The Palliative Care and Covid-19 Pandemic

Asian Pacific Journal of Cancer Care, 2020

With or without COVID-19, “palliative care” is about basics. 1) Good control of symptoms due either to the disease or treatment, 2) Good decisions, especially when it becomes clear that control of the disease is no longer possible, with trying to help the patient do what means most to them, 3) Patient/family support in every phase of the illness from diagnosis throughout all phases of care until the moment of death, and 4) Care of bereaved person. Palliative care, the care of patients (adults or children) with probably fatal illnesses, whether they are still having anti disease therapy or not must occur in many places, many wards, clinics, at home, and even virtual. The COVID-19 crisis has a serious impact on patients’ care, but with respect for every person, and a great deal of education, training and support of staff, we would overcome it successfully.

Journal of Pain and Symptom Management, 2020

After COVID-19 crisis in Italy, serious restrictions have been introduced for relatives, with limitations or prohibitions on hospital visits. To partially overcome these issues ''WhatsApp'' has been adopted to get family members to participate in clinical rounds. Family members of patients admitted to the acute palliative care unit and hospice were screened for a period of two weeks. Four formal questions were posed: 1) Are you happy to virtually attend the clinical round? 2) Are you happy with the information gained in this occasion? 3) Do you think that your loved one was happy to see you during the clinical rounds? 4) This technology may substitute your presence during the clinical rounds? The scores were 0 ¼ no, 1 ¼ a little bit, 2 ¼ much, 3 ¼ very much. Relatives were free to comment about these points. Sixteen of 25 screened family members were interviewed. Most family members had a good impression, providing scores of 2 or 3 for the first three items. However, the real presence bedside (forth question) was considered irreplaceable. They perceived that their loved one, when admitted to hospice, had to say goodbye before dying.

Frontiers in Psychiatry, 2021

Throughout history, humankind has survived several epidemics that have caused a high number of deaths and suffering (1). Those events have had profound economic, social, political, cultural, medical, and psychological impacts on humanity (2). More recently, in December 2019, in Wuhan city in China, a previously unknown coronavirus was identified in humans (3). The new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes a highly contagious and infectious disease, which has been designated Coronavirus Disease 2019 (COVID-19) (4). People with COVID-19 can present a wide variety of symptoms, ranging from mild, or even asymptomatic carriers, to fatal cases, with about one in six infected becoming seriously ill (5). SARS-CoV-2 affects mainly the respiratory tract, resulting in difficulty in breathing, shortness of breath (6), or pneumonia, but can also affect the gastrointestinal, nervous, cardiovascular, dermatologic, or ophthalmic systems (7). At the time of writing, the number of deaths by coronavirus in the world already exceeds 1,815,518 and continues to increase (8). Experts have warned about the possibility of a new wave during winter 2020 (9), which is already happening in Portugal. Given the high number of deaths, the coronavirus pandemic will leave behind many more to grieve their lives (10). Studies indicate that each COVID-19 death corresponds with approximately nine bereaved people (11). Faced with this threat in public health, the Directorate-General of Health, which is a division of the Portuguese public administration concerned with public health, prepared the National Preparedness and Response Plan for the Disease Caused by a New Coronavirus, which is a strategic tool to mitigate the impact of the SARS-CoV-2 outbreak (12). This document contains appropriate measures for each phase of the pandemic, focusing on interrupting transmission chains, preventing the spread, reducing the intensity, and decreasing the number of cases (13). On March 26, 2020, Portugal entered the highest alert and response level against coronavirus-the mitigation phase-and here remains. At that time, one of the measures put in place in Portuguese hospitals advocated that all people with an acute respiratory condition (cough, dyspnea, or breathing difficulty) should be managed as a suspect case (14). However, studies indicate that dyspnea, apart from being one of the hallmark symptoms of COVID-19, can arise from many different underlying conditions (15). Dyspnea is even one of the most frequent and prevalent symptoms in advanced illness of any etiology, whether oncological or non-oncological. It is present in 75% of patients (15), and its prevalence and severity increase with the approach of death-about 70% in the last 6 weeks of life (16). This implies that, even though COVID-19 is not the cause of dyspnea of some patients who resort to the hospital emergency room, including terminally ill

Palliative Medicine in Practice

It is this year's second issue of the journal, being published in circumstances which are difficult for palliative care from the perspective of patients, their families as well as hospice employees and volunteers. Dangers stemming from the COVID-19 pandemic resulted in the need to introduce changes in the functioning of facilities, and prompted the search for new solutions concerning the support provided to patients and their families. In an article published in The Lancet, prof. Lucas Radbruch et al. indicated basic strategies for actions in this regard. These actions comprise, in particular, the application of telemedicine solutions, including the possibility of online contact [1]. The short communication by Prof. David Olivier, Associate Editor of Palliative Medicine in Practice, entitled "Neurological palliative care-who, how, when?", discusses the role of palliative care in patients diagnosed with neurological conditions, including, especially, amyotrophic lateral sclerosis (a motor neuron disease) and multiple sclerosis. Citing international documents and the many years of his own experience, the Author emphasises the crucial role of an interdisciplinary team in ensuring best palliative care to this group of patients and their families. The current epidemiological situation also shows that there is a the need to adjust the contents of pre-and postgraduate teaching of palliative care to the new conditions. The results of the project implemented by the European Association for Palliative Care in cooperation with the World Health Organisation, aimed at developing a complex and interdisciplinary programme of postgraduate teaching of palliative care in Europe can constitute the basis for the introduction of the curriculum [2].

