Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study)

Abstract

ObjectivesThe objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands.MethodsAn in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis.ResultsSeveral aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains.ConclusionThe palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.

Continuity of care for patients with de novo metastatic cancer during the COVID‐19 pandemic: A population‐based observational study

“…Findings from interviews with Dutch healthcare providers suggest that the COVID-19 pandemic negatively affected certain aspects of palliative care delivery, mainly in the emotional, spiritual and social domains. 29 However, evidence also suggests that the pandemic may be beneficial to palliative care, by raising awareness of the importance of advance care planning and focusing on individual patient needs and preferences. [29][30][31][32]…”

“…29 However, evidence also suggests that the pandemic may be beneficial to palliative care, by raising awareness of the importance of advance care planning and focusing on individual patient needs and preferences. [29][30][31][32]…”

“…Therefore, an understanding of the extent to which palliative and supportive care could be adequately provided to patients with metastatic cancer during the pandemic is necessary to more comprehensively assess the continuity and quality of care for these patients during the COVID‐19 pandemic. Findings from interviews with Dutch healthcare providers suggest that the COVID‐19 pandemic negatively affected certain aspects of palliative care delivery, mainly in the emotional, spiritual and social domains 29 . However, evidence also suggests that the pandemic may be beneficial to palliative care, by raising awareness of the importance of advance care planning and focusing on individual patient needs and preferences 29–32 …”

Challenges of using body bags for COVID-19 deaths from the healthcare provider perspective – a qualitative study

“…During the COVID-19 pandemic, many difficulties arose not only concerning patients and their families but also for healthcare professionals (HCPs) and facilities in providing end-of-life care for COVID-19 patients. 1–6 Infectious disease control measures led to visiting restrictions that caused separation between patients and families 7–12 limited care by HCPs, 12–14 communication difficulties between patients, their families and HCPs, 11 12 15 16 and patient isolation. 17–19 It has been suggested that the high workload for HCPs affected the quality of end-of-life care, prioritising urgent physical care over emotional, social and spiritual aspects.…”

“… 17–19 It has been suggested that the high workload for HCPs affected the quality of end-of-life care, prioritising urgent physical care over emotional, social and spiritual aspects. 12 …”