Working Upstream in Advance Care Planning in Pandemic Palliative Care

Abstract

T he coronavirus disease 2019 (COVID-19) pandemic has highlighted the central importance of palliative care to our increasingly strained healthcare system. Palliative care is specialized care for people struggling with serious illnesses. Its aim is to improve the patient's quality of life by providing expert-level symptom management and skilled communication and by supporting caregivers to ensure patients and their families receive goal-concordant care. 1 Faced with a reality that patients with frailty and serious illness are the most vulnerable to critical illness and death, early inquiries into patient and family wishes were essential to avoid preventable suffering. To prevent spread

Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19

“…The authors of the papers within this category also suggested the necessity of innovations in ACP, including, again, the use of telehealth to facilitate discussions [ 126 , 127 , 128 , 130 , 145 , 146 , 147 , 148 ], and temporary policy changes or innovations to ease the completion and accessibility of ACP documents [ 135 , 138 , 145 , 146 , 147 , 148 ]. However, the urgency of the situation also highlighted the potential for misunderstandings and mistrust [ 125 , 137 ], suggesting the importance of clear, empathetic communication and ongoing dialogue [ 133 , 141 , 149 ].…”

“…There were recommendations that ACP discussions during the pandemic should encompass preferences concerning COVID-19 treatment options, ventilator use, and hospitalization [ 132 , 133 , 135 , 144 , 149 ]. The pandemic has prompted a reevaluation of ACP processes, encouraging a more nuanced approach that considers individual relationships, cultural, and religious aspects, within the evolving nature of the healthcare crisis [ 136 , 137 , 140 , 141 , 148 ].…”

“…The COVID-19 disease itself presented a number of barriers to ACP. The novel and unpredictable nature of COVID-19 made prognostication challenging, complicating ACP discussions [ 98 , 124 , 125 , 128 , 149 ]. Uncertainty about the disease’s progression, outcomes, and long-term effects made it difficult for both patients and healthcare providers to make informed decisions about future care preferences.…”

“…Resources for physicians included websites for palliative care/ACP information, visual aids, video materials, telephone call-center support, ACP tip sheets, etc. Among the most important resources for clinicians, identified as a ACP facilitators, were guidance and protocols for ACP discussions [ 139 , 141 , 144 , 146 , 147 , 148 , 149 ], including established guides such as Vital Talk [ 139 , 148 ] and COVID-19-specific goals-of-care discussion guides [ 94 , 112 ]. The development of specific guidance and protocols for ACP during the pandemic provided clinicians with clear frameworks to help ensure that ACP discussions are consistent, comprehensive, and adapted to the COVID-19 context.…”