Article: Families of COVID-19 patients say goodbye on video

This article describes a new tool developed during the Covid pandemic to enable families to say goodbye to a dying relative.  They describe the development of The Video Goodbye Tool, the preparation and use of it with families and the role of healthcare staff in enabling this to happen.

Frydman, J. et al.  Families of COVID-19 Patients Say Goodbye on Video:  A Structured Approach to Virtual End-of-Life Conversations.  Journal of Palliative Medicine,  July 30 2020

 

Contact the library for a copy

Online Article: Virtual visits in palliative care: about time or against the grain

Published earlier this year, two UK hospices looked at the issues relating to virtual visits including clinical issues, ethical, logistical, and relating to the Covid-19 lockdown.    They found a number of areas to help guide longer term service design, but concluded a one size fits all approach was a poor fit.   They concluded virtual visits have great potential but not in any way a complete solution. 

Hawkins, J.P. et al. 2020.  Virtual visits in palliative care: about time or against the grain.  BMJ Supportive & Palliative Care, 10 (3) p 331-336.

Download here or contact the library for a copy

Guidance: Keeping in touch when you can't be with someone who is very ill and might die

This guide by the National Bereavement Alliance has been put together to suggest ways someone can continue to feel close to their loved one, even at a distance.  The ideas are intended to help whether or not there is a hope that they will recover.  It provides ideas for both children and adults. 

Download the guide here

Online Article: Can video consultations replace face-to-face interviews? Palliative medicine and the Covid-19 review?

During the Covid-19 pandemic it became essential to minimise face to face visits, and consider other ways of offering consultations and clinical assessments. The authors of this paper undertook a rapid literature review to identify the highest level of evidence to inform this major change in practice.    They found global evidence supporting video consultations as an effective, acceptable and cost effective method of service. Considerations for organisations include software that is simple to use, reliable, and with the highest level of security for confidentiality along with staff training and administrative support.   They recommend the following of WHO guidance as detailed in their paper.

Can video consultations replace face-to-face interviews?   Palliative medicine and the Covid-19 review?   BMJ Supportive and Palliative Care.  

Download here or request a copy from the library

Online Article: An audit of end-of-life symptom control in patients with coronavirus disease 2019 (COVID-19) dying in a hospital in the UK

This audit was undertaken at a general hospital in England, covered the 8 weeks from 16 March to 11 May 2020 and included all inpatients with COVID-19 who had an end-of-life care plan (and died).  Sixty-one patients met the audit criteria.  The commonest problem was shortness of breath (57.5%), which was generally controlled with conservative doses of morphine (10–20 mg/24 h via a syringe pump). Cough and audible respiratory secretions were relatively uncommon. The second most common problem was agitation/delirium (55.5%), which was generally controlled with standard pharmacological interventions. The cumulative number of patients with shortness of breath, agitation and audible respiratory secretions increased over the last 72 h of life, but most patients were symptom controlled at the point of death. Conclusion: Patients dying of COVID-19 experience similar end-of-life problems to other groups of patients. Moreover, they generally respond to standard interventions for these end-of-life problems.

Alderman, B. et al. 2020.  An audit of end-of-life symptom  control in patients with coronavirus disease 2019 (COVID-19) dying in a hospital in the UK.  Palliative Medicine, 34 (9) p 1249 - 1255.

Download article here or request a copy from the library

Online Article: End of life care in Covid-19 - an audit of pharmacological management in hospital patients

Hospital healthcare staff have had to rapidly develop expertise in managing Covid-19 symptoms common at end of life, such as breathlessness and agitation. This UK study aimed to establish whether prescribing for symptom control in patients dying with Covid-19 adhered to existing local guidance.  A retrospective review of the patient records of 61 patients referred to specialist palliative care were included.  Intubated patients were excluded.  Findings showed 83% of patients were prescribed with opioids at a starting dose consistent with local guidelines.   The paper concluded that while some patients may require increased doses, routine prescription of higher starting opioid and benzodiazepine doses beyond local guidelines was not observed

Jackson, T. et al. 2020.  End of life care in Covid-19 - an audit of pharmacological management in hospital patients.  Palliative Medicine, 34 (9) p 1235-1240.

Download article here or request from the library

Online Article: COVID-19 and Hospital Palliative Care - a service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care

This Scottish study aimed to characterise the symptom profile, symptom management requirements and outcomes of hospitalised Covid-19 positive patients referred for palliative care.  It was also aimed to establish how this may differ to a 'typical' palliative care caseload.  Data was captured from the 30th March 2020 - 26th April.   186 patients were included.  Dyspnoea and agitation were the most prevalent symptoms, 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients.  Compared to a 'typical caseload', the COVID-19 cohort were on the caseload for less time and had a higher death rate.

Hetherington, L. et al.  COVID-19 and Hospital Palliative Care - A service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care.  Palliative Medicine, 34 (9) p 1256 - 1262.

Download article here or contact the library for a copy

Online Article: Changing patterns of mortality during the Covid-19 pandemic

In the first 10 weeks of the Covid-19 pandemic, the number of people dying in care homes increased by 222% in England and Wales.  The authors of the paper estimate that just over one in five of all Covid-19 deaths occurred among people who might have been in their last year of life in the absence of a pandemic.  The paper discusses the need of health and care systems to be available to provide palliative care to support people with severe Covid-19 particularly in the care home setting.

Bone, A. E., et al. 2020.  Changing patterns of mortality during the Covid-19 pandemic: population-based modelling to understand palliative care implications.  Palliative Medicine, 34 (9) p 1193-1201.

Download here or request a copy from the library

Online Article : Advance care planning in the community in the context of Covid-19

From the Centre of Evidence-Based Medicine (CEBM) this research looks at the importance of advance care planning (ACP) and presents opportunities to widen access to its benefits.  This rapid review brings together all the current evidence regarding ACP in the community setting, including its implications for Covid-19 and highlights existing guidelines and resources

Selmen, L. et al. August 2020.  Advance care planning in the community in the context of Covid-19.  Centre for Evidence Based Medicine.

View here

Online Article: Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers

Published in July of this year, this US paper discusses the COVID-19 pandemic and the anticipatory grief, disenfranchised grief, and complicated grief experienced by individuals, families, and their providers.  It looks at how to counter the grief through communication, advance care planning, and self-care practices.  Resources for health care providers are provided along with a request to palliative care providers to consider their own role as a resource to other specialties during this public health emergency.

Wallace, C. L. et al. 2020. Grief during the Covid-19 pandemic: considerations for Palliative Care Providers.  Journal of Pain and Symptom Management, 60 (1) p e70 - e76.

Download here or email the library for a copy

Online Article: The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics

Only five studies met the criteria in this UK study, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics.  Findings were synthesised using a pandemic response framework according to ‘systems’ (community providers feeling disadvantaged in terms of receiving timely information and protocols), ‘space’ (recognised need for more care in the community), ‘staff’ (training needs and resilience) and ‘stuff’ (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations).  As the COVID-19 pandemic continues, the authors concluded there is an urgent need to increase understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.

Mitchell, S. et al 2020. The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the
COVID-19 pandemic.  Palliative Medicine, 34 (9) p 1182-1192

Contact the library for a copy.

Article: What palliative care can learn from the Covid-19 pandemic

The authors reflect on the things palliative care can learn from the Covid-19 pandemic and their experiences at St Christopher's Hospice London.  Topics include the changing way of working, the changes to healthcare workers personal and professional lives and the importance of online communications and connecting with patients, families and carers. 

Kelly D. & Doods, N. 2020.  What palliative care can learn from the Covid-19 pandemic.  International Journal of Palliative Nursing, August 26 (2) p 261-262.

Contact the library for a copy

Guidance: Special edition of Care After Death - Registered Nurse verification of expected adult death - 3rd edition

Published in June 2020, the aim of this guidance is to provide a framework for the timely verification of expected death.  It was reviewed and updated by Hospice UK in response to the Covid-19 outbreak and the need for clarity.

Download from the Hospice UK web site  or request a copy from the library