COVID-19 has affected
the social interactions
and daily functioning
of all individuals tremendously.
The infectious and contagious nature
of the virus has led people to live
and operate differently
and has left severely ill patients
alone during their last days of life.
The quarantine and physical isolation
reinforced in hospital settings
have restricted human contact
to prevent contamination.
Thus,
the psychological suffering related
to anxiety, depression, loneliness, insomnia,
and stigma has compounded the physical illness
and pressed a sense of fear, vulnerability,
and isolation among patients,
health care workers, and families.
Through its multidisciplinary approach,
the role of palliative care extends
beyond symptom relief
caused directly by the infection,
to include advocacy of family support,
and open space for the occurrence
of difficult conversations
between patients and health care providers
regarding preferences in the plan of care.
COVID-19 infected patients
with multiple coexisting disorders
and a frail health profile
may be in a state
where mechanical ventilators
or other invasive procedures
would rather prolong their suffering
than improve it.
Thus,
health care providers are
in a crucial position to
clearly communicate options of care
to patients and their caregivers
to guarantee an informed decision
and best quality of life.
Tough conversations
that allow patients and families to reflect
on personal values and preferences
are essential aspects of palliative care
that aim to preserve the patient’s
autonomy and cultural values.
https://web.archive.org/web/20210526025155/https://www.aub.edu.lb/fm/Anesthesiology/meja/Documents2/12-Yamout%20et%20al-3.pdf
the social interactions
and daily functioning
of all individuals tremendously.
The infectious and contagious nature
of the virus has led people to live
and operate differently
and has left severely ill patients
alone during their last days of life.
The quarantine and physical isolation
reinforced in hospital settings
have restricted human contact
to prevent contamination.
Thus,
the psychological suffering related
to anxiety, depression, loneliness, insomnia,
and stigma has compounded the physical illness
and pressed a sense of fear, vulnerability,
and isolation among patients,
health care workers, and families.
Through its multidisciplinary approach,
the role of palliative care extends
beyond symptom relief
caused directly by the infection,
to include advocacy of family support,
and open space for the occurrence
of difficult conversations
between patients and health care providers
regarding preferences in the plan of care.
COVID-19 infected patients
with multiple coexisting disorders
and a frail health profile
may be in a state
where mechanical ventilators
or other invasive procedures
would rather prolong their suffering
than improve it.
Thus,
health care providers are
in a crucial position to
clearly communicate options of care
to patients and their caregivers
to guarantee an informed decision
and best quality of life.
Tough conversations
that allow patients and families to reflect
on personal values and preferences
are essential aspects of palliative care
that aim to preserve the patient’s
autonomy and cultural values.
https://web.archive.org/web/20210526025155/https://www.aub.edu.lb/fm/Anesthesiology/meja/Documents2/12-Yamout%20et%20al-3.pdf
In people with severe covid-19, who may deteriorate rapidly, there should be a low threshold for the use of parenteral infusions so that patients do not die before their symptoms can be controlled. Continuous parenteral infusions have the advantage of reducing the requirement for frequent “as needed” doses. Some symptomatic patients with severe breathlessness will still require “as needed” doses, and these should remain available to the patient to support symptom management. Use of an alternative opioid, such as fentanyl or alfentanil, should be considered in people with significant renal impairment, taking care to achieve equianalgesic starting doses.
https://web.archive.org/web/20211117125006/https://www.bmj.com/content/bmj/370/bmj.m2710.full.pdf
https://web.archive.org/web/20211117125006/https://www.bmj.com/content/bmj/370/bmj.m2710.full.pdf
The death had nothing to do with COVID-19 and the funeral had everything to do with the virus. To lose a young member of the family with no warning or preparation is emotionally wrenching. To lose this same bright and eager person during social distancing limitations felt like a supreme torture as all the usual rituals were marred by masks, distance, rules and fear.
Earlier this year, this phrase captured the hearts of the nation. Now, as the devastation caused by COVID-19 challenges our physical, emotional and psychological health, it takes on a whole new meaning for nursing staff
https://www.rcn.org.uk/magazines/bulletin/2020/may/in-a-world-where-you-can-be-anything-be-kind-covid-19
CLINICAL MANAGEMENT OF COVID-19 - Interim Guidance WHO
Download: https://cdn1.redemc.net/campus/wp-content/uploads/2020/04/MANEJO-CLINICO-DEL-COVID.pdf
CAPC has organized a COVID-19 toolkit including crisis communication and symptom management protocols for all clinicians, guidance on using Medicare COVID-19 emergency waivers, and tools to help palliative care teams address high levels of volume and stress during a crisis. All toolkit resources and online courses have been made publicly available.
