karin Oechsle, Farina Hodiamont and on behalf of the PallPan Study Group
J. Clin. Med. 2022, 11(13), 3863; https://doi.org/10.3390/jcm11133863 - 3 Jul 2022
Cited by 6 | Viewed by 2018
Abstract
During humanitarian crises, such as a pandemic, healthcare systems worldwide face unknown challenges. This study aimed to explore and describe the effect of the SARS-CoV-2 pandemic on the needs of non-infected patients and family caregivers in specialist palliative care, using qualitative, semi-structured interviews. [...] Read more.
During humanitarian crises, such as a pandemic, healthcare systems worldwide face unknown challenges. This study aimed to explore and describe the effect of the SARS-CoV-2 pandemic on the needs of non-infected patients and family caregivers in specialist palliative care, using qualitative, semi-structured interviews. Data were analyzed using inductive content analysis, following the framework approach. Thirty-one interviews were conducted with patients/family caregivers (15/16) in palliative care units/specialist palliative home care (21/10) from June 2020 to January 2021. Well-known needs of patients and family caregivers at the end of life remained during the pandemic. Pandemic- dependent themes were (1) implications of the risk of contagion, (2) impact of the restriction of social interactions, (3) effects on the delivery of healthcare, and (4) changes in the relative’s role as family caregiver. Restriction on visits limited family caregivers’ ability to be present in palliative care units. In specialist palliative home care, family caregivers were concerned about the balance between preserving social contacts at the end of life and preventing infection. Specialist palliative care during a pandemic needs to meet both the well-known needs at the end of life and additional needs in the pandemic context. In particular, attention should be given to the needs and burden of family caregivers, which became more multifaceted with regards to the pandemic. Full article
(This article belongs to the Special Issue Palliative Care in Times of the COVID-19 Pandemic)
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