ObjectivesThe objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands.MethodsAn in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis.ResultsSeveral aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains.ConclusionThe palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.

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Objective: To assess experiences of medical practitioners who are on the staff of nursing homes with communication with nursing staff about identifying emerging and changing (palliative) care needs of residents of nursing homes in the Netherlands. Design: Qualitative interview study. Setting and Participants: Fifteen physicians and two nurse practitioners employed by eight care organizations in the western urbanized region of the Netherlands. Methods: We conducted individual semi-structured interviews in 2018 informed by a topic list that was based on a qualitative dataset about facilitators to palliative care in dementia reported by elderly care physicians. The interviews were recorded, transcribed verbatim and analysed with Atlas.ti. We used both deductive and inductive coding adding refined codes related to communication. Results: All interviewees expressed appreciation for nursing staff on whom they relied to communicate palliative care needs, yet they reported a variety of communication challenges around important changes in the condition of the residents which were covered by two themes. (1) Teamwork was facilitated or impeded by team size and structure, quality of relationships and clarity in hierarchical relationships. (2) Continuity of information was affected by (in)effective routes of consultation and (lack of) detail in communicating observations. Conclusions and Implications: Also in the case of on-staff physicians, functioning of the multidisciplinary team and accurate sharing of observed changes in the condition of nursing home residents are crucial for physicians to be able to address palliative care needs. The expressions of the physicians of how they would favor nursing staff to communicate can inspire interprofessional training, such as reporting objective observations and phrasing a clear request for help while avoiding overly demanding appeals.