The significance of the COVID-19 pandemic for family caregivers of non-COVID-19 patients in need of specialized palliative care at home: a qualitative study.

PURPOSE: It is well known that being a family caregiver of a palliative patient in general is rewarding as well as burdensome. The COVID-19 pandemic may have exacerbated this situation. We therefore explored the significance of the COVID-19 pandemic for family caregivers of non-COVID-19 patients in need of specialized palliative care at home. METHODS: Open-ended, semi-structured telephone interviews were conducted with 15 family caregivers of patients treated by a specialized palliative outpatient unit in a Danish hospital. Interviews were analysed using inductive thematic analysis. RESULTS: Four themes concerning the significance of the COVID-19 pandemic were identified: 1) being a family caregiver of a patient whose lifespan is already limited, 2) dealing with the risk of passing on COVID-19 oneself, 3) dealing with the risk of others passing on COVID-19 to the patient at home, and 4) living with modified specialized palliative care. CONCLUSION: The COVID-19 pandemic had a radical impact on some family caregivers causing emotional despair. They feared not only infecting the patient with SARS-CoV-2 to cause an untimely death but also being unable to be there for the patient during hospitalization, especially in the patient's final days.

Pride and Uncertainty: A Qualitative Study of Danish Nursing Staff in Temporary COVID-19 Wards.

There is limited knowledge about the psychosocial stress among the nursing staff working on the COVID-19 wards. This article reports on the experiences of frontline health care workers as it was described to supervisors counseling the nursing staff engaged in the response to the outbreak of COVID-19. Frontline health care workers, nurses, and nurses' aides experienced major work changes. Some were transferred to the newly formed COVID-19 wards in a large Danish hospital, were given new tasks, and had to collaborate with new colleagues, while treating a new deadly and contagious disease. This study aimed to describe the reflections and experiences of the nursing staff attending supervision sessions. The palliative unit offered supervision from April 2020. A total of 9 supervision sessions were held as part of this study, and 57 nursing staff members participated in the sessions. The supervision was available to employees until the first COVID wave subsided in June 2020. During each session, supervisors took field notes and wrote field memos. The topics raised by the nursing staff during the supervision sessions ranged between pride and uncertainty. Nursing staff in COVID-19 wards were at risk of feeling an increasing burden, and there was a need for ongoing managerial attention as well as continuous visible presence and support.

COVID-19: guidance on palliative care from a European Respiratory Society international task force.

BACKGROUND: Many people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process. METHODS: We invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted. RESULTS: 68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation. CONCLUSION: This multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.