We Will All Be Changed: Palliative Care Transformation in the Time of COVID-19

Changes in Communicating Bad News in the Context of COVID-19: Adaptations to the SPIKES Protocol in the Context of Telemedicine

“…How to provide information safely if the knowledge produced so far is scarce? (6,10). So in the step "S" (Setting Up), in the context of the pandemic, we advise that:…”

“…This factor also affects not only step "S" (Strategy and Summary), but also the "S" (Setting Up) and "P" (Perception) (6). This fact rests on two prerogatives: (I) the work overload due to the exhaustive routines of the care units for COVID-19 and (II) the lack of training in palliative care, which is usually reflected in some professional discourse rich in automatic, impersonal and technical information (10). Therefore, the COVID-19 pandemic has led to growing concerns not only about limited medical and hospital resources (e.g.,: ventilators, medications, gauze, and intensive care beds), but concern about the professionals' interpersonal limitations (20).…”

“…Thus, the implementation of telemedicine can be a facilitating agent in these meetings with inpatients (19). However, the lack of skills and attitudes about the use of technologies and social media (6,10) in a stressful environment such as the COVID-19 units can also be a factor that impairs care. Therefore, at this step, two elements must be taken into account: a. Summarize the information given, preferably repeating it in the same way as it was presented (13-16); b.…”

“…How do you bond with people you don't know without being there? Therefore, health teams have been adapting and incorporating the use of social media in practice making the implementation of protocols such as SPIKES challenging (3,6,9,10).…”

Perceptions of Palliative Care Program Viability During the Pandemic: Qualitative Results From a National Survey

“…During the pandemic, US palliative care teams have provided direct care to patients with COVID-19, support for caregivers and families, and guidance to other clinicians in communication skills, symptom management, and coping with loss. 1 - 4 During the pandemic surges, the influx of critically ill patients with COVID-19 created a significant demand for palliative care services, which were temporarily addressed., 5 - 7 However, it is difficult to envision how even well-supported palliative care programs can remain viable with a continuous demand for services. 8 …”