Systems Barriers to Assessment and Treatment of COVID-19 Positive Patients at the End of Life

Abstract

The Novel Coronavirus SARS-CoV-2 (COVID-19) pandemic is changing how we deliver expert palliative care. We can expect many to die prematurely secondary to COVID-19 across the United States. We present a case of how several hospital systems-based interventions, intended to slow viral spread and to protect health care workers, have inadvertently created barriers to routine palliative interventions in this patient population. Isolation of patients, limitation of visitors and interdisciplinary support, and changes in nursing and provider assessment have all had their impact on how we deliver palliative care. These barriers have altered many aspects of our established workflow and algorithms for care, including changes in communication, goals of care discussions, how providers and nurses are monitoring for symptoms, and end-of-life monitoring. These challenges required real-time solutions such as technology utilization, proposing a change in medical delivery systems, and reducing redundancy to preserve personal protective equipment. To continue to deliver quality care for this patient population, palliative medicine must adapt quickly.We present a case that illustrates how safety precautions implemented for COVID-19 have created unique barriers to assessing and treating symptoms in this patient population at the end of life and changes made within our system to overcome these barriers.

Opportunities to improve COVID-19 provider communication resources: A systematic review

“…Physicians in Switzerland interacted with elderly patients with hearing aids who had difficulty understanding masked voices [ 93 ]. A second communication barrier during the COVID-19 pandemic is that patients are anxious and fearful because they are left alone to face illness and their family cannot be physically present [ 52 , 53 , 58 , 64 , 73 , 77 , 79 , 82 , 83 , 85 , 88 , 89 ]. For example, COVID-19 patients with a diagnosis of end stage renal failure were challenged to make dialysis decisions without their family members present to help comprehend language and provide emotional support [ 79 ].…”

Palliative care delivery in cancer patients in the era of Covid-19 outbreak: Unique needs, barriers, and tools for solutions

“…The difficulty in monitoring the patient during EOLC can be mitigated with acquiring telemetry beds. [ 80 81 ] It may decrease the requirement of multiple visits by health workers and consumption of PPE. [ 80 ] The decision for initiation of EOLC has to be in consensus with primary oncologists treating the patient and family members.…”

“…[ 80 81 ] It may decrease the requirement of multiple visits by health workers and consumption of PPE. [ 80 ] The decision for initiation of EOLC has to be in consensus with primary oncologists treating the patient and family members. Family members can be contacted via telecommunication for this purpose if the patient is in isolation due to infection.…”

Impact of Covid-19 in the field of oncology

“…Estos retos han requerido soluciones en tiempo real como la implementación de la tecnología, cambios en la prestación de la asistencia sanitaria y evitar la redundancia para proteger también a los profesionales sanitarios. Por ejemplo, los equipos de Cuidados Paliativos han tenido que adaptarse rápidamente para poder continuar prestando atención sanitaria al colectivo de pacientes en situación de últimos días (50).…”