The Impact of COVID-19 Surge on Clinical Palliative Care: A Descriptive Study From a New York Hospital System

Moriyama, Derek; Scherer, Jennifer S.; Sullivan, Ryan; Lowy, Joseph; Berger, Jeffrey T.

doi:10.1016/j.jpainsymman.2020.12.011

Cited by 28 publications

(36 citation statements)

References 7 publications

(7 reference statements)

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“…Taken together, these results could indicate that the reasons for palliation differed between our cohort and the previous ones, with more patients in our study being placed under palliative care due to treatment failure rather than poor baseline functional status. Indeed, a report of palliative care service volume and patients’ characteristics during the COVID-19 pandemic in New York demonstrated that time for referral for palliation among COVID-19 patients was longer than for non-COVID-19 patients( 17 ). They also had longer hospital stay and were more frequently treated in intensive care units than COVID-19 negative patients, but unfortunately the authors do not disclose the reasons for palliative care in each group.…”

Section: Discussionmentioning

confidence: 99%

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Almeida

Avelino‐Silva

Silva³

et al. 2022

Journal of Pain and Symptom Management

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Background : As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. Aim : To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. Design : Retrospective cohort Setting/participants : Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. Results : We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age ≥80 years, dementia, history of stroke or cancer, frailty, having a PaO 2 /FiO 2 <200 or a C-reactive protein ≥150mg/dl at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. Conclusions : one in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.

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Section: Discussionmentioning

confidence: 99%

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Almeida

Avelino‐Silva

Silva³

et al. 2022

Journal of Pain and Symptom Management

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“…For example, 16.9% of MCCM-participating hospices are for-profit, compared to 69.5% of all Medicare-certified hospices. 11 We cannot differentiate which of our observations on hospice operations stemming from our analysis of survey themes are solely related to MCCM participation although we surmise that operational changes made by the hospice likely impacted all hospice staff and beneficiaries and not just the staff and beneficiaries participating in MCCM.…”

Section: Discussionmentioning

confidence: 88%

Early Impacts of COVID-19 on Select Hospices: Operations, Care Delivery, and Service Utilization

Shugarman

McMillan²,

Mitchell

et al. 2022

J Palliat Care

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Objective The COVID-19 public health emergency (PHE) has important implications for health care service delivery. Little is understood about how the PHE impacted community-based hospice providers and service delivery to hospice-eligible beneficiaries. The aim of this study was to describe hospice response to the PHE and correlated impacts on beneficiary receipt of hospice support services delivered to hospice-eligible beneficiaries participating in the Centers for Medicare & Medicaid Services (CMS) Medicare Care Choices Model (MCCM), a national model testing the provision of certain hospice-like supportive services with concurrent usual care among seriously ill, community-residing Medicare beneficiaries that have not elected to receive hospice care. Methods We employed descriptive analysis using concurrent qualitative and quantitative data sources, consisting of provider surveys, beneficiary-level encounter data submitted by hospices, and Medicare administrative claims describing beneficiary service utilization. The sample included both hospice providers (N = 82) and beneficiaries (N = 2294) voluntarily participating in MCCM. Results Nearly all participating MCCM hospices adopted operational changes to address their staff and beneficiaries’ safety during the COVID-19 PHE. We report changes to service delivery, including declines in total encounters as well as service modality, and the types of services provided. Conclusions While the analyses reported indicate that seriously ill Medicare beneficiaries participating in MCCM were directly impacted by the PHE, we are still unclear whether changes in the service modality and encounters by provider type and the decline in average service counts per beneficiary are driven more by hospices or by beneficiary decisions to minimize exposure. Future research should attempt to disentangle these factors.

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“… 78 Consultation of palliative care teams, when available, helped clarifying advance directives and minimize futile resuscitation efforts. 79 , 80 Some institutions registered an increase in palliative care consultations during COVID-19 outbreak 81 even though it is reported that palliative care consultations often happened late during hospitalization and in a minority of patients. 76 , 82 When a specialty palliative care team was not available strategies of integrative primary palliative care delivery were adopted by anesthesiologists trying to optimize patient’s comfort while minimizing staff exposure to infection.…”

Section: Palliative Care and Covid-19mentioning

confidence: 99%

Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives

Catalisano

Ippolito

Mariño

et al. 2021

JMDH

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Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.

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The Impact of COVID-19 Surge on Clinical Palliative Care: A Descriptive Study From a New York Hospital System

Cited by 28 publications

References 7 publications

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Early Impacts of COVID-19 on Select Hospices: Operations, Care Delivery, and Service Utilization

Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives

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