ABSTRACT
Background: During the SARS-CoV-2 pandemic all health care systems faced enormous challenges. Due to increased severity of illness, palliative care patients continued to require comprehensive care. In order to provide general palliative care during a pandemic, experiences of staff should be utilized. Aim: Description and analysis of experiences, challenges and potential solutions of multiprofessional hospital staff in general palliative care with regard to care of severely ill and dying patients (with/without SARSCoV- 2) and their relatives. Method: After ethical approval qualitative semi-structured online focus groups were conducted. Individual interviews were also used when necessary. The results were recorded, transcribed, and analysed with the qualitative content analysis by Kuckartz. Results: Five focus groups having four to eight participants and one additional individual interview were conducted. The participants either work in intensive care, isolation wards or with patients being exceedingly burdened (e.g. dementia). Fifteen main categories with two to eight subcategories were formed. Patients, relatives and staff as well as visitation regulations and farewell were elaborated as most important main categories. Subcategories are for example insecurity, strain and reprocessing or with regards to visitation: restraints, guidelines or exceptions. The biggest challenge addressed by all interviewees were visitations as the restrictions caused a lot of suffering for everyone involved. Discussion: Current general precautions and general palliative care are insufficiently meeting the needs of severely ill and dying patients. Their needs are still existing throughout the pandemic and should be addressed accordingly. Interprofessional and -disciplinary cooperation is a precondition for individualised care of seriously ill patients and their relatives. Measures preventing infections (e.g. concepts) should be transparently communicated in hospitals. Funding: BMBF.
ABSTRACT
Background: The SARS-CoV-2 pandemic challenged interdisciplinary cooperation between hospital staff and specialized palliative care (SPC) by facing sudden restrictions, yet dying patients still required comprehensive palliative care. Aim: Examination of interdisciplinary cooperation from the point of generalist palliative care between hospital staff and SPC during the SARS-CoV-2 pandemic in German hospitals as a part of a multicenter project (PallPan). Method: A 43-Items-questionnaire was developed based on literature and semi-structured qualitative interviews concerning the first pandemic phase and was sent to hospital staff via the online platform UniPark (n=10.357). Excluded were inhospital specialized palliative care. Interviewees were able to answer the questions beginning from 01/12/20 until 20/01/21. The data was analyzed via SPSS and descriptive statistics and cross tables were done. Results: In total 550 hospital staff did answer the questionnaire and after exclusion of SPC-respondents 530 questionnaires were analyzed. While 32.4% (n=159) did not have the possibility to include SPC into the care process, 74.1% (n=215) did often incorporate SPC in their daily work. There was a significant discrepancy for SPC-co-management regarding Covid-19 positive (46.6%, n=152) and Covid-19 negative patients (69.9%, n=228, p= < .001). Most hospital staff considered additional support by SPC as helpful (83.1%, n=368). This contains mainly easily accessible information (69.0%, n=254) and training in palliative care (63.9%, n=235). Discussion: Inhospital SPC was present in the pandemic, yet there is space for improvement. The discrepancy concerning SPC-co-management at the patients' bed is one major issue that needs to be addressed. In order for a comprehensive care SPC should provide training and easily accessible information to generalist palliative care during and outside a pandemic.
ABSTRACT
BACKGROUND: The German healthcare system is facing unprecedented challenges due to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic. Palliative care for critically ill patients and their families was also severely compromised, especially during the first wave of the pandemic, in both inpatient and outpatient settings. MATERIALS AND METHODS: The paper is based on our experience in routine inpatient palliative care and partial results of a study conducted as part of the collaborative project "National Strategy for Palliative Care in Pandemic Times (PallPan)". Based on our experience from the inpatient care of patients suffering from severe or life-limiting disease, best-practice examples for improving or maintaining care in the on-going pandemic are described. RESULTS: Restrictive visitor regulations, communication barriers and insufficient possibilities to accompany dying patients or their grieving relatives continue to pose major challenges in general and specialized inpatient palliative care. In order to maintain high-quality palliative care, it is necessary to create structures that enable targeted therapy discussions and end-of-life care in the presence of relatives. Therefore, innovative communication methods like video calls or individualized exceptions from visitor restrictions are needed. CONCLUSIONS: Adequate care for seriously ill and dying patients and their relatives must be guaranteed during the pandemic. Individual arrangements should be arranged and implemented. If available, earlier involvement of specialized palliative care teams can be beneficial.