Palliative Care in Toronto During the COVID-19 Pandemic

Abstract

Coronavirus disease 2019 (COVID-19) first emerged in China in December 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Clinicians around the world looked to cities that first experienced major surges to inform their preparations to prevent and manage the impact the pandemic would bring to their patients and health care systems. Although this information provided insight into how COVID-19 could affect the Canadian palliative care system, it remained unclear what to expect. Toronto, the largest city in Canada, experienced its first known case of COVID-19 in January 2020, with the first peak in cases occurring in April and its second wave beginning this September. Despite warnings of increased clinical loads, as well as widespread shortages of staff, personal protection equipment, medications, and inpatient beds, the calls to action by international colleagues to support the palliative care needs of patients with COVID-19 were not realized in Toronto. This article explores the effects of the pandemic on Toronto's palliative care planning and reports of clinical load and capacity, beds, staffing and redeployment, and medication and PPE shortages. The Toronto palliative care experience illustrates the international need for strategies to ensure the integration of palliative care into COVID-19 management, and to optimize the use of palliative care systems during the pandemic. J

Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study

“…COVID-19 has a high mortality rate in patients requiring hospitalization, especially in older patients [ 1 , 2 , 3 ], prompting reflection on the need for palliative care in this population [ 3 ]. To date, studies have analyzed the support and involvement of the palliative medicine unit in end-of-life care in COVID-19 [ 4 , 5 ], the experience of palliative departments and hospital palliative care with these patients [ 6 , 7 , 8 ], the management of COVID-19 end-of-life care by clinicians who are not specialists in palliative care [ 9 ], and the changes that COVID-19 has brought about in the care of oncological and non-oncological palliative patients [ 10 , 11 , 12 ].…”

“…These symptoms, such as dyspnea or delirium can become distressing and even intolerable for patients. The use of palliative sedation prior to death in patients with COVID-19 has been described in small cohorts [ 9 , 13 , 14 ]. We were interested in analyzing the clinical–epidemiological characteristics of patients who died from COVID-19 in the medical ward during the first and second wave of infections and compare patients who received or did not receive palliative sedation.…”

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective

“…All healthcare workers, including palliative care workers, have faced severe challenges such as shortage of beds and staff, long working hours, and a lack of personal protective equipment [ 1 , 2 , 3 ]. The Toronto palliative care situation illustrates the need to integrate palliative care into COVID-19 management, and to optimize it for the pandemic [ 4 ].…”

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective

“…COVID-19 has laid bare the inadequacies of palliative care services with over 4 million deaths and 100 million confirmed cases; all health care workers, including palliative care workers, have faced severe challenges, such as shortage of beds, staff, long working hours, and lack of personal protective equipment (Hannon et al, 2021;Oluyase et al, 2021;Pastrana et al, 2021). The Toronto palliative care situation illustrates the need to integrate palliative care into COVID-19 management, and to optimize it for the pandemic (Wentlandt et al, 2021).…”