COVID-19 Resource Center

COVID-19 Resource Center

April 20, 2020
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COVID-19 pandemic prompts changes to palliative care

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Amit Arya
Amit Arya

The unique challenges of COVID-19 require adjustments to the delivery of palliative care during the pandemic, according to an article in the Canadian Medical Association Journal.

With the pandemic straining health care systems and causing thousands of deaths daily, co-author Amit Arya, MD, a palliative care physician in Ontario, Canada, and colleagues advised hospitals to scale up palliative care resources for patients.

“We expect that all patients who become severely ill in the COVID-19 pandemic will receive equitable access to palliative care,” Arya told Healio Primary Care. “This would include having sufficient comfort medicines available and the supplies to deliver them, as well as equipping all front-line health workers with the focused training required to provide this care.”

Triage care

 
Maria Silveira
Maria Silveira

In a letter published in the Journal of Pain and Symptom Management, The University of Michigan School of Medicine’s Victoria Powell, MD, and Maria Silveira, MD, wrote that seriously ill patients with COVID-19 should receive “primary palliative care,” which “is the responsibility of every provider” who cares for the patient.

All health care providers should discuss physical, financial, social and spiritual concerns with patients in palliative care, according to Arya and colleagues. Non-palliative care providers should identify and manage patients’ pain, dyspnea, agitated delirium and respiratory congestion, as well as manage caregivers’ grief and facilitate discussions about prognosis, treatment goals, suffering and resuscitation status.

Palliative care specialists should concentrate on patients who have refractory or complex symptoms, behavioral health concerns, pre-existing opioid use disorder, young children, marginalized populations, those who require palliative sedation therapy and those who are denied access to desired critical care due to a triage protocol. Arya and colleagues provided health care providers at their facility with scripts for when a patient or family member is refused admittance to the ICU because of resource scarcity and for discussing a treatment plan with someone who is unlikely to survive a critical illness.

Powell, clinical lecturer in geriatric and palliative medicine, recommended that palliative care providers prepare resources such as online guidelines and electronic medical record-embedded order sets for front-line providers.

“Palliative care providers may not be able to keep up with the demand for their help,” she told Healio Primary Care.

When a palliative care team member is not available, Powell said that front-line health care providers should express empathy and acknowledge emotions; eschew terms like futility; and assure patients and families of health care provider support and continued “compassionate care.” She encouraged consulting VitalTalk’s Conversation Guide for more information about these conversations.

Conduct appointments via telemedicine

Social distancing measures often requires palliative care providers “to deliver the same care in an entirely different way,” such as through video chat or phone, Silveira said.

“Though the care may be delivered in a different fashion, I’m optimistic that as long as there is some palliative care input, patients will receive the support they need,” she said. – by Janel Miller

References:

Arya A, et al. CMAJ. 2020;doi:10.1503/cmaj.200465.

Powell VD, Silveira MJ. J Pain Symptom Manage. 2020;doi:10.1016/j.jpainsymman.2020.03.013.

Disclosures: Amit, Powell and Silveira all report no relevant financial disclosures. Please see the Arya study for all other authors’ relevant financial disclosures.