Cultural Responsiveness and Palliative Care during the COVID-19 Pandemic

Abstract

During the COVID-19 pandemic, much has changed in the delivery of palliative care (PC). However, cultural responsiveness remains critical to our mission. It is essential to our aims of identifying individual goals of care and providing relief of suffering for our patients. Cultural responsiveness may also enhance trust and could be a mitigating factor in the staggering health care disparities unmasked during this pandemic. In this study, the authors outline the rationale for renewed focus on this issue, and offer some initial suggestions for how culturally responsive PC can be provided even in this extraordinary time.

Desafios e Oportunidades: O Impacto da COVID-19 nos Cuidados Paliativos em Portugal

“…9 Tal realidade, se for ignorada, pode atentar contra a preservação da dignidade e auto-estima. 10,11 O sofrimento de base, determinado pela vivência do fim de vida, é agravado pelos condicionalismos impostos pela COVID-19. Com o agravamento da ansiedade, o controlo sintomático poderá tornar--se mais complexo e desafiante, exigindo maior foco e supervisão por parte da equipa assistencial.…”

“…Maior distanciamento e o comprometimento no apoio directo aumentam também o risco de futuros lutos patológicos nos entes próximos. [6][7][8]10,11 Estes fatores concorrem para aumentar a pressão sobre os profissionais, eles próprios a viverem uma situação de maior exigência assistencial em resultado das regras estritas necessárias à proteção de todos (incluindo o uso de materiais de proteção menos confortáveis ou a realização de mais turnos), pela exposição a casos positivos e receio de contágio, pela maior tensão experimentada durante o trabalho, com possível sensação de incapacidade ou de dever não cumprido.…”

A reflection on: Breitbart W (2020). Life and death in the age of COVID-19. Palliative and Supportive Care 18, 252–253

“…We believe that the resulting anguish, anxiety, fear, and depression will negatively affect the preservation of dignity. The suffering present in dealing with the complexity of end-of-life issues (fear of death, feeling vulnerable, self-esteem, and dignity self-concept) (Chochinov et al, 2020; Patneaude and Kett, 2020) will be augmented by the social impositions of this COVID-19 pandemic. Symptom control will become more complex and require more supervision and focus from a specialist PC team.…”

“…This may be an opportunity, if resources allow, for PC teams to reach out to colleagues in other specialties and expand the PC approach models, focusing on the importance of teamwork and highlighting relief of suffering as a genuine goal of care, rather than survival alone (Abbot et al, 2020; Fadul et al, 2020). Taking this opportunity to disseminate good symptom control protocols and draw attention to the significance of the relationship with our patients, offering training in communication skills and in advance care planning (Back et al, 2020; Chochinov et al, 2020; Marra et al, 2020; Patneaude and Kett, 2020).…”

“…Despite this crisis, health professionals should not lose their capacity for empathy (Back et al, 2020; Patneaude and Kett, 2020). It is essential to be attuned to patients’ emotions, validate them and provide guidance for dealing with them.…”