Community-based palliative care during the COVID 19 pandemic

Abstract

Novel Coronavirus (COVID 19) has usurped human peace and mobility. Since December 2019, the virus has claimed the lives of 87,816 people across the globe as of April 9, 2020 with India reporting a high case fatality of 3.4%. Among the vulnerable population, elderly people, and patients with comorbidities such as diabetes, chronic life-threatening illnesses, such as COPD and advanced malignancies are susceptible to COVID-19 infection and may have poor clinical outcomes. Considering the imbalance in demand and supply of healthcare resources, initiating palliative care will be essential to alleviate the suffering of such patients. The current paper deliberates on the following aspects of palliative care delivery in the community; the need for palliative care in a pandemic crisis, the role of telemedicine in palliative care delivery in the community, the vital role of a family physician in providing primary palliative care in the community and a “wholistic” community palliative care package to serve the needy in the community.

Our knowledge of Covid-19 is expanding and accelerating fast

“…underscore the importance of community-based palliative care during the ongoing Covid-19 pandemic in the Current Issue of the Journal. [ 1 ] Due to several local and intermittent restrictions on commutation, for rightful reasons, and when it is not possible and safe for patients and their caregivers to move freely, teleconsultation and App-based care are emerging as alternative management strategies. In their Editorial, the authors illustrate its importance, usefulness, pragmatic value, and limitations to family physicians, who are serving patients—sometimes taking extraordinary risks.…”

COVID-19 Publications in Family Medicine Journals in 2020: A PubMed-Based Bibliometric Analysis

“…Moreover, on analyzing all articles published in the entire year, prevention accounted for 43.3% of all articles. Among these articles on prevention, although there were several articles related to prevention of COVID-19 transmission and infection, a higher proportion of articles were on prevention of the subsequent issues faced from combating the virus, such as exercise-and nutrition-related issues owing to isolation [39,40], domestic violence issues [41], difficulty faced by students returning to school after being released from isolation [42], psychological issues experienced by families and medical personnel in the face of mass death [43,44], and issues of hospice and palliative care in an epidemic [45]. Although these articles on prevention did not receive a large number of citations, they are vital in terms of the practical aspects of development of the epidemic and its recovery.…”

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“…Fear of separation from family 3 Fear of dying alone 3 Concerns over pain and dignity in death 3 Anxiety over management decisions 3 Transportation to healthcare amidst lockdowns 7 Disruption in access to medicines and essentials due to pandemic and lockdown 7 Fear of acquiring infection from patients and families 3 Fear of transmitting infection to their own families 3 Increased burden of work 3 Limited availability of personal protective equipments (PPE) and other protective measures 3 Lack of shared decision-making 3 Psychological burden of managing terminal patients in isolation 3 Anxiety over dealing with family with regard to decision-making 3 Ethical concerns related to justifiable resource allocation 3 Fear of acquiring infection from healthcare providers 3 Fear of losing loved ones in isolation 3 Anxiety over isolation measures 3 Anxiety over treatment decisions made by doctors 3 Travel to health care in the midst of restrictions 7 Economic disruptions in family 3,7 Competition for reduced resources 3 Understaffing in palliative care due to redirected health cadre towards COVID care 3 Supply chain disruptions in palliative care medications due to lockdowns 3 Delay or denial in admissions due to patient overload in hospitals 3 Patient perspective 3 Provider's perspective 3 Family's perspective 3 Health System perspective 3 Challenges in access and delivery of palliative care in the pandemic context 3 The way forward Palliative care is a human right and a moral imperative of all health systems and the pandemic has exposed the inadequacy of the country states to protect this basic right for those in need. 2 8 All clinicians should be trained in identifying patients in need of various stages of palliative care at triage and appropriate referral.…”

“…3 The preparedness phase could be used to implement and validate the utility of telemedicine and strengthen the services in provision of palliative care. 7,10 Country-specific, standard guidelines or recommendations for tele-consultation in palliative care should be framed with specific emphasis on documentation and consideration for cultural, social, spiritual, ethical and legal contexts. 7 Effective tele-consultation services can allay anxiety and fears and serve as a source of support during the COVID-19 pandemic.…”