ABSTRACT
Introduction The onset of the COVID-19 pandemic in early 2020 triggered reorganisation of hospital departments around the world as resources were configured to prioritise critical care. In spring 2020, NHS England issued national guidance proposing acceptable time intervals for postponing different types of surgical procedures for patients with cancer and other conditions. The 'Consider-19' study sought to investigate prioritisation decisions in practice, with in-depth examination of colorectal cancer surgery as a case-study, given recommendations that these procedures could be delayed by up to 12 weeks. Methods Twenty-seven semi-structured interviews were conducted with healthcare professionals between June - November 2020. A key informant sampling approach was used, followed by snowballing to achieve maximum regional variation across the UK. Data were analysed thematically using the constant comparison approach. Results Interviewees reported a spectrum of perceived disruption to colorectal cancer surgery services in the early phase of the pandemic, with some services reporting greater scarcity of resources than others. Nonetheless, all reported a need to prioritise patients based on local judgments. Prioritisation was framed by many as unfamiliar territory, requiring significant deliberation and emotional effort. Whilst national guidance provided a framework for prioritising, it was largely left to local teams to devise processes for prioritising within surgical specialities and then between different specialities, resulting in much local variation in practice. Discussion The pandemic necessitated a significant change in practice as surgeons, in a tense and uncertain situation, found themselves having to navigate clinically, emotionally, and ethically- charged decisions about how best to use limited surgical resources. Whilst unavoidable, many felt uncomfortable with the task and the consequences for their patients. The findings point to a need to better support surgeons tasked with prioritising patients and raise questions about who should be involved in this activity.
ABSTRACT
Background/Purpose: Candidates for endoscopic treatment for craniosynostosis must be less than 6 months old. Given the narrow window of eligibility for endoscopic therapy, there is significant potential for barriers to health care access to impact the type of surgery a patient receives. We hypothesized that COVID may further worsen these potential disparities. Therefore this study evaluates the impact of COVID on proportion of surgeries for craniosynostosis performed open vs endoscopically based on race and ethnicity as well as socioeconomic status. Methods/Description: Charts were reviewed for children with single suture craniosynostosis from January 2014- March 2020 (pre-COVID cohort) and March 2020- September 2021 (COVID cohort). Children with syndromic craniosynostosis, significant comorbidities, or who presented after age 3 years were excluded. 110 children were in the pre-COVID group;56 were treated open and 54 endoscopically. The mean age of presentation for the endo group was 1.86 months and 10.7 months for the open group;mean age of surgery for the endo group was 2.60 months and 13.4 months for the open group. Of the 47 patients in the COVID cohort, 26 were treated endoscopically and 21 were treated open. The average age of presentation for the endo group in the COVID cohort was 1.91 months and average age of the open group was 10.6 months. Mean age at time of surgery for endoscopy in the COVID cohort was 2.66 months;mean age at time of open surgery in the COVID cohort was 12.66 months. There was no significant difference in age of presentation or age of surgery across cohorts when considering type of surgery performed. Rate of endoscopy in the pre-COVID versus COVID cohorts was not significantly different with 49% of patients in the pre-COVID cohort treated endoscopically and 55% treated endoscopically during the COVID period (P= 0.49). In both the pre-COVID and COVID cohorts there were significant differences between age of presentation, age of surgery, and type of surgery received based on race- black and Hispanic patients presented later, had surgery later and underwent open surgery more frequently than their white/Asian counterparts (P= 0.0095, P=0.0067). With respect to insurance status, in the Pre-COVID cohort 68% of patients without insurance or with Medicaid underwent open surgery and 32.6% underwent endoscopic surgery. In those with private insurance, 40.3% underwent open surgery and 59.7% had endoscopic surgery (P= 0.0071). However, there was no difference in age of presentation or type of surgery based on insurance status during COVID. The pandemic did not alter age of presentation/ age of surgery or rates of patients receiving endoscopic surgery in patients with single suture craniosynostosis. There was no relationship between insurance status and type of surgery received during the pandemic, however Hispanic and black patients continued to present later and underwent surgery at an older age compared to their white/ Asian counterparts as they did pre pandemic.
ABSTRACT
Introduction: Breast Cancer Haven (BCH), a national UK breast cancer support charity, temporarily closed its five regional and two outreach centres following government advice regarding social distancing due to COVID-19 on 17th March 2020. To continue to support people with breast cancer, the charity has expanded its provision of telephone, and online individual and group therapy sessions via Zoom. The aim of the service evaluation was to explore the effect of the pandemic on the emotional and physical health/medical treatment of BCH users, and the use and helpfulness of telephone and online support services. Methods: A link to a short online survey was emailed out during 20th May to 4th June 2020 to 4,261 breast cancer survivors who were past or current BCH users. Frequency analyses of pooled responses to Yes/No questions were downloaded from the SurveyMonkey website. Individual free text responses were analysed by coding into common themes, clustered into categories. Results: A total of 382 people completed the survey (8.9% response rate). 76 (19.9%) stated that they had not needed to use the on-line support services and were removed from the analysis. Emotional health (71.4%) and to a lesser extent, physical health/medical treatment (54.1%) were perceived to be affected by the COVID-19 pandemic. 44.1% felt that BCH helped them cope now, and 84.4% wanted BCH to expand its online services in the following areas: one-to-one therapies e.g. counselling, group therapies e.g. yoga, pilates, support groups, classes/courses, advice and emotional support. Conclusions: BCH has accelerated its provision of phone and online support services to help to mitigate the effects of COVID-19 on the emotional and physical health of breast cancer survivors. Further development of these beneficial, cost-effective services is needed to expand their reach to a wider audience of people affected by breast cancer. Keywords: Online support;breast cancer survivors;COVID-19;survey