COVID-19: Implications for Advanced Care Planning and End-of-life Care

Abstract

Disclaimer: Due to the rapidly evolving nature of this outbreak, and in the interests of rapid dissemination of reliable, actionable information, this paper went through expedited peer review. Additionally, information should be considered current only at the time of publication and may evolve as the science develops. Dear Editor: It was 4 am when the hospital admitting medicine service phone rang. "Ten patients with suspected COVID-19 were sent from a nursing home; it's possible that they all may need intensive care unit [ICU] beds. How many beds are available right now?" I will never forget the series of events that followed. The urgency was palpable as evidenced by the frenzy of navigating the emergency department, careful donning and doffing of personal protective equipment, and rapid-fire triaging of each patient. It was 6 am when several more patients from that same nursing home arrived. The nasal cannulas turned into non-rebreathers, which quickly transitioned to high-flow nasal cannulas. The next obvious step was intubation. But one question persisted in our minds: "Are we doing the right thing?"

The COVID-19 pandemic: A tipping point for advance care planning? Experiences of general practitioners

“…7,8 Also professionals in hospitals, confronted with critically ill COVID-19 patients without advance directives, did an urgent appeal for advance care planning in primary care. 9 As it is not yet common practice, 10,11 many GPs were suddenly confronted with a large number of patients in urgent need of it. However, measures to prevent the spread of COVID-19 (like physical distancing, hygiene, quarantine and isolation), as well as a lack of time and unfamiliarity with advance care planning, made conversations about it more challenging.…”

Implementation of advance care planning amid the COVID‐19 crisis: A narrative review and synthesis

“…The design of the primary studies was retrospective observational ( n = 4), 17–20 comparative cross‐sectional ( n = 1), 21 design process ( n = 2), 22,23 quality improvement intervention ( n = 1), 24 case report/study ( n = 2) 25,26 and virtual workshop ( n = 1) 27 . The rest of the articles were perspective papers ( n = 5), 3,28–31 letters to the editor ( n = 2), 32,33 newspaper analysis ( n = 1) 34 and guideline review ( n = 1) 35 . The primary studies were conducted in the USA, UK, the Netherlands, Japan and Taiwan.…”

Worden’s Task-Based Model for Treating Persistent Complex Bereavement Disorder During the Coronavirus Disease-19 Pandemic: A Narrative Review

“…During the COVID-19 pandemic, multiple losses could delay mourning attributable to the weight and burden of bereavement overload [12], [22]. Such delayed reactions could occur not only following a subsequent loss but also by encountering other survivors or watching a movie/TV show/other media events about loss [23].…”

“…However, it is notable that these tasks are not similarly challenged in any death loss [32]. Certain features need to be taken into account as to the survivors of patients infected by COVID-19, who suffer from PCBD [12], [22]. Usually, unexpected death makes survivors have unreal feelings about the loss, which may last a long time.…”