Palliative care interventions for people who use substances during communicable disease outbreaks: a scoping review

Objectives When resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question, € what is known about communicable disease outbreaks, palliative care and people who use substances?', such as palliative care interventions that can improve the quality of life of patients with life-limiting illnesses. Design We conducted a scoping review that involved comprehensive searches in six bibliographic databases from inception to April 2021 (Medline ALL (Medline and Epub Ahead of Print and In-Process and Other Non-Indexed Citations), Embase Classic+Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial, PsycInfo all from the OvidSP platform, Scopus from Elsevier) and grey literature searches. We included English and French records about people ≥18 years old with life-limiting illnesses who use substances during communicable disease outbreaks. We identified, summarised and presented the findings about palliative care interventions in figures, tables and narrative descriptions. Results We identified 32 records about palliative care interventions for people who use substances during communicable disease outbreaks. The majority focused on palliative care for people who use substances with AIDS during HIV epidemics (n=27, 84.4%), and approximately half were published in the USA (n=15, 46.9%). Most common substances used were alcohol (n=18, 56.3%), opioids (n=14, 43.8%) and cocaine (n=10, 31.3%). Four groups of palliative care interventions were identified: (1) symptom management (n=20, 62.5%), (2) psychosocial support (n=15, 46.9%), (3) advance care planning (n=8, 25.0%) and (4) healthcare provider training (n=6, 18.8%). Conclusions Beyond studies on HIV epidemics, there is limited knowledge about palliative care interventions for people who use substances during communicable disease outbreaks. Research and guidance are needed about how best to provide palliative care to this population with complex needs including in resource-limited countries. Protocol Buchman DZ, Ding P, Lo S, et al. Palliative care for people who use substances during communicable disease epidemics and pandemics. BMJ Open 2021;11: e053124

Palliative Care for People Who Use Substances During Communicable Disease Epidemics and Pandemics: A Scoping Review

Background/aims: Communicable disease epidemics and pandemics magnify the health inequities experienced by marginalized populations. Given the pre-existing inequities to palliative care access for people with life-limiting illnesses who use substances, it is important to understand the impact of communicable disease epidemics and pandemics COVID-19 on this population. A scoping review was conducted to answer the research question, “what is known about communicable disease epidemics and pandemics, palliative care and people who use substances?” Methods: We conducted a scoping review of seven bibliographic databases from the inception of each database to April 2021. We also performed a grey literature search to identify the publications not indexed in the bibliographic databases in August 2020 and June 2021. We extracted quantitative data using a standardized data extraction form and summarized it using descriptive statistics. Additionally, we conducted thematic qualitative analyses and presented our findings as narrative summaries. Results: Included in our review were 54 records published between 1988 and 2021, of which 18 (33.3%) were peer-reviewed articles. The majority of reported populations were people with advanced HIV (n = 39, 72.2%) who use alcohol (n = 25, 46.3%) during HIV (n = 40, 74.1%) and COVID-19 (n = 15, 27.8%) outbreaks. Palliative care outcomes were heterogeneous but fell into four themes: 1) intervention (e.g., symptom management), 2) access (e.g., financial barriers), 3) clinical program (e.g., interdisciplinary collaboration), and 4) policy/guideline (e.g., drug regulations). Conclusions: Strategies and interventions can be implemented during communicable disease outbreaks to promote equitable access to palliative care by people who use substances.

Why people living with mental illnesses should have been prioritized earlier for COVID-19 vaccines

Researchers and advocates have argued that people living with severe mental illnesses are a vulnerable group and should be prioritized for COVID-19 vaccines. People living with severe mental illnesses, including substance use disorders, bear an elevated burden of intersecting risk factors related to the social determinants of health and medical comorbidities leading to greater COVID-19 morbidity and mortality. This increased risk is based on several intersecting factors, including the likelihood of living in unstable and crowded living conditions such as shelters, group homes, or institutions;unsafe working conditions;high rate of comorbidities;and marginalization and stigmatization. Nonetheless, many of the initial iterations of vaccine allocation frameworks internationally did not prioritize people living with severe mental illnesses. Moreover, people with severe mental illness who are long-stay inpatients in psychiatric institutions were left off of vaccine priority setting lists that included long-term care facilities and other congregate settings. In this commentary, we question why people living with severe mental illnesses – particularly those who are institutionalized – were not initially considered a priority for vaccine access given the supposed vulnerability. We describe how people are made vulnerable by intersecting aspects of systematic disadvantage such as stigma, poverty, and racism. We suggest that the lack of attention given to intersectional factors in vaccine prioritization compromises health equity for people living with mental health and substance use disorders. We end the commentary by suggesting how vaccine distribution and allocation could be more equitable by including people with lived experience of mental illness in designing and implementing vaccination strategies. Understanding how people with mental illnesses have experienced structural vulnerability and intersecting risk factors throughout the pandemic can help inform the creation of effective and ethical vaccine-related responses to the COVID-19 pandemic. © 2021, University of Toronto. All rights reserved.