Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada

Abstract

ObjectiveTo compare end-of-life in-person family presence, patient–family communication and healthcare team–family communication encounters in hospitalised decedents before and during the COVID-19 pandemic.DesignIn a regional multicentre retrospective cohort study, electronic health record data were abstracted for a prepandemic group (pre-COVID) and two intrapandemic (March–August 2020, wave 1) groups, one COVID-19 free (COVID-ve) and one with COVID-19 infection (COVID+ve). Pre-COVID and COVID-ve groups were matched 2:1 (age, sex and care service) with the COVID+ve group.SettingOne quaternary and two tertiary adult, acute care hospitals in Ottawa, Canada.ParticipantsDecedents (n=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170).Main outcome measuresEnd-of-life (last 48 hours) in-person family presence and virtual (video) patient–family communication, and end-of-life (last 5 days) virtual team–family communication encounter occurrences were examined using logistic regression with ORs and 95% CIs. End-of-life (last 5 days) rates of in-person and telephone team–family communication encounters were examined using mixed-effects negative binomial models with incidence rate ratios (IRRs) and 95% CIs.ResultsEnd-of-life in-person family presence decreased progressively across pre-COVID (90.6%), COVID-ve (79.4%) and COVID+ve (47.1%) groups: adjusted ORs=0.38 (0.2–0.73) and 0.09 (0.04–0.17) for COVID-ve and COVID+ve groups, respectively. COVID-ve and COVID+ve groups had reduced in-person but increased telephone team–family communication encounters: IRRs=0.76 (0.64–0.9) and 0.61 (0.47–0.79) for in-person, and IRRs=2.6 (2.1–3.3) and 4.8 (3.7–6.1) for telephone communications, respectively. Virtual team–family communication encounters occurred in 17/85 (20%) and 10/170 (5.9%) of the COVID+ve and COVID-ve groups, respectively: adjusted OR=3.68 (1.51–8.95).ConclusionsIn hospitalised COVID-19 pandemic wave 1 decedents, in-person family presence and in-person team–family communication encounters decreased at end of life, particularly in the COVID+ve group; virtual modalities were adopted for communication, and telephone use increased in team–family communication encounters. The implications of these communication changes for the patient, family and healthcare team warrant further study.

Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis

“…Not being prepared for death is a potential problem for all persons involved, implying psychosocial consequences, such as stress, anxiety, depression, and fear [33,46,50], and the consequences of death, such as prolonged grief symptoms [33,47,55]. The evidence indicates new ways of communication, compassionate professional support, and effective remote communication [40,47,[51][52][53]55,57,64].…”

“…-Poor quality communication [32,40,42,43,50,51]; -Absence of strategies for remote communication or poor virtual communication [40,52].…”

“…The concept is preceded by contextual domains: the place of death [35,47,51,59]; quarantine measures, such as social distancing policies to control contagion and travel prohibitions [32,34,36,39,40,47,48,50,60,61]; unpredictability, the unexpected increase in death numbers [33,60]; and lockdowns on contacts and visits [47,48,57,60], which impede the resolution of previous conflicts [33]. When death occurred, the impossibility of funeral ceremonies or their postponement until 6 months after death [60] caused family suffering due to religious and cultural beliefs [34].…”