Palliative care needs better integration with health care systems for this and future pandemics

The first ever survey of the palliative care response to the Covid10 pandemic has found a huge surge in demand on palliative and end of life care services during the first wave, with hospital palliative care teams and community teams becoming extremely busy, including those supporting care homes and at home nursing.

Despite this, the crucial role palliative care teams are playing during the pandemic must be better recognised and integrated, as the findings show staff felt ignored by national and international pandemic responses and often lacked equipment, staff, medicines, integration and recognition.

For the first time, researchers from Lancaster University, the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Hull York Medical School, (University of Hull), and the University of York carried out a systematic multinational survey on the palliative care response and challenges faced during the COVID-19 pandemic, to inform care provision for those who are likely to die, and/or have severe symptoms.

Professor Catherine Walshe from Lancaster University said: “With over 80% of services involved in the response to COVID-19, this shows how important palliative care is to the pandemic response. We mustn’t forget the impact on staff, not only caring for patients, but where many became ill themselves. It is imperative that such services, often managed outside the NHS, are integrated into a whole system response and recognised for their vital contribution’.”

The COVID-19 pandemic has placed an unprecedented strain on health care services globally, with 1% to 4% of patients dying from this disease.

The CovPall study aimed understand the response of and challenges faced by palliative care services during the COVID-19 pandemic and identify factors associated with this. Researchers surveyed staff in palliative care and hospice services and multivariable logistic regression was used to identify associations with challenges and content analysis explored free text responses.

The main findings include:

· 458 services responded: 277 UK, 85 rest of Europe, 95 rest of the world (1 country unreported).

· 81% cared for patients with suspected or confirmed COVID-19. Three groups of patients dying from and/or with severe symptoms due to COVID-19 were observed:

· patients with underlying conditions and/or multimorbid disease not previously known to palliative care (70% of services)

· patients already known to palliative care services (47% of services)

· patients, previously healthy, now dying from COVID-19 (37% of services)

· 77% had staff with suspected or confirmed COVID-19

· 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.

Staff described increased workload, concerns for their colleagues who were ill, while spending time struggling to get essential equipment and medicines, and worrying about the financial viability of their service.

Major challenges included shortages: 48% reported shortages of Personal Protective Equipment (PPE); 40% staff shortages; 24% shortages of medicines; 14% shortages of other equipment. Charity managed services were more likely to experience shortages of PPE compared to publicly managed services. Services in the UK were more likely to experience staff shortages compared with those in the rest of Europe or elsewhere in the world.

Dr Adejoke O. Oluyase, Research Associate and lead author said: “Our findings show the importance of palliative care in caring for those dying from COVID-19 and those with severe symptoms. Urgent action is needed to ensure palliative care inclusion in pandemic planning and the availability of PPE to protect staff and patients, medicines, and equipment in this and subsequent waves of the pandemic. The need for training in palliative care for clinicians cannot be overemphasised.”

Dr Mevhibe B Hocaoglu, Research Associate and lead author said: “Our research showed that the active involvement of team members the palliative care teams, staff’s openness to multidisciplinary collaboration and their willingness to change the way they work, work harder and longer hours, organise rapid training all enabled a very impressive and successful response.”

Senior author Professor Irene J. Higginson said: ‘Palliative and hospice care responded actively to the COVID-19 pandemic but were missed from multinational pandemic responses. We need better integration of palliative care with health systems, especially the charity managed services. I am delighted that our findings have been useful in developing the recent Cicely Saunders International Action Plan for Better Palliative Care.’

This study was sponsored by King’s College London and King’s College Hospital NHS Foundation Trust.

You can read the full paper on the Journal of Pain and Symptom Management website

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