COVID-19: guidance on palliative care from a European Respiratory Society international task force

Abstract

BackgroundMany people are dying from COVID-19, but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with increased need of palliative care provided to many patients by clinicians with limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process.MethodsWe invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted.Results68 experts (75.6%) responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58/68 (85.3%) of the first round experts responded, resulting in consensus also for the 14th recommendation.ConclusionsThis multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.

End-Of-Life Care in the Time of COVID-19: Communication Matters More Than Ever

“…To implement these approaches, clinicians may turn to existing guidelines for enhancing remote communication in healthcare settings during natural disasters, including pandemics. ( 4 , 5 , 6 , 7 , 8 ) However, little is known about their effectiveness in promoting positive patient and family outcomes.…”

Propuesta de protocolo de visita del familiar o acompañante para despedir durante la agonía a pacientes afectados por Covid-19 en México

“…Las «recomendaciones internacionales para los cuidados paliativos para pacientes al final de la vida con Covid-19» implican el proceso de despedida (8). Éste incluye las siguientes acciones: a) comunicación médico-paciente; b) comunicación remota médico-familia; c) cuidados paliativos en pacientes con Covid-19 grave, y d) cuidado espiritual, atención psicosocial y cuidado del duelo.…”

Consensus-based recommendations in respiratory medicine

“…To ensure that the findings were trustworthy, we repeated our study using guidelines on idiopathic pulmonary fibrosis [7] and community-acquired pneumonia (undergoing peer review) as comparators, and again found that the CORE process yielded recommendations that were highly concordant with recommendations informed by a systematic review of the literature. The CORE process has transitioned from being validated to being utilised [8,9]. This edition of the European Respiratory Journal includes one of the first guidance documents developed with the CORE process, in which experts formulate suggestions about pulmonary rehabilitation during the COVID-19 pandemic [10].…”