The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic

Abstract

Background: The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. Aim: To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. Design: Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. Data sources: Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. Results: Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to ‘systems’ (community providers feeling disadvantaged in terms of receiving timely information and protocols), ‘space’ (recognised need for more care in the community), ‘staff’ (training needs and resilience) and ‘stuff’ (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). Conclusions: As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.

Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

“…Of note, the availability of a stock of palliative medicines and corticoids did not allow monitoring the end-of-life scenario in the NH, whose adequate management is essential in this lethal disease and in some cases may alter outcomes. 31 …”

Home palliative care professionals perception of challenges during the Covid-19 outbreak: A qualitative study

“…The overload of healthcare facilities and the need to protect vulnerable patients from contracting the virus imposed important changes in the management and provision of palliative care services, bringing out many clinical and logistic issues. [5][6][7][8] Some studies considered the crucial role of palliative care in the management of the seriously infected people in the Covid-19 pandemic, 9,10 but few have investigated the impact of the emergency on palliative care services. 2,11 Palliative care workers faced an unprecedented scenario where communication and the human touch changed profoundly 12 and the increased number of discharges of patients from healthcare facilities as well as the reduced number of admissions in hospitals and hospices due to overcrowding and the risk of new coronavirus hotspots made the situation even more complicated.…”

Community end-of-life care during the COVID-19 pandemic: Initial findings of a UK primary care survey

“…There is a lack of previous research to inform practice, service delivery or policy (9, 16) despite the importance of the provision of high quality end-of-life care in a pandemic (17, 18). Respondents in this study perceive that their role in the pandemic response has received less focus than the response of hospital care (19, 20).…”

“…The STROBE checklist informed the study design (10). An online survey instrument was devised, informed by patient and public involvement, a literature review conducted by this research team (9), the CovPall study of palliative care services (11) and feedback from a study advisory group of clinicians and commissioners. The survey instrument was pre-tested by a group of 17 general practitioners (GPs) and community nurses.…”