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. 2024 Jul 25:11:1390057.
doi: 10.3389/fmed.2024.1390057. eCollection 2024.

Palliative care and COVID-19: acknowledging past mistakes to forge a better future

Camila Rabelo Monteiro de Andrade  1 , Fernanda Silva Trindade Luz  2 , Neimy Ramos de Oliveira  3 , Luciane Kopittke  4   5 , Luiza Marinho Motta Santa Rosa  6 , Angelica Gomides Dos Reis Gomes  7 , Frederico Bartolazzi  8 , Saionara Cristina Francisco  9 , Felicio Roberto da Costa  2 , Alzira de Oliveira Jorge  10 , Christiane Corrêa Rodrigues Cimini  11 , Marcelo Carneiro  12 , Karen Brasil Ruschel  13   14 , Alexandre Vargas Schwarzbold  15 , Daniela Ponce  16 , Maria Angélica Pires Ferreira  17 , Milton Henriques Guimarães Júnior  18 , Daniel Vitório Silveira  19 , Fernando Graça Aranha  20 , Rafael Lima Rodrigues de Carvalho  21   22 , Mariana Frizzo de Godoy  23 , Lucas Macedo Pereira Viana  24 , Vânia Naomi Hirakata  4 , Maria Aparecida Camargos Bicalho  25   26   27   28 , Milena Soriano Marcolino  27   29
Affiliations

Palliative care and COVID-19: acknowledging past mistakes to forge a better future

Camila Rabelo Monteiro de Andrade et al. Front Med (Lausanne). .

Abstract

Context: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly.

Objectives: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.

Methods: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG).

Results: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves.

Conclusion: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.

Keywords: COVID-19; clinical characteristics; frailty; hospitalization; outcomes assessment; palliative care.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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