Characteristics and Palliative Care Needs of COVID‐19 Patients Receiving Comfort‐Directed Care

Abstract

Since then, the rapid increase in the number of patients with COVID-19 associated with acute respiratory distress syndrome (ARDS) 1 and high rates of mortality 2,3 has highlighted the critical need for high-quality end-of-life care. On March 31, 2020, an eight-bed Palliative Care Unit (PCU) was established at our institution for patients with COVID-19 whose surrogates opted to not initiate or continue life-sustaining therapies. To our knowledge, this is the first report describing COVID-19 patients receiving comfort-directed care.This case series aims to describe the characteristics and palliative care needs in patients admitted to the PCU at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital to inform other clinicians caring for this population at the end of life. METHODSDeceased patients with confirmed severe acute respiratory syndrome coronavirus 2 infection by polymerase chain reaction testing of a nasopharyngeal sample, admitted to the PCU at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital between March 31, 2020, and April 10, 2020, were included.Before data collection, a waiver was obtained from the Columbia University institutional review board. Deidentified patient data were collected from the electronic medical record Epic Hyperspace and analyzed using Microsoft Excel. Laboratory testing was reviewed at PCU admission. Patient outcome data were evaluated at time of death. Due to the descriptive nature of this case series, no analysis for statistical significance was performed. RESULTSA total of 30 patients were included in this case series (mean age = 84.5 years; 53% male) (Table 1). Most patients were of Hispanic origin (20 [66.7%]), followed by white (4 [13.3%]). All 30 patients had comorbidities before hospital admission, with 70% of patients having more than one comorbidity. Twenty-four patients (80%) had metabolic abnormalities, with hypernatremia observed in 17 patients (57%). Before PCU admission, all 30 patients

COVID-19: guidance on palliative care from a European Respiratory Society international task force

“…Another case series of 30 hospitalized deceased patients showed that 76.7% of the patients used intravenous morphine but, again, effectiveness was not evaluated. [17] Results. Most experts recommended strongly (55.9%) or conditionally (27.9%) that patients presenting with serious COVID-19 and distressing breathlessness, despite optimal treatment of underlying causes, should be given low-dose opioids for the palliative treatment of breathlessness.…”

“…[29] Results: Most experts provided a strong (58.8%) or conditional ( Rationale: Psychological symptoms such as anxiety and agitation are highly prevalent in dying patients with COVID-19. [6,17] Psychosocial interventions in palliative care can relieve emotional and existential distress and improve quality of life. [34] Therefore, a rapid review recommended to healthcare professionals providing psychosocial care in palliative care for patients with COVID-19, [31] although data in COVID- 19 are not yet available.…”

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

“…6 Only recently has evidence emerged to help characterise symptom burden and outcomes in end stage COVID-19, but with small patient numbers and focussed geographical locations. [7][8][9] Our primary aim was to further characterise the symptom profile, outcomes and symptom management requirements of hospitalised patients with COVID-19 referred to Hospital Palliative Care. Our secondary aim was to contextualise Palliative Care demands from COVID-19 against a 'typical' Palliative Care caseload pre-pandemic.…”

Cuidados paliativos no contexto da pandemia de COVID-19: desafios e contribuições

“…Em relação às temáticas, duas categorias sintetizam os principais aspectos abordados nos estudos: "Estratégias para implementação dos cuidados paliativos no enfrentamento da COVID-19" (17)(18)(19)21,23,25,(27)(28)(29)(30)(31)(32)35,36,(38)(39)(40)(41)(42)44) (19; 63,3%) e "Terapêutica paliativista no contexto da pandemia: desafios e contribuições" (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)31,33,34,(36)(37)(38)(39)(40)(41)(43)(44)(45) (24; 80%).…”

“…Entre as estratégias utilizadas para implementação dos cuidados paliativos no enfrentamento da COVID-19, destacaram-se a telemedicina e a comunicação entre os atores envolvidos, (17)(18)(19)21,25,27,28,30,32,35,36,(38)(39)(40)(41)(42)44) o planejamento das ações, (17)(18)(19)21,23,25,32,35,(39)(40)(41)44) a utilização adequada dos equipamentos de proteção individual e outros materiais (19,21,27,28,36,39) e o uso de ferramentas de gestão como planos, diretrizes e protocolos. (18,21,23,25,27,28,30-32,35,39,40,42,44 ou cuidadores.…”