Self-awareness and self-care as a way to cope with suffering and death: A participatory action-research in palliative care

Aim: Palliative care is an emotionally and spiritually highly demanding setting of care. Research on how to train on self-awareness, self-care and inner life of the healthcare professionals, according to available resources and local context, is still needed. We examined the effects implied in a training on self-awareness structured as an action-research for a Hospital Palliative Care Unit. Methods: Action-research training experience for four physicians and two nurses in the setting of continuous medical education, based on qualitative data, comprehending self-assessments, field notes, group reflection sessions and satisfaction questionnaires. Thematic analysis of open-ended questions, researcher's field notes, oral and written feedback from trainers and participants on training outcomes and satisfaction questionnaires were used. Results: The training course resulted in: 1) ameliorative adjustments of the program;2) improved skills in self-awareness and sharing of perceived emotional and spiritual burden;practicing 'compassionate presence' with patients also in COVID Pandemic;shared language to address previously uncharted aspects of coping;3) giving continuity to the skills learned: the language learned is translated into daily clinical practices through specific facilitation;4) Staff Support Case for the emotional experience about the incoming year. Conclusion: Coping with death and awareness are important predictors of quality of life, being positively related to Compassion Satisfaction. The core of this work was to encourage a meta-perspective in which the trainees developed greater perspicacity about their professional role in the working alliance, also recognizing the contribution of their personal preoccupations to impasse experienced with patients. The learned lesson from training course during pandemic was that being aware of compassionate presence during the short visits to isolated COVID-19 patients restored dignity and humanity.

Perception of dignity in patients, family members and healthcare professionals during the covid-19 epidemic: A qualitative study based on the model of dignity in the terminally ill

Aim: The Model of Dignity in the terminally ill identifies three main dimensions around which patients can construct the perception of dignity: illness-related concerns, dignity-conserving repertoire and social dignity inventory. These domains subsume both physical, social and spiritual domains of suffering. During COVID-19, there were several obstacles in maintaining patient's dignity, i.e.: healthcare professionals (HCPs) wearing personal protective equipment;the nature of COVID-19 symptomatology;patient's isolation. We evaluated the dignity perception of patients who have experienced COVID-19, their families, and HCPs. Design: Qualitative, prospective study, conducted through semi-structured interviews including: 10 HCPs (5 doctors and 5 nurses) who have cared for patients with COVID-19, 10 patients who had COVID-19 and 10 of their family members. The interview explored: how patients and families cope with COVID-19 and their perception of dignity;and how HCPs perceived the patient's dignity and their families. A multi-disciplinary expert panel (one palliative doctor, one research doctor, one bioethicist and one psychologist) determined the scope of the interview, after reviewing the recent literature on the concept of dignity in the terminally ill patients. They conducted the interviews and thematic analysis of the transcribed verbatim. Content analysis was validated by two external researchers. Results: Preliminary data on HCPs show that: patient's dignity can be influenced by resources and organizational problems;accessibility of care (principle of equality);and difficult communication issues. Moreover, HCPs highlight the importance of 'seeing' the patient as a whole person and convey 'peace' to patients. Final results regarding patients and family members will also be presented during the congress. Conclusion: The results will highlight the strategies to improve the patients' care during the pandemic while preserving their dignity.

Do professionals' palliative care needs change during COVID-19 Pandemic? A longitudinal before/after qualitative study

Background: In Italy, Specialist Palliative Care Teams (SPCTs) have had an essential role during the COVID-19 Pandemic, most of all developing models of 'shared care' with non-specialist in Palliative Care. SPCTs contributed to physical symptom control and to psychological or spiritual support for patients, carers and health care professionals (HCPs), with a special focus on advance care planning. Our SPCT, during the first epidemic wave of COVID-19, developed and implemented an intensive experiential training program for all HCPs of the Infectious Disease Department supporting them in clinical, decisionmaking and communication fields. Aim of the study: This study aims to evaluate the changes of palliative care needs and patient management perceived by HCPs between the first (T1) and second wave (T2) of the COVID-19. Population and methods: The intensive experiential training was addressed to HCPs (forty physicians and nurses) involved in T1 of COVID- 19. The training included supervision of daily briefings, bedside consultations, brief lectures on palliative care topics (especially delirium and dyspnea), a booklet addressing the assessment and treatment of palliative care needs. This is a qualitative longitudinal study. Semi-structured interviews were performed after T1 and T2 of COVID-19 exploring the changing palliative care needs perceived and the solutions approached. The results of the interviews have been analyzed through thematic analysis to identify any possible changes in meanings attributed to that phenomenon from T1 to T2. Results: The interviews analyzed at T1 highlighted three main thematic areas:1.The professional's unpreparedness for this emergency;2.The request to the SPCT for support and training in clinical, decision-making and communication fields;3.The positive feedback by HCPs about the collaboration with SPCT. The results of the analysis of the interviews after T2 and the meaning shift between T1 and T2 will be presented during the Congress.

Learning a palliative care approach during the COVID-19 pandemic: A case study in an Infectious Diseases Unit.

BACKGROUND: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. AIM: The aim of the study was to describe a palliative care unit's consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. DESIGN: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. SETTING/PARTICIPANTS: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. RESULTS: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study.Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. CONCLUSION: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients' use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.