COVID-19: Challenges and solutions for the provision of care to seriously ill and dying people and their relatives during SARS-CoV-2 pandemic – perspectives of pandemic response team members: A qualitative study on the basis of expert interviews (part of PallPan)

Abstract

Background: During the SARS-CoV-2 pandemic’s initial waves, bans on visiting and isolation measures placed limits on providing services for seriously ill and dying people and their relatives. Pandemic response teams at governmental level (macro), at federal state and municipal level (meso) and in healthcare facilities (micro) played their role in pandemic management procedures. Aim: To explore pandemic-related challenges and solutions of pandemic response teams regarding the provision of care to seriously ill and dying people and their relatives. Findings were to be integrated into a national strategy (PallPan). Design: Semi-structured expert interviews (10/2020–2/2021) analysed via structured content analysis. SettingParticipants: We interviewed 41 members, who discussed the work of 43 German pandemic response teams (micro n = 23; meso n = 20; no members were available at macro level) from 14 German federal states. Results: Twenty-nine of 43 teams took account of the needs of seriously ill and dying. Their main challenges resulted from pandemic-related legal requirements in hospitals and long-term care facilities. The implementation of such was in the remits of the meso level. Dysfunctional or non-existent communication between the levels was reported to be challenging. To foster patient-related solutions the micro level pandemic response teams supported individual decisions to enable patient-relative contact for example, visiting and saying goodbye outside, meeting via digital solutions. Conclusions: Pandemic response teams evidently struggled to find appropriate solutions to ease pandemic-related impact on the care of seriously ill and dying patients and their relatives. We recommend bringing palliative care expertise on board.

End-of-life care in Germany between 2016 and 2020 – A repeated cross-sectional analysis of statutory health insurance data

“…The number of hospitalisations and the number of treatment days in hospital slightly decreased over the study period, in alignment with previous research [15]. In 2020, fewer patients died in an inpatient setting, but this reduction may have been in uenced by the COVID-19 pandemic [32]. While hospitalisations at the end of life may be indicated and bene cial for some patients, they are often experienced as inappropriate and burdensome by patients, relatives and health care providers [49][50][51].…”

“…A majority of the surveyed population received generalist outpatient PC, which is mainly provided by GPs. Since 2020, GPs have been heavily burdened by numerous factors, including COVID-19 [31][32][33][34][35]. Specialist outpatient PC teams have also been severely loaded [36], and resources for outpatient PC might be collectively exhausted.…”

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses’ Perspectives

“…The COVID-19 virus created a nontherapeutic hospital environment for staff, patients, and family members in the metropolitan PCUs and regional acute wards. Where previously, many patients felt stressed within the acute hospital environment due to noise, unfamiliarity, and loss of control ( Abuatiq et al, 2020 ; Miller et al, 2022b ), COVID-19 impacted the physical environment as single-patient rooms were reallocated to COVID-19 patients and patient’s psychosocial environment through isolation from their loved ones with numerous research highlighting the resultant suffering and psychological harm ( Bloomer & Walshe, 2021 ; Kirby et al, 2021 ; Klinger et al, 2022 ; Rokach, 2022 ; Usher et al, 2020 ), human conditions that the palliative approach aims to prevent (WHO, 2020). Nurses forced into a gatekeeping role they knew was harmful to patients and families clashed with their values of providing excellent palliative care.…”

“…Hospitalized palliative and end-of-life patients have different physical and psychosocial needs than other acute patients ( Miller et al, 2022b ) yet are often cared for in the same fast-paced, noisy, task-focused environment ( Chan et al, 2018 ), especially in regional areas of Victoria, Australia, that do not have a Palliative Care Unit (PCU). In addition, COVID-19 has severely impacted the physical and psychosocial hospital experience for patients, family members, and staff ( Bloomer & Walshe, 2021 ; Kirby et al, 2021 ; Klinger et al, 2022 ; Rokach, 2022 ; Usher et al, 2020 ), creating a nontherapeutic environment, contrary to the needs of palliative and end-of-life patients and their families. Nurses providing care to patients and their families create some of these environments and witness how they affect the patients they care for.…”

Psychosocial burdens in palliative care – a longitudinal cohort study in nursing homes and impacts of the COVID-19 pandemic

“…Although some studies have investigated the impacts of the pandemic on palliative care in Germany [23,[25][26][27][28][29][30] or on the workloads faced by nursing home staff [17,21], no study that specifically addressed the psychosocial burdens of palliative care in nursing staff working in German nursing homes and the impact of the COVID-19 pandemic could be found. Therefore, this research focused on the questions of how the psychosocial burdens of palliative care in nursing homes have been affected by the COVID-19 pandemic and how these psychosocial burdens differ from those of general care.…”