COVID‐19 and hospice community palliative care in New Zealand: A qualitative study

Abstract

Within the context of an ageing population and the added challenges posed by COVID‐19, the need to optimise palliative care management in the community – the setting where a significant proportion of people prefer to die – cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID‐19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February–18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID‐19‐positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged ‘challenges’ and 'adaptations’. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in‐home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID‐19 pandemic and ensure that these services are incorporated into the healthcare system response.

The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: An integrative review

“…The majority of studies utilized survey designs with samples of less than 1000 participants (Bayly et al 2022;Costantini et al 2020;Dunleavy et al 2021;Hasson et al 2022;Jones et al 2022;Kates et al 2021;Luckett et al 2021;Mitchell et al 2022Mitchell et al , 2021Ritchie et al 2021;Rogers et al 2021 (Chou et al 2020). While some of the articles exclusively focused on palliative care delivery in the community (Franchini et al 2021;Frey and Balmer 2022;Page et al 2020;Silva and Schack 2021;Sterling et al 2020;Sumitha et al 2022;Varani et al 2021;Weisse and Melekis 2021) or primary care settings (Mitchell et al 2022(Mitchell et al , 2021Ritchie et al 2021;Tielker et al 2021), the majority included palliative care delivery in other settings as well (Bayly et al 2022;Chou et al 2020;Chua et al 2022;Costantini et al 2020;Dunleavy et al 2021;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Rogers et al 2021;Sleeman et al 2022;Wentlandt et al 2021) (Jansky et al 2021;...…”

“…Fourteen articles reported both inadequate supplies, including PPE supplies and medicines (Bayly et al 2022;Costantini et al 2020;Dhavale et al 2020;Franchini et al 2021;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Luckett et al 2021;Page et al 2020;Ritchie et al 2021;Rogers et al 2021;Sterling et al 2020;Weisse and Melekis 2021;Wentlandt et al 2021). Staff number reductions due to furloughs and redistribution and staff self-isolating (Bayly et al 2022;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Mitchell et al 2021;Ritchie et al 2021;Rogers et al 2021;Sleeman et al 2022) as well as a decrease in service provision from volunteers and the allied health workforce (Costantini et al 2020;Frey and Balmer 2022;Jansky et al 2021;Jones et al 2022;Luckett et al 2021;Mitchell et al 2021;Ritchie et al 2021;Weisse and Melekis 2021) resulted in increased staff workload (Bayly et al 2022;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;…”

“…Both health professionals and patients faced communication challenges during the pandemic. Due to the rapidly evolving situation during the pandemic, messaging for health professionals from national and local governmental authorities sometimes led to confusion due to information overload, mixed messaging, or lack of information (Dunleavy et al 2021;Frey and Balmer 2022;Jansky et al 2021;Luckett et al 2021;Rogers et al 2021;Sterling et al 2020). Internal messaging in specialist organizations (e.g., reduction in team meetings) also led to limited communication among health professional teams (Bayly et al 2022;Franchini et al 2021;Frey and Balmer 2022;Jansky et al 2021;Jones et al 2022;Rogers et al 2021).…”

“…Due to the rapidly evolving situation during the pandemic, messaging for health professionals from national and local governmental authorities sometimes led to confusion due to information overload, mixed messaging, or lack of information (Dunleavy et al 2021;Frey and Balmer 2022;Jansky et al 2021;Luckett et al 2021;Rogers et al 2021;Sterling et al 2020). Internal messaging in specialist organizations (e.g., reduction in team meetings) also led to limited communication among health professional teams (Bayly et al 2022;Franchini et al 2021;Frey and Balmer 2022;Jansky et al 2021;Jones et al 2022;Rogers et al 2021). A shift to telephone and virtual technology for the delivery of care to reduce the possibility of infection was reported by most studies (Bayly et al 2022;Costantini et al 2020;Dhavale et al 2020;Dunleavy et al 2021;Franchini et al 2021;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Mitchell et al 2022;Page et al 2020;Ritchie et al 2021;Rogers et al 2021;Silva and Schack 2021;Sumitha et al 2022;Tielker et al 2021;Wentlandt et al 2021).…”

“…Internal messaging in specialist organizations (e.g., reduction in team meetings) also led to limited communication among health professional teams (Bayly et al 2022;Franchini et al 2021;Frey and Balmer 2022;Jansky et al 2021;Jones et al 2022;Rogers et al 2021). A shift to telephone and virtual technology for the delivery of care to reduce the possibility of infection was reported by most studies (Bayly et al 2022;Costantini et al 2020;Dhavale et al 2020;Dunleavy et al 2021;Franchini et al 2021;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Mitchell et al 2022;Page et al 2020;Ritchie et al 2021;Rogers et al 2021;Silva and Schack 2021;Sumitha et al 2022;Tielker et al 2021;Wentlandt et al 2021). However, digital technology used to provide care to patients led to challenges in terms of both technical problems and the availability of equipment (Chua et al 2022;Dunleavy et al 2021;Lalani et al 2022;Luckett et al 2021), as well as equity issues related to patient and family access (the digital divide), including digital literacy and connectivity issues (Bayly et al 2022;Chua et al 2022;Lalani et al 2022;Luckett et al 2021;Page et al 2020;Ritchie et al 2021;…”