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Practice Guideline
. 2020 Sep 3;56(3):2002583.
doi: 10.1183/13993003.02583-2020. Print 2020 Sep.

COVID-19: guidance on palliative care from a European Respiratory Society international task force

Daisy J A Janssen  1   2 , Magnus Ekström  3   4 , David C Currow  4   5 , Miriam J Johnson  5 , Matthew Maddocks  6 , Anita K Simonds  7 , Thomy Tonia  8 , Kristoffer Marsaa  9
Affiliations
Practice Guideline

COVID-19: guidance on palliative care from a European Respiratory Society international task force

Daisy J A Janssen et al. Eur Respir J. .

Abstract

Background: Many people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process.

Methods: We invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted.

Results: 68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation.

Conclusion: This multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.

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Conflict of interest statement

Conflict of interest: M. Ekström has nothing to disclose. Conflict of interest: D.C. Currow reports that he is an unpaid advisory board member for Helsinn Pharmaceuticals, is a paid consultant and receives payment for intellectual property with Mayne Pharma, and is a consultant with Specialised Therapeutics Australia Pty. Ltd. Conflict of interest: M.J. Johnson reports institutional payments for consultancy from Mayne Pharma, during the conduct of the study. Conflict of interest: M. Maddocks has nothing to disclose. Conflict of interest: A.K. Simonds has nothing to disclose. Conflict of interest: T. Tonia is an ERS methodologist. Conflict of interest: K. Marsaa reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Novartis, Roche, Bristol-Myers Squibb, Chiesi Pharma, Kyowa Kirin AB and Norgine, outside the submitted work. Conflict of interest: D.J.A. Janssen reports personal fees for lectures from Novartis, Boehringer Ingelheim and AstraZeneca, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Experts’ responses to the 14 questions. *: results from the second round.
See this image and copyright information in PMC

References

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