Meaning-making following loss among bereaved spouses during the COVID-19 pandemic (the CO-LIVE study).

This study investigates how individuals construe, understand, and make sense of experiences during the first wave of the COVID-19 pandemic. Seventeen semi-structured interviews were conducted with bereaved spouses focusing on meaning attribution to the death of their partner. The interviewees were lacking adequate information, personalized care, and physical or emotional proximity; these challenges complicated their experience of a meaningful death of their partner. Concomitantly, many interviewees appreciated the exchange of experiences with others and any last moments together with their partner. Bereaved spouses actively sought valuable moments, during and after bereavement, that contributed to the perceived meaning.

Signs of Distress Among Dutch Healthcare Professionals Who Provided End-Of-Life Care During the COVID-19 Pandemic: A Longitudinal Online Survey (the CO-LIVE Study)

Background/aims: Providing end-of-life care during the COVID-19 pandemic often involved high workload under unusual circumstances. Aim: To describe the well-being of healthcare professionals who provided end-of-life care in the first year of the COVID-19 pandemic. Methods: A longitudinal online survey filled in multiple times by the same 169 healthcare professionals from different professions (57% nurses, 12% physicians, 31% other) and settings (26% hospital, 15% nursing home, 22% hospice, 18% home, 19% other), who provided end-of-life care during the COVID-19 pandemic. They responded to five statements about their well-being in three different time periods: during the first wave (Mar 2020 - May 2020), second wave (Sept 2020 - Nov 2020) and a third period (Dec 2020 - Apr 2021) of the COVID-19 pandemic. Differences between these time periods were assessed using confidence intervals. Results: During the first wave, second wave and third period: 64%, 36% and 39% of respondents reported that they were more stressed than usual 50%, 31% and 35% stated that their work was emotionally demanding 37%, 23% and 30% stated that their work was physically demanding 47%, 38% and 42% stated that they felt exhausted regularly 47%, 26% and 29% stated that they needed more emotional support than usual. For every statement, except the one on exhaustion, the decrease in percentage of respondents agreeing with the statement between the first and second wave was significant. The percentages were slightly higher again in the third period, although not significant. Conclusions: During the first year of the COVID-19 pandemic, a substantial part of healthcare professionals showed signs of distress. That means that the well-being of healthcare professionals is at stake. It is important to study how this further develops and what healthcare professionals' needs are to endure and recover from these challenging times.

Grief After the First Wave of the Corona Pandemic: An Online Survey Among Dutch Bereaved Relatives of Patients Who Died With and Without COVID-19 (the CO-LIVE Study)

Background/aims: The circumstances under which patients died during the first wave of the COVID-19 pandemic, such as visiting restrictions, can affect the grieving process of bereaved relatives. The aim of this study was to examine how characteristics of bereaved relatives, their evaluation of the dying process, and being allowed to be with the patient in the last days of life are related to their grieving process. Methods: We conducted an open observational online survey (Nov 2020-Apr 2021) among 258 bereaved relatives to study their experience of end-of-life care for a loved one who had died during the first wave (Mar 2020-Jun 2020) of the COVID-19 pandemic. Grief was measured with the Hogan despair subscale (scores between 13 and 65), with higher scores indicating more despair. Data were analysed using descriptive statistics and multivariate analyses. Results: Most respondents were female (82%) and were children (63%) or partners (22%) of the deceased patients. The overall mean despair score was 24.6. Partners had a significantly higher mean despair score than children (33.6 vs 22.9). Terms which relatives most often selected to describe the dying process of the patient were: sad (63%), quiet (43%), painful (30%), shocking (27%) and degrading (26%). Relatives who described the dying process in more negative terms had worse mean despair scores than those who used more positive terms. Sixty percent of the relatives had not been allowed to be with the patient at the time of dying. They had higher mean despair scores (25.1) than relatives who had been allowed to be present (23.8). Conclusions: The findings indicate that the circumstances in which patients died are related to the extent of relatives' grief. These findings underline the importance of striving for a good death in the physical presence of relatives during a pandemic. Supporting relatives is important to prevent complex grief, recognising the vulnerability of especially bereaved partners.

Was End-of-life care limited during the first and second wave of the COVID-19 Pandemic? An online survey among healthcare professionals working in different settings. (Co-Live)

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.