Drastic changes in the practice of end-of-life care during the COVID-19 pandemic

Ben-Jacob, Talia K.; Peterson, Lars-Kristofer N.

doi:10.1016/j.jcrc.2021.09.019

Cited by 9 publications

(15 citation statements)

References 6 publications

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“…Moreover, nurses considered that despite doing everything possible to save the patient’s life or to provide excellent quality and ethical care, the pandemic situation prevented them from providing care as they would have liked [ 8 , 9 , 36 ]; this generates feelings of frustration and helplessness, considering that the situation became unsustainable [ 16 , 35 ]. In addition, they sometimes felt guilty about the care provided, which can be detrimental to their mental health and cause added moral damage [ 4 , 8 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this context, nurses encountered new tensions related to traditional ethical principles: social justice versus individual patient autonomy or beneficence versus public health non-maleficence [ 9 ]. The inability to involve patients and their families in decisions about their process and to accompany their patients in their suffering was a major source of ethical conflict [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Nurses’ Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

Caro-Alonso

Martín

Rodríguez‐Almagro

et al. 2023

IJERPH

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The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses’ ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi’s descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi’s phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nurses’ Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

Caro-Alonso

Martín

Rodríguez‐Almagro

et al. 2023

IJERPH

View full text Add to dashboard Cite

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“…Fourteen studies were excluded because they were not related to advance care planning (13,14,15,16,17,18,19,20,21,22,23,24,25,26). Additionally, 18 studies were excluded because they were different article types (27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44). A total of seven studies-two systematic reviews (45,46), three scoping reviews (7,47,48), one narrative review (49), and one critical realist review (50)-were nally included in this systematic review.…”

Section: Study Selectionmentioning

confidence: 99%

Barriers to and facilitators of advance care planning implementation for medical staff after the coronavirus disease 2019 pandemic: An overview of reviews

Inokuchi

Hanari

Shimada

et al. 2023

Preprint

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Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted the capacity for advance care planning between patients, families, and healthcare teams. The barriers to and facilitators of advance care planning vary with settings. This study sought to identify and review the barriers to and facilitators of advance care planning implementation for medical staff in different settings (e.g., hospitals, outpatients, care and nursing homes) during the COVID-19 pandemic. Methods: This study followed an overview of review design and was registered in the International Prospective Register of Systematic Reviews (CRD42022351362). A search of MEDLINE, CENTRAL, Web of Science, and Embase databases was performed through November 14, 2022. AMSTAR 2 was used to assess the risk of bias. Results: The final analyses included seven studies. Common barriers to advance care planning implementation included visitation restrictions, limited resources and personnel, and lack of coordination among health professionals. In care and nursing homes, the lack of palliative care physicians and the psychological burden on staff were identified as barriers. Using telemedicine for information-sharing was a common facilitator. In hospitals, facilitators were short-term training in palliative care and palliative care physicians joining the acute care team; in care homes and nursing homes, they were advance care planning education and emotional support for staff. Conclusions: Although inadequate staff education regarding advance care planning in hospitals and facilities and the lack of community-level information-sharing have long been noted, the pandemic highlighted these issues. Short-term training programs for staff and immediate information-sharing could facilitate advance care planning.

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“…During the early, chaotic months of the first 2020 COVID-19 surge, nursing homes struggled to contain COVID-19 outbreaks 12 and hospitals became overwhelmed. 13 Consequently, there has been extensive research focused on EOL care within institutional settings including mortality risk factors, 14 - 16 changes in service delivery (e.g., telehealth 17 ) and the profound impact of visitor restrictions and isolation. 17 - 19 Yet relatively little is known about the experience of medically complex patients at home.…”

Section: Introductionmentioning

confidence: 99%

“…13 Consequently, there has been extensive research focused on EOL care within institutional settings including mortality risk factors, 14 - 16 changes in service delivery (e.g., telehealth 17 ) and the profound impact of visitor restrictions and isolation. 17 - 19 Yet relatively little is known about the experience of medically complex patients at home. We examined the EOL experience of homebound patients in New York City, the initial epicenter of the US COVID-19 pandemic, 20 through the lens of their interactions with a HBPC practice using a retrospective chart review.…”

Section: Introductionmentioning

confidence: 99%

Care Disruptions and End-Of-Life Care Experiences Among Home-Based Primary Care Patients During the COVID-19 Pandemic in New York City: A Retrospective Chart Review

Franzosa

Kim

Reckrey

et al. 2022

Am J Hosp Palliat Care

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Background: Research on deaths during COVID-19 has largely focused on hospitals and nursing homes. Less is known about medically complex patients receiving care in the community. We examined care disruptions and end-of-life experiences of homebound patients receiving home-based primary care (HBPC) in New York City during the initial 2020 COVID-19 surge. Methods: We conducted a retrospective chart review of patients enrolled in Mount Sinai Visiting Doctors who died between March 1-June 30, 2020. We collected patient sociodemographic and clinical data and analyzed care disruptions and end-of-life experiences using clinical notes, informed by thematic and narrative analysis. Results: Among 1300 homebound patients, 112 (9%) died during the study period. Patients who died were more likely to be older, non-Hispanic white, and have dementia than those who survived. Thirty percent of decedents had confirmed or probable COVID-19. Fifty-eight (52%) were referred to hospice and 50 enrolled. Seventy-three percent died at home. We identified multiple intersecting disruptions in family caregiving, paid caregiving, medical supplies and services, and hospice care, as well as hospital avoidance, complicating EOL experiences. The HBPC team responded by providing clinical, logistical and emotional support to patients and families. Conclusion: Despite substantial care disruptions, the majority of patients in our study died at home with support from their HBPC team as the practice worked to manage care disruptions. Our findings suggest HBPC’s multi-disciplinary, team-based model may be uniquely suited to meet the needs of the most medically and socially vulnerable older adults at end of life during public health emergencies.

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Drastic changes in the practice of end-of-life care during the COVID-19 pandemic

Cited by 9 publications

References 6 publications

Nurses’ Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

Nurses’ Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

Barriers to and facilitators of advance care planning implementation for medical staff after the coronavirus disease 2019 pandemic: An overview of reviews

Care Disruptions and End-Of-Life Care Experiences Among Home-Based Primary Care Patients During the COVID-19 Pandemic in New York City: A Retrospective Chart Review

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