Hospital palliative care is an essential part of the COVID-19 response but data are lacking. We identified symptom burden, management, response to treatment, and outcomes for a case series of 101 inpatients with confirmed COVID-19 referred to hospital palliative care. Patients (64 men, median [interquartile range {IQR}] age 82 [72e89] years, Elixhauser Comorbidity Index 6 [2e10], Australian-modified Karnofsky Performance Status 20 [10e20]) were most frequently referred for end-of-life care or symptom control. Median [IQR] days from hospital admission to referral was 4 [1e12] days. Most prevalent symptoms (n) were breathlessness (67), agitation (43), drowsiness (36), pain (23), and delirium (24). Fifty-eight patients were prescribed a subcutaneous infusion. Frequently used medicines (median [range] dose/ 24 hours) were opioids (morphine, 10 [5e30] mg; fentanyl, 100 [100e200] mcg; alfentanil, 500 [150e1000] mcg) and midazolam (10 [5e20] mg). Infusions were assessed as at least partially effective for 40/58 patients, while 13 patients died before review. Patients spent a median [IQR] of 2 [1e4] days under the palliative care team, who made 3 [2e5] contacts across patient, family, and clinicians. At March 30, 2020, 75 patients had died; 13 been discharged back to team, home, or hospice; and 13 continued to receive inpatient palliative care. Palliative care is an essential component to the COVID-19 response, and teams must rapidly adapt with new ways of working. Breathlessness and agitation are common but respond well to opioids and benzodiazepines. Availability of subcutaneous infusion pumps is essential. An international minimum data set for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops.
@ERSpublicationsFor patients with COVID-19, there is a moral obligation to provide good supportive care to prevent avoidable suffering. This article provides a succinct informative overview, clinical guidance and information sheets for both patients and families. https://bit.ly/2UPFsOj Cite this article as: Bajwah S, Wilcock A, Towers R, et al. Managing the supportive care needs of those affected by COVID-19. Eur Respir J 2020; 55: 2000815 [https://doi.
The aim of this study was to use both quantitative and qualitative data to assess pain in idiopathic Parkinson's disease (IPD) and classify it according to cause. In this descriptive cross-sectional study, 123 patients were interviewed and pain was assessed using patient descriptions, the Brief Pain Inventory, and Visual Analogue Scales. Patients reported 285 pains (median 2 per patient), and 22.8% had 4 or more pains. Pain was reported as a problem in 85% and was IPD-related in 62.6% of patients, unrelated to IPD in 64.2%, indirectly related to IPD in 8.1%, related to multiple causes in 4.1%, and treatment related in 0.8%. Pain unrelated to IPD was more common, more constant, and more severe than IPD-related pain. Overall, analgesic use was low. This study demonstrates the benefits of adopting a systematic and logical approach to the assessment of pain in IPD and the merits of a simple new classification system.
Background:Clinical uncertainty is emotionally challenging for patients and carers and creates additional pressures for those clinicians in acute hospitals. The AMBER care bundle was designed to improve care for patients identified as clinically unstable, deteriorating, with limited reversibility and at risk of dying in the next 1–2 months.Aim:To examine the experience of care supported by the AMBER care bundle compared to standard care in the context of clinical uncertainty, deterioration and limited reversibility.Design:A comparative observational mixed-methods study using semi-structured qualitative interviews and a followback survey.Setting/participants:Three large London acute tertiary National Health Service hospitals. Nineteen interviews with 23 patients and carers (10 supported by AMBER care bundle and 9 standard care). Surveys completed by next of kin of 95 deceased patients (59 AMBER care bundle and 36 standard care).Results:The AMBER care bundle was associated with increased frequency of discussions about prognosis between clinicians and patients (χ2 = 4.09, p = 0.04), higher awareness of their prognosis by patients (χ2 = 4.29, p = 0.04) and lower clarity in the information received about their condition (χ2 = 6.26, p = 0.04). Although the consistency and quality of communication were not different between the two groups, those supported by the AMBER care bundle described more unresolved concerns about caring for someone at home.Conclusion:Awareness of prognosis appears to be higher among patients supported by the AMBER care bundle, but in this small study this was not translated into higher quality communication, and information was judged less easy to understand. Adequately powered comparative evaluation is urgently needed.
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