Homecare and the COVID-19 pandemic – Experience at an urban specialist cancer palliative center

Abstract

Background: With the COVID-19 pandemic wreaking havoc globally, the extremely vulnerable subset of cancer palliative care patients has to go through the worst nightmare. Difficulty in accessing medical care in the event of increased symptom burden, obstacles in reaching hospitals at time of emergencies or end of life, limited access to medication, social distancing causing isolation, leading to psychosocial burden, lack of bereavement support, are few of the issues we identified. Palliative home care is an important tool to allay the anxieties and address the fears of cancer patients and caregivers, by ensuring continuity of care and providing the much needed handholding in these difficult times. This article aims to highlight the home-based care strategy and experience of the Cipla Palliative Care and Training Center during the COVID-19 lockdown. Materials and Methods: We have utilized the data of documentation of the process of designing the protocol, the data entered by the team on unique data management software that is used at the palliative care center to record all palliative care interventions and reflections of the team on their experience of home visits during this period. Results: Continuity of care through home visits will ensure better management of patients in terms of physical symptoms, psychosocial support, allaying fears, and anxieties, as well as the ultimate goal of an improved quality of life. Physical symptoms (24%), morphine drop off (19%), psychosocial support (15%), end of life care (33%), and procedures (9%) were the major indications of visits. Conclusion: The COVID-19 pandemic has increased the need for support, thus reiterating the importance of continuity of care. With abundant precautions and protocols in place, home care through visits is possible. With the lockdown and restrictions now entering their fourth phase, we need to be ready now more than ever to adapt to changing times and evolving definitions of the “New Normal.”

Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States

“…In the more traditional interpretation of advanced care planning, patients who were working closely with their physician and care team may have already identified palliative care as the next progression in their care plan [ 12 , 20 ]. These patients were able to be connected to variable resources that were still available despite many of the barriers in the outpatient setting [ 7 , 11 , 12 , 13 , 15 , 16 , 19 , 20 ].…”

“…A lack of healthcare resources was a major barrier to the sustainability of palliative care services during the pandemic. Patients were restricted from visiting their healthcare providers due to supply shortages, staff on sick leave, and facilities that were at or above capacity and could not accept new patients due to a lack of resources [ 1 , 7 , 8 , 9 , 11 , 12 , 14 , 15 , 19 , 20 ]. Personal protective equipment (PPE) and supplies were in short supply and acted as a barrier to palliative care delivery because hospitals did not have enough supplies to accept an influx of COVID-19 patients [ 5 , 8 , 13 , 18 ] or had routine care suspended altogether for the unforeseen future.…”

“…Facilities closed and services were interrupted worldwide, with temporary and even long-term access to palliative care in the ambulatory care setting becoming nonexistent. In addition to decreased access to facilities, palliative care agencies faced challenges with in-home visits due to inadequate supplies, lack of personal protective equipment (PPE), and lack of staff [ 18 , 19 ]. The lack of emergent plans for how the outpatient care organization would function during a pandemic also became a barrier to access.…”

Home Palliative Care during the COVID-19 Pandemic: A Scoping Review

“… 13 , 14 , 18 Most of the available articles were qualitative studies, 13 , 18 and some were quantitative based on medical records. 19 Qualitative studies focused mainly on the experiences/perception of home palliative care professionals, 13 , 20 and less on the experience of patients. 13 , 14 Consequently, the current review article aimed to answer the following questions: 1.…”

Elaboração de um procedimento de gestão de EPI na visitação domiciliária em contexto covid19

“…Sucintamente, a VD pressupõe a prestação integral, no domicílio do utente, dos cuidados de saúde que ele necessita, sendo o tratamento de feridas e os cuidados de reabilitação as duas tipologias de cuidados maioritárias na UCC Vallis Longus. Em ambas as situações, existe grande proximidade com o utente durante a prestação de cuidados, com possível contacto com fluidos corporais (entre os quais gotículas respiratórias), o que complexifica a prestação segura de cuidados domiciliários em contexto de pandemia (5) .…”