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Observational Study
. 2021 Sep;62(3):460-470.
doi: 10.1016/j.jpainsymman.2021.01.138. Epub 2021 Feb 5.

The Challenges of Caring for People Dying From COVID-19: A Multinational, Observational Study (CovPall)

Adejoke O Oluyase  1 , Mevhibe Hocaoglu  1 , Rachel L Cripps  1 , Matthew Maddocks  1 , Catherine Walshe  2 , Lorna K Fraser  3 , Nancy Preston  2 , Lesley Dunleavy  2 , Andy Bradshaw  4 , Fliss E M Murtagh  5 , Sabrina Bajwah  6 , Katherine E Sleeman  6 , Irene J Higginson  7 ; CovPall study team
Affiliations
Observational Study

The Challenges of Caring for People Dying From COVID-19: A Multinational, Observational Study (CovPall)

Adejoke O Oluyase et al. J Pain Symptom Manage. 2021 Sep.

Abstract

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.

Keywords: COVID-19; Palliative care; end of life care; hospices; pandemics; severe acute respiratory syndrome coronavirus 2.

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Conflict of interest statement

Conflict of Interest IJH is a National Institute for Health Research (NIHR) Emeritus Senior Investigator and is supported by the NIHR Applied Research Collaboration (ARC) South London (SL) at King's College Hospital National Health Service Foundation Trust. IJH leads the Palliative and End of Life Care theme of the NIHR ARC SL and co-leads the national theme in this. MM is funded by a NIHR Career Development Fellowship (CDF-2017-10-009) and NIHR ARC SL. LF is funded by a NIHR Career Development Fellowship (CDF-2018-11-ST2-002). KS is funded by a NIHR Clinician Scientist Fellowship (CS-2015-15-005). RC is funded by Cicely Saunders International. FEM is a NIHR Senior Investigator. MBH is supported by the NIHR ARC SL. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care.

Figures

Fig 1
Fig. 1
Quotes on the impact of PPE shortages on palliative care services, derived from free text responses.
Fig 2
Fig. 2
Percentage of shortages by management type, world regions and settings, derived from responses to closed format questions.
Fig 3
Fig. 3
Strategies, enablers, specific actions and quotes about shortages, derived from free text responses.
See this image and copyright information in PMC

References

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