BMJ Supportive & Palliative Care, 2020

The current COVID-19 pandemic is unprecedented and requires innovation beyond existing approaches to contribute to global health and well-being. This is essential to support the care of people at the end of their lives or who are critically ill from COVID-19 or other life-limiting illnesses. Palliative care (PC) is centred on effective symptom control, promotion of quality of life, complex decision-making, and holistic care of physical, psychological, social and spiritual health. It is ideally placed to both provide and contribute to care for patients, families, communities and colleagues during the pandemic. Where recovery is uncertain, emphasis should be on care and relief of suffering, as well as survival. Where healthcare resources and facilities come under intense pressure, lessons can be learnt from models of care in other settings around the world. This article explores how the field can contribute by ensuring that PC principles and practices are woven into everyday healthcar...

Revista Bioética

People’s routines, especially of individuals affected by chronic illnesses, underwent significant changes due to the emergence and widespread dissemination of the COVID-19 pandemic. Thus, this literature review analyzed the impact of palliative care in chronically ill patients during the pandemic. The fear and feeling of loneliness produced by social isolation enhanced their suffering, highlighting the importance of palliative care teams in aiding the sick and their core family face this reality, especially at end of life. In this regard, humanized care brings psychosocial benefits to patients, as well as economic advantages to the health system. Theoretical discussion highlight that implementing palliative care teams is fundamental to afford qualitive of life and dignity to these individuals.

European Journal Cancer, 2020

The lack of integration between public health approaches, cancer care and pallia-tive and end-of-life care in the majority of health systems globally became strikingly evident in the context of the coronavirus disease 2019 (COVID-19) pandemic. At the same time, the collapse of the boundaries between these domains imposed by the pandemic created unique opportunities for intersectoral planning and collaboration. While the challenge of integration is not unique to oncology, the organisation of cancer care and its linkages to palliative care and to global health may allow it to be a demonstration model for how the problem of integration can be addressed. Before the pandemic, the large majority of individuals with cancer in need of palliative care in low-and middle-income countries and the poor or marginalised in European Journal of Cancer 136 (2020) 95e98 Medicine; Pandemic high-income countries were denied access. This inequity was highlighted by the COVID-19 pandemic, as individuals in impoverished or population-dense settings with weak health systems have been more likely to become infected and to have less access to medical care and to palliative and end-of-life care. Such inequities deserve attention by government, financial institutions and decision makers in health care. However, there has been no framework in most countries for integrated decision-making that takes into account the requirements of public health, clinical medicine and palliative and end-of-life care. Integrated planning across these domains at all levels would allow for more coordinated resource allocation and better preparedness for the inevitability of future systemic threats to population health. ª

BMC Palliative Care

Background In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliativ...

Journal of Bioethical Inquiry, 2020

Among the far-reaching impacts of COVID-19 is its impact on care systems, the social and other systems that we rely in to maintain and provide care for those with "illness." This paper will examine these impacts through a description of the influence on palliative care systems that have arisen within this pandemic. It will explore the impact on the meaning of care, how care is performed and identified, and the responses of palliative care systems to these challenges. It will also highlight the current and potential future implications of these dynamics within the unfolding crisis of this pandemic.

BMJ Supportive & Palliative Care

ObjectivesThe aim of this work is to describe the multidisciplinary model of intervention applied and the characteristics of some COVID-19 patients assisted by the hospital palliative care unit (UCP-H) of an Italian hospital in Lombardy, the Italian region most affected by the COVID-19 pandemic.MethodsA retrospective study was conducted on patients admitted to the A. Manzoni Hospital (Lecco, Lombardy Region, Italy) and referred to the UCP-H between 11 March 2020 and 18 April 2020, the period of maximum spread of COVID-19 in this area. Data were collected on the type of hospitalisation, triage process, modality of palliative care and psychological support provided.Results146 COVID-10 patients were referred to the UCP-H. Of these, 120 died during the observation time (82%) while 15 (10.2%) improved and were discharged from the UCP-H care. 93 had less favourable characteristics (rapid deterioration of respiratory function, old age, multiple comorbidities) and an intensive clinical appr...