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

Abstract

Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population. Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a ‘typical’ caseload from 2019. Design: Service evaluation based on a retrospective cohort review of patient records. Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020. Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a ‘typical’ caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced ‘typical’ caseload; overall numbers of referrals were not increased. Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from ‘typical’ caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.

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Dying in times of the coronavirus: An online survey among healthcare professionals about end-of-life care for patients dying with and without COVID-19 (the CO-LIVE study)

“…Empirical studies about care at the end of life during the COVID-19 pandemic that have been published until now, predominantly focused on symptom burden and management in studies in patients attended by palliative care services in hospitals. [4][5][6][7][8] They show that dyspnoea, agitation and pain are prevalent and can generally be controlled relatively well. However, it is known that many people die in other settings, such as care homes, or without involvement of palliative care services.…”

The challenges of caring for people dying from COVID-19: a multinational, observational study of palliative and hospice services (CovPall)

“…Palliative care puts the person before their disease wherever they are cared for: it is neither disease nor setting specific. The symptoms and problems of severe COVID-19 are commonly breathlessness and agitation, 19,20 both familiar to palliative care clinicians. Current case reports suggest that these symptoms in end stage COVID-19 can be alleviated with low doses of opioids and benzodiazepines, delivered subcutaneously with a battery operated syringe driver.…”