The Prevalence of Palliative Care Consultation in Deceased COVID-19 Patients and Its Association with End-of-Life Care

Abstract

Background: During the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, COVID-19 hospitalization was associated with high mortality. It is unknown how palliative care was utilized in this context. Objectives: To describe the frequency of palliative care consultation and its association with end-of-life care for deceased patients with COVID-19. Methods: Adults who were admitted to our institution between February 23, 2020, and April 21, 2020, and died from COVID-19 were included. The primary outcome was the frequency of palliative care consultation. Secondary analyses included the association of palliative care consultation with code status at the time of death, life-sustaining treatments, mechanical ventilation, invasive procedures, intensive care unit (ICU) admissions, and length of hospital stay. Results: The 203 patients were 61% male with median age 76 (interquartile range [IQR] 67-84) years. Palliative care was consulted for 113 patients (56%). At baseline, they were less independent in instrumental activities of daily living (28 patients, 26.1%, vs. 47 patients, 49.0%, p < 0.01) and had more do-not-resuscitate orders (35 patients, 32.7%, vs. 11 patients, 11.5%, p < 0.01). Palliative care consultation was associated with fewer invasive procedures (0, IQR 0-2, vs. 2, IQR 0-3, p < 0.01), less mechanical ventilation (32 patients, 29.9% vs. 65 patients, 67.7%, p < 0.01), and fewer ICU admissions (33 patients, 30.8% vs. 69 patients, 71.9%, p < 0.01). Palliative care was associated with shorter ICU stays (0 days, IQR 0-4, vs. 4 days, IQR 0-12, p < 0.01), whereas hospital stays did not differ significantly (8 days, IQR 5-12.5, vs. 10 days, IQR 5-16.3, p = 0.15). Conclusion: Palliative care was consulted for roughly half of deceased patients with COVID-19 and those patients were less likely to undergo invasive procedures or life-sustaining treatments and spent less time in the ICU at the end of life.

Specialized palliative care for hospitalized patients with SARS-CoV-2 infection: an analysis of the LEOSS registry

“…A previous study looking at critically ill patients in intensive care units has shown a similar proportion of SPC involvement [ 21 ], but our data are in contrast to previous data from hospitalized patients that reported a much higher proportion. For example, Golob et al reported palliative care consultations in New York in 56% of 203 patients who died from COVID-19 [ 22 ]. Among the many challenges to provide SPC during the pandemic is the acute care setting, in which the time from acknowledging the need for palliative care to death is shorter than before the pandemic [ 5 , 13 ].…”

The clinical practice of palliative sedation in patients dying from COVID-19: a retrospective chart review

“…In our study we also investigated the involvement of palliative care teams (PCT). Involvement of a PCT is considered important to improve the quality of care [ 9 ]. Especially when palliative care, of e.g.…”

Specialist Palliative Care Consultations in COVID-19 Patients in the ICU—A Retrospective Analysis of Patient Characteristics and Symptoms at a German University Hospital

“…Another retrospective analysis of hospitalized COVID-19 patients showed sPC involvement in 17% of all and 48% of the deceased patients [ 31 ]. Golob and colleagues investigated the prevalence and association of sPC with end-of-life care in deceased COVID-19 patients from February until April 2020 [ 32 ]. Of the total 203 patients (61% male, median age 76 years), 56% received sPC and were thereby less likely to undergo invasive procedures or life-sustaining treatments and spent less time in the ICU at the end of life [ 32 ].…”

“…Golob and colleagues investigated the prevalence and association of sPC with end-of-life care in deceased COVID-19 patients from February until April 2020 [ 32 ]. Of the total 203 patients (61% male, median age 76 years), 56% received sPC and were thereby less likely to undergo invasive procedures or life-sustaining treatments and spent less time in the ICU at the end of life [ 32 ]. However, other studies revealed higher rates of life-sustaining treatments in patients with sPC [ 33 , 34 ].…”