Responding to Palliative Care Training Needs in the Coronavirus Disease 2019 Era: The Context and Process of Developing and Disseminating Training Resources and Guidance for Low- and Middle-Income Countries from Kerala, South India.

BACKGROUND: Palliative care has an important role to play in the global coronavirus disease 2019 (COVID-19) pandemic. It is integrated and is a key component in the governmental and community structures and services in Kerala, in India. Palliative care in the state has grown to be a viable model recognized in global palliative care and public health scene. The community network of palliative care, especially the volunteers linking with clinical teams, is a strong force for advocacy, relief support including provision of emergency medications, and clinical care. OBJECTIVE: To develop a palliative care resource tool kit for holistic care of patients affected with COVID-19 and to support the health-care workers looking after them to enable palliative care integration with COVID-I9 management. METHODS: The Kerala State government included senior palliative care advisors in the COVID-19 task force and 22 palliative care professionals formed a virtual task force named Palli COVID Kerala as an immediate response to develop recommendations. Results: Developed a palliative care in COVID-19 resource toolkