The arrival of the COVID-19 pandemic to hospitals in New York City stressed our emergency departments (ED) with high patient volume, stresses on hospital resources and the arrival of numerous high acuity, critically ill patients. Amid this time, we sought to leverage the ED Information Systems (EDIS), to assist in connecting critically ill patients, their families, and providers in the ED with palliative care resources. We discuss 4 innovative, thoughtful solutions to assist ED providers in identifying and addressing the acute and unique palliative care needs of COVID patients.
Family caregivers are essential to the overall care and well-being of individuals with chronic and serious illness. As important partners in healthcare, caregivers provide critical assistance to ill relatives, caring for their day-to-day needs, assisting with decision-making, assessing symptoms, administering medications, and providing companionship. Palliative care teams recognize the importance of family caregivers in care planning. The palliative social worker is uniquely trained in caregiver assessment with the requisite skills to directly address caregiver needs, promote coping, link caregivers with community resources, and provide continuity and support throughout the illness trajectory. This chapter provides an overview of caregivers in the United States, including policy developments and needs during the COVID-19 pandemic. Caregiver assessment is discussed using the framework of the National Consensus Project domains. A wide range of social work interventions are shared. The chapter ends with a call to action in the areas of clinical social work, research, and education.
Good communication is considered fundamental to high-quality palliative care. Communication includes serious illness conversations with patients and family caregivers, collaborative communication across teams and disciplines, and communication with community providers. This chapter explores definitions, evidence-based research, training, and best clinical practices in three areas of enhanced communication. Narrative medicine promotes empathy, patient-centered listening, and life review through reflective journaling, writing, and self-reflection. Goals-of-care discussions, which may include advance care planning, ensure that providers align care with what matters most to the patient. The family meeting is used to facilitate communication, discuss the illness experience, present treatment choices, and facilitate end-of-life decision-making. Quality healthcare mandates training for healthcare clinicians in communication using a systematic approach.
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