Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU

Schoenherr, Laura; Cook, Albert S.; Peck, Sarah; Humphreys, Jessi; Goto, Yuika; Saks, Naomi Tzril; Huddleston, Lindsey; Elia, Giovanni; Pantilat, Steven Z.

doi:10.1016/j.jpainsymman.2020.06.008

Cited by 18 publications

(13 citation statements)

References 8 publications

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“…19 Specialist palliative care teams play an essential role in the care of patients with COVID-19 infection. [20][21][22][23] Specific palliative care team actions can include symptom management, assistance with complex medical decision making, and patient/family support including spiritual, psychological, and bereavement care. 24,25 The need for these actions is particularly evident when patients are critically ill and require advanced medical technologies such as ECMO, arguing for the involvement of palliative care in these situations.…”

Section: Introductionmentioning

confidence: 99%

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Rao

Zaaqoq

Kang

et al. 2021

Am J Hosp Palliat Care

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Background: Critically ill patients with COVID-19 infection on extracorporeal membrane oxygenation (ECMO) face high morbidity and mortality. Palliative care consultation may benefit these patients and their families. Prior to the pandemic, our institution implemented a policy of automatic palliative care consultation for all patients on ECMO due to the high mortality, medical complexity, and psychosocial distress associated with these cases. Objectives: The main objective was to describe the role of the palliative care team for patients on ECMO for COVID-19 infection. The secondary objective was to describe the clinical outcomes for this cohort. Design: Case series. Settings/Subjects: All patients age 18 or older infected by the novel coronavirus who required cannulation on ECMO from March through July of 2020, at an urban, academic medical center in the United States. Inter-disciplinary palliative care consultation occurred for all patients. Results: Twenty-three patients (median age 43 years [range 28-64], mean body mass index 34.9 kg/m2 [SD 9.2], 65% Hispanic ethnicity) were cannulated on ECMO. Eleven patients died during the hospitalization (48%). Patients older than 50 years of age demonstrated a trend toward increased odds of death compared to those younger than 50 years of age (OR 9.1, P = 0.07). Patients received an average of 6.8 (SD 3.7) palliative clinical encounters across all disciplines. The actions provided by the palliative care team included psychosocial support and counseling, determination of surrogate decision maker (for 100% of patients), pain management (83%), and non-pain symptom management (83%). Conclusions: Here, we present one of the first studies describing the patient characteristics, outcomes, and palliative care actions for critically ill patients with COVID-19 on ECMO. Almost half of the patients in this cohort died during their hospitalization. Given the high morbidity and mortality of this condition, we recommend involvement of palliative care for patients/families with COVID-19 infection who are on ECMO. The impact of palliative care on patient and family outcomes, such as symptom control, satisfaction with communication, rates of anxiety, and grief experience merits further investigation.

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Section: Introductionmentioning

confidence: 99%

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Rao

Zaaqoq

Kang

et al. 2021

Am J Hosp Palliat Care

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“…6 This research has also highlighted the overall utilisation of palliative care services in patients admitted to the hospital with COVID-19, 7 along with proactive strategies applied in ICU settings to quickly identify patients with palliative care needs. 8 The objective of this study was to examine the utilisation rates of palliative care consultation in critically ill patients with COVID-19 pneumonia admitted to two ICUs in New York City.…”

Section: Introductionmentioning

confidence: 99%

Palliative care in critically ill COVID-19 patients: the early New York City experience

Sheehan

Poon

et al. 2020

BMJ Support Palliat Care

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ObjectivesThe COVID-19 pandemic in the USA has been accompanied by high rates of mortality and an unprecedented need for palliative care delivery. Little is known about the use of palliative care services in intensive care unit (ICU) settings during the COVID-19 pandemic.MethodsThis is a retrospective cohort study of critically ill COVID-19 patients requiring ICU admission, between 7 March and 14 April 2020 to two academic teaching hospitals in New York City. Palliative care consultation included a one-time telemedicine consultation or continued telemedicine consultation and follow-up with multidisciplinary team involvement. Patient information was collected from the electronic health record and analyses were conducted with Stata V.15.1 (StataCorp) statistical software.ResultsA total of 151 critically ill patients with COVID-19 pneumonia requiring ICU admission were identified, of whom 59 (39.07%) received an inpatient palliative care consultation. More than half of patients died (n=85/151, 56.29%), with 57.65% (n=49/85) of these patients receiving palliative care services during their hospitalisation. Patients who received palliative care consultation were more likely to be older, sicker and receive mechanical ventilation than their counterparts. Patients who died and did not receive palliative care were younger and required non-invasive ventilation support.ConclusionThere is a lack of utilisation of palliative care in COVID-19 patients admitted to the ICU. Further research into predictors of poor outcomes in critically ill COVID-19 patients may help identify patients that would benefit from early palliative care involvement going forward.

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“…Here, the early involvement of specialized palliative care or ethical expertise can reduce the risk of overtherapy at the end of life [ 30 ]. This also applies to emergency departments or intensive care units, not least by providing support for Advance Care Planning (ACP) and initiating regular discussions of therapeutic goals [ 31 , 32 ]. Here, too, it is advisable to involve nurses proactively in decision-making, because of their closer contact to the patients [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Inpatient generalist palliative care during the SARS-CoV-2 pandemic – experiences, challenges and potential solutions from the perspective of health care workers

et al. 2022

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Background The SARS-CoV-2 pandemic has presented major challenges to the health system. Despite high acute case numbers, patients without Covid-19 still need to be cared for. Due to the severity of the disease and a possible stressful overall situation, patients with palliative care needs also require comprehensive care during pandemic times. In addition to specialized palliative care facilities, this also takes place in non palliative care wards. In order to ensure this general palliative care also in pandemic times, the experience of the staff should be used. The aim of this paper is to examine challenges and possible solutions for general palliative care inpatients in relation to the care of seriously ill and dying patients and their relatives. Methods Qualitative semi-structured focus groups were conducted online for the study. Participants were staff from intensive care or isolation wards or from units where vulnerable patients (e.g. with cognitive impairment) are cared for. The focus groups were recorded and subsequently transcribed. The data material was analysed with the content structuring content analysis according to Kuckartz. Results Five focus groups with four to eight health care professionals with various backgrounds were conducted. Fifteen main categories with two to eight subcategories were identified. Based on frequency and the importance expressed by the focus groups, six categories were extracted as central aspects: visiting regulations, communication with relatives, hygiene measures, cooperation, determination of the patients will and the possibility to say good bye. Conclusion The pandemic situation produced several challenges needing specific solutions in order to manage the care of seriously ill and dying patients. Especially visiting needs regulation to prevent social isolation and dying alone. Finding alternative communication ways as well as interprofessional and interdisciplinary cooperation is a precondition for individualised care of seriously ill and dying patients and their relatives. Measures preventing infections should be transparently communicated in hospitals.

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Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU

Cited by 18 publications

References 8 publications

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Palliative care in critically ill COVID-19 patients: the early New York City experience

Inpatient generalist palliative care during the SARS-CoV-2 pandemic – experiences, challenges and potential solutions from the perspective of health care workers

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