ABSTRACT
Background: How COVID-19 has impacted end-of-life care in the Netherlands may differ between the first and second wave, as for instance in the second wave visiting restrictions were less strict. We can learn from data of the two waves of this pandemic and the impact on end-of-life care for future waves or other pandemics. Aim: To describe to what extent end-of-life care was limited due to the COVID-19 pandemic according to healthcare professionals in different settings during the first and second wave of the pandemic in the Netherlands. Methods: An open online survey between November 2020 and February 2021 among health care professionals who provided end-of-life care during the first and second wave of the COVID-19 pandemic in the Netherlands (between March 2020 and February 2021). We tested differences between healthcare settings and waves using confidence intervals. Results: 255 healthcare professionals (42 physicians, 199 nurses, 66 other healthcare workers) from different settings. In all settings, psychosocial care and spiritual care were more often limited compared to nursing care and medical care in both waves. For all aspects, except medical care, care was most often limited in nursing homes and hospitals, in both waves. Overall, more than half of the healthcare workers said that psychosocial care (57%), spiritual care (55%) and preparing patients and relatives for death (53%) were limited during the first wave. With resp. 31%, 30% and 22% these percentages were lower in the second wave. Discussion: Especially psychosocial and spiritual care were limited, possibly due to a focus on preventing infections with measures such as physical distance and visiting restrictions. Since psychosocial and spiritual aspects are essential for good end-of-life care, it is important to weigh pros and cons of preventing infections and limiting psychosocial and spiritual care. This seems to have been done better in the second wave.
ABSTRACT
Background: The COVID-19 pandemic and restricting measures may have affected end-of life care, including experiences of relatives who lost a loved one. Aims: To describe experiences of bereaved relatives with end-of-life care for a loved one who died at home, in a hospital, nursing home or hospice during the pandemic, and to examine how restricting measures influenced their evaluation of care. Methods: Bereaved relatives completed an open observational online questionnaire about their evaluation of end-of-life care as provided to a loved one who died between March and July 2020. Results: The questionnaire was filled out by 393 bereaved relatives whose loved ones died at home (n=68), in a hospital (n=114), nursing home (n=176) or hospice (n=35). Patients who had died were more often men (49% vs 47%), aged 75 years or older (72%), and had COVID- 19 (57%). Patients who died in a hospital more often had COVID-19 (76%) than patients in nursing homes (62%), hospices (43%) or at home (18%). Bereaved relatives were mostly women (81%), aged 45 years or older (82%), and a child (55%) of the patient. Bereaved relatives of patients who died in a hospital most often evaluated medical (79%), nursing (75%) and personal care (72%) as sufficient, whereas medical (55%) and personal care (62%) in nursing homes and nursing care at home (66%) were least often evaluated as sufficient. Hospitals, nursing homes and hospices had implemented visiting restrictions in the majority of cases (76%, 90%, 71%, respectively). These restrictions were negatively associated with bereaved relatives' evaluation of medical and personal care in nursing homes, and medical care in hospitals. Conclusion: End-of-life care during the COVID-19 pandemic was evaluated most favourably in hospitals and least favourably in nursing homes. Our study suggests that visiting restrictions had a major impact, especially in nursing homes.