The impacts of visitor restrictions for palliative patients during the COVID-19 pandemic on family members and healthcare providers: a Canadian qualitative study

Abstract

Background: Visitor restrictions to healthcare facilities were enacted throughout the course of the COVID-19 pandemic and changed over time. Further research on the consequences of restrictions, particularly in relation to palliative care and from multiple key stakeholder perspectives, is needed. We investigated the impact of COVID-19 visitor restrictions on family members of patients with a life limiting diagnosis or who received palliative care during the pandemic, and health care providers (HCPs) for patients with life limiting diagnoses within New Brunswick, Canada.

Methods: Semi-structured interviews were conducted with 12 family members and 11 HCPs. Reflexive thematic analysis was used to allow for the inductive generation of themes from the qualitative data, while investigating and comparing participants' experiences.

Results: The analysis found that HCP and family member themes had a great deal of similarities. The themes developed for family members were: Visitor restrictions have negative impacts on palliative patients and their families; Visitor restrictions impacted patient-family care decisions and timing; Family members had more positive experiences when a patient-centred approach to care was used; Exceptions need to be made when it comes to palliative care and visitation; COVID restrictions didn't make sense; and, COVID led to healthcare providers being further overextended. HCP themes developed were: COVID restrictions and policies impacted satisfaction with work life; The impact of not visiting on families was terrible; HCP had to figure out new ways of providing care; We believe that patients need their families; Patients are lonely and miss family; Weren't always made clearly aware of the changes happening in hospital visitor restrictions; and, COVID restrictions led to people keeping loved ones at home.

Conclusions: Results unveiled dynamic relationships between HCPs and family members, whose perspectives on the impacts of visitor restrictions overlapped. Main findings emphasized the overall negative impacts of visitor restrictions and a clear need to enact policies with a particular focus on understanding the need for a flexible patient and family-centred approach and quality of life considerations. Clear and consistent communication with all stakeholders regarding policies is recommended, as well as consistent exceptions for patients with life-limiting diagnoses.

Keywords: COVID-19 pandemic; Canada; End-of-life care; Healthcare policy; Life-limited diagnoses; Palliative care; Pandemic challenges; Qualitative research; Visitor restrictions.