These resources are intended to provide guidance for primary care providers who are palliating COVID-19 patients across various care settings
https://bit.ly/3cAccS5
The International Association for Hospice and Palliative Care (IAHPC) has compiled this list of resources relevant to palliative care and COVID-19 published by academia, civil society organizations, member states and special agencies of the United Nations, with links to all of the websites and documents listed.
http://globalpalliativecare.org/covid-19/
http://globalpalliativecare.org/covid-19/
Coronavirus and the palliative care response In unprecedented times, the EAPC knows that many of our members, supporters and colleagues are providing care in challenging circumstances.
https://www.eapcnet.eu/publications/coronavirus-and-the-palliative-care-response
The COVID-19 outbreak currently being experienced around the world is unprecedented and requires everyone to work together to contribute to the health and well-being of populations as well as ensure that appropriate guidance and sharing of good practice occurs. This is essential in order to support the care of patients at the end of their lives or who are significantly unwell as the result of both COVID-19 or other possibly life-limiting illnesses.
https://apmonline.org/
https://www.elsevier.com/novel-coronavirus-covid-19
As we are all facing an unprecedented time in healthcare with regards to the COVID-19 pandemic, the antecedent implication for Palliative Care teams and Hospices may be very dramatic. Here is a list of Hospice and Palliative Care specific resources which may be helpful to you all.
https://www.mypcnow.org/covid-19/
Respecting Choices COVID-19 tools and resources available
https://respectingchoices.org/covid-19-resources/
COVID-19 information resources for the OUH: Palliative Care We're supporting the OUH trust and the University of Oxford to respond quickly to the challenges of the coronavirus pandemic. We've brought together information that may help you.
https://libguides.bodleian.ox.ac.uk/COVID-19/palliativecare
Novel Coronavirus Information Center Elsevier’s free health and medical research on the novel coronavirus (SARS-CoV-2) and COVID-19
https://www.elsevier.com/connect/coronavirus-information-center
COVID-19 Palliative Care Clinical Resources Package The Northern Health Palliative Care Task Group has developed a package of palliative care clinical resources to assist clinicians in providing palliative care for COVID-19 patients.
https://bit.ly/3cAccS5
Coronavirus COVID-19 Resources & Links Scottish Palliative Care Guidelines (Published 03/04/2020)
https://www.palliativecareggc.org.uk/?page_id=5515
The information on COVID-19 is evolving day to day. If you’re a caregiver, you may want to ensure you have a plan in place should you or your family member, partner, friend or neighbour need to self-quarantine or become ill. This includes speaking with your family doctor and other physicians as well as homecare providers.
https://ontariocaregiver.ca/covid-19/
COVID-19 Evidence to support use of alternative drugs and routes of administration for management of End of Life symptoms
https://www.futureplanning.org.uk/covid_eoldrugchart.html
Recommendations for treatment of patients with COVID-19 from the palliative care perspective V2.0
https://www.dgpalliativmedizin.de/
COVID-19 and Palliative, End of Life and Bereavement Care in Secondary Care
https://apmonline.org/wp-content/uploads/2020/03/COVID-19-and-Palliative-End-of-Life-and-Bereavement-Care-27-March-2020.pdf
Health care staff across the nation are encouraged to use these “Top 6” resources developed by experts in communication and symptom management. COVID-19 has brought on a rapid onset of very seriously ill patients in a short period of time.
https://www.nationalcoalitionhpc.org/covid19toolkit/
End of Life Care guidance when a person is imminently dying from Covid-19 lung disease
https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/end-of-life-care-guidance-when-a-person-is-imminently-dying-from-covid-19-lung-disease.aspx
COVID-Ready Communication Skills
Respecting Choices COVID-19 tools and resources available
Training for any clinician caring for patients in the context of COVID-19. Includes continuing education courses and downloadable protocols for crisis symptom management, and communication resources specific to conversations with patients and families about COVID-19.
On-Demand Webinars Palliative Care and the Impact of COVID-19
UW Medicine COVID-19 Resource Site
The Coalition represents the 12 leading professional organizations dedicated to advancing the delivery of high-quality serious illness care to all who need it. The outbreak of COVID-19 is impacting our work as hospice and palliative care providers, and we are committed to supporting people diagnosed with this disease while continuing our vital services to those with other serious illnesses
A virtual visit algorithm: how to differentiate and code telehealth visits, e-visits, and virtual check-ins
Dr. Michael Fratkin makes the case for telemedicine and provides tips for the best possible interaction during the COVID-19 pandemic.
A central strategy for health care surge control is “forward triage” — the sorting of patients before they arrive in the emergency department (ED).
Current emergencies Here’s information and updates about natural disasters, man-made incidents, and public health emergencies that are happening now.
Coronavirus (COVID-19)
Coronavirus (COVID-19) We're supporting the NHS and social care to respond quickly to the challenges of the coronavirus pandemic. We've brought together information that may help you.
https://www.nice.org.uk/covid-19
How to Protect Yourself
Are You at Higher Risk for Severe Illness?
Steps to help prevent the spread of COVID-19 if you are sick
This page will update you on the work we’re doing. Over the next few weeks, we will roll out the work we’re doing on a national and local scale to help patients during this crisis.
Coronavirus (COVID-19) Partner Toolkit The Centers for Medicare & Medicaid Services (CMS) is taking action to protect the health and safety of our nation’s patients and providers in the wake of the 2019 Coronavirus (COVID-19) outbreak.
Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020
CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19
The DEA is unaware of any shortages of controlled substances at this time. DEA is working with the Food and Drug Administration (FDA) on monitoring the supply of controlled substances available to manufacture drug products during the COVID-19 Pandemic. Please see the link to the FDA’s website www.fda.gov for more information on FDA’s response.
COVID-19 Patient Care Information
Since the COVID-19 outbreak began, the American Hospital Association has worked closely with the CDC, and other federal, state and local partners to respond to this challenge and to make sure hospitals and health systems have the most up-to-date information.
The Executive Committee of AMDA’s Board of Directors is monitoring the COVID-19 (novel coronavirus) outbreak and posting updates as they occur. The health, safety, and well-being of the community is our highest priority. This is a rapidly evolving situation; please check the CDC website often for the latest recommendations.
Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19)
Resource Hub for 2019-nCOV (COVID-19; Novel coronavirus) Preparedness
Resources to Address Coronavirus Disease 2019 (COVID-19)
https://advancingexpertcare.org/covid-19-resources
Managing the supportive care needs of those affected by COVID-19
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144268/
To support the information needs of nurses caring for COVID-19 patients in the acute, post-acute, and community settings, the Hospice and Palliative Nurses Association (HPNA) has developed a series of Primary Palliative Nursing COVID-19 Patient Care Guides.
https://advancingexpertcare.org/HPNAweb/Education/COVID19_PrimaryPalliativeNursing.aspx
Palliative care in the time of the Coronavirus This page will be listing publications at the intersection of Coronavirus and palliative and end of life care. For now they are organised only chronologically.
https://www.phpc.cam.ac.uk/pcu/palchase/coronavirus-and-palliative-care/
In this time of the COVID-19 pandemic, healthcare systems and healthcare professionals are stressed and bracing for or already managing an influx of affected patients.
8 thoughts on “Palliative Care in the Time of COVID”
The information on this page is also available here as a downloadable PDF, including links.
https://www.criticalcarenice.org.uk/resources
A proportion of patients dying of COVID-19 lung disease could have severe symptoms with rapid decline. In this situation it is important to deliver effective medications, at effective doses, from the outset. Early management of symptoms will be the most effective way to reduce suffering.
https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/end-of-life-care-guidance-when-a-person-is-imminently-dying-from-covid-19-lung-disease.aspx
"Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice (Federal Register 2008)."Are you or a loved one living with a serious illness? Palliative Care can help.
The International Association for Hospice and Palliative Care (IAHPC) has compiled this list of resources relevant to palliative care and COVID-19 published by academia, civil society organizations, member states and special agencies of the United Nations, with links to all of the websites and documents listed.
http://globalpalliativecare.org/covid-19/
PALLIATIVE CARE FOR COVID-19 PATIENTS
Palliative care is also needed for
COVID-19 patients.
Palliative care teams are specialists
in alleviating
dyspnoea, cough, fever, shortness of
breath and other symptoms
that affect COVID-19 patients.
They are trained to
manage complications that affect COVID-19 patients
at the end of life.
They also play a role in
detecting and treating delirium
via pharmaceutical
as well as non-pharmaceutical interventions.
Palliative sedation
can be prescribed to patients
not eligible for intensive care
who present refractory symptoms.
And for all COVID-19 patients,
palliative care is of utmost importance
for humanizing care
so that care is effective and aligned
with the expectations of patients.
Patients facing severe COVID-19 infection
and their families
undergo emotions
that require kindness and empathy,
which may be challenging
to provide in a
context of limited resources
and increased workload.
In general,
COVID-19 patients in the hospital setting are
not allowed to receive visits.
Palliative care providers are
trained to communicate compassionately
with families,
to provide emotional support
and, when needed, to facilitate time
and space to say goodbye.
Okay kan, Bro!
IKA SYAMSUL HUDA MZ
