Palliative Renal Care and the Covid-19 Pandemic

Abstract

Introduction Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection. Discussion The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team’s reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater. Conclusion The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.

National and international non-therapeutic recommendations for adult palliative and end-of-life care in times of pandemics: A scoping review

“…Building a therapeutic relationship is very important (Mottiar et al, 2020) and patients have to be involved in decisions. If this is not possible, the clinicians should rely on relatives (shared-decision-making between team, patient, and relatives) (Eriksen et al, 2020; Feder et al, 2020; Gaur et al, 2020; Koffman et al, 2020; Milano, 2020; Santos et al, 2020). Already existing assessment tools should be used to support decisions and can be included in GoC/ACP discussions with patients as well (Fiorentino et al, 2020; Lapid et al, 2020; McIntosh, 2020).…”

“…All rules of communication that exist in palliative care continue to apply (Gibbon et al, 2020; Santos et al, 2020; Schlögl and Jones, 2020). Additionally, a COVID-19 specific language should be used (Nakagawa et al, 2020) (e.g., “COMMUNICoVID” — How to communicate with families living in complete isolation) (Mistraletti et al, 2020) and it is strongly recommended to encourage palliative care providers to honestly communicate the clinical uncertainty (e.g., of the COVID-19 trajectory) to families and patients.…”

“…These discussions and conversations should be honest and direct (Burke et al, 2020). Nevertheless, the general rules of communication in palliative care still apply (Gibbon et al, 2020; Santos et al, 2020; Schlögl and Jones, 2020). Therefore, it is important to also train other non-specialist staff on the basics of palliative care communication skills (Desai et al, 2020; Gibbon et al, 2020; Hannon et al, 2020; Mottiar et al, 2020; Murray et al, 2020; Rajagopal, 2020; Sese et al, 2020; Singh et al, 2020).…”

“Saying goodbye all alone with no close support was difficult”- Dying during the COVID-19 pandemic: an online survey among bereaved relatives about end-of-life care for patients with or without SARS-CoV2 infection

“…Furthermore, the pandemic caused emotional challenges[ 40 ] and huge uncertainty about how to react to the pandemic crisis. Still, studies underline that communication rules applied in palliative care should be used [ 41 – 43 ], that healthcare teams need to communicate clinical uncertainty to the relatives[ 44 ] to ensure transparent medical care, and to use COVID-19 specific language [ 45 ].…”

Ethical dilemmas on the right of access to palliative care in the COVID-19 pandemic

“…E foi evidenciado que a pandemia COVID-19 é uma razão para a ocorrência de alterações mentais, como estresse, sintomas depressivos, insônia, negação, raiva e medo 29 . C. G. da S., Tavares, A. P. dos S., Tzanno-Martins, C., Barros Neto, J.,Silva, A. M. M. da, Lotaif, L., & Souza, J. V. L. (2020).Palliative renal care and the covid-19 pandemic. Brazilian Journal of Nephrology, 42(2 suppl 1), 44-46.…”