ABSTRACT
Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
ABSTRACT
Background: Professionals in specialist palliative home care face the challenge to adapt their working methods to the framework conditions required by the Covid-19 pandemic. Namely the stricter regulations in terms of hygiene and the restrictions on contact and visitation possibilities influence their central field of activity. Aim: In order to improve the preparation of specialist palliative home care with regard to coming pandemics, the following questions are of central interest: •What effect does the Covid-19 pandemic have on the care for critically ill and dying patients from a 'specialist palliative home care'-point-of-view? •Which solution approaches were developed? Methods: With the help of a newly developed online questionnaire based on the based on the results of focus groups, a Germany-wide recruitment of specialist palliative home care teams was carried out. The online survey was conducted between Oct. 2020 and Jan. 2021. IBM SPSS 26.0 software is used to analyse the data collected Results: 154 teams took part in this online survey. This represents a response rate of 43%. 55.4% of the teams have cared for patients infected with SARS-CoV-2. 41% reported an increase in number of patients, 43.2% state that their everyday work changed. One example is the increase in telephone consultations. Nevertheless, 62% of the teams report that they have been able to provide patient care and symptom management as well as usual. One possible solution mentioned was the establishment of home office. Conclusion: The work of professionals in specialist palliative home care is affected strongly by the Covid-19 pandemic. The systematic recording of their experiences can have a positive impact on the care for critically ill and dying patients in times of a pandemic.