End-of-life and goals of care discussions with cancer patients in the coronavirus pandemic

Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study

“…Surprisingly, we observed an increase in the use of inotropes/vasopressors and cardiopulmonary resuscitation in 2020 compared to 2019, although the proportions of patients who received other life-sustaining treatments were not elevated. The increase in these aggressive measures near death might have been due to increased clinical uncertainty and difficulty in early and detailed advance care planning, including the implementation of specific medical procedures, during the COVID-19 pandemic [ 23 , 24 ]. We also found that the increase in these measures was more evident in places where visitor restrictions are usually stricter, potentially making communication between the patient and family more difficult than in other places.…”

“…The ongoing pandemic has raised uncertainty in clinical settings in many ways. Therefore, goal-of-care discussions and communication about the implementation of medical procedures at the EOL, including suddenly deteriorating situations without the family’s presence beside the patient, may help the patient avoid unnecessary and futile procedures, such as inotrope/vasopressor use or cardiopulmonary resuscitation [ 2 , 24 ]. The enhancement of home-based and transitional care can also be considered as an alternative for patients who remain at home at the EOL to prevent avoidable ER visits [ 10 ].…”

Communicating with patients and families about illness progression and end of life: a review of studies using direct observation of clinical practice

“…There are known benefits to these conversations [ 7 – 10 ], but it is also known that many clinicians find discussions about prognosis and dying deeply challenging [ 11 ]. During high-pressure periods such as the COVID-19 pandemic, the challenging nature of these conversations can be intensified, especially for clinicians who do not routinely manage such discussions outside these high-pressure periods [ 5 , 12 , 13 ].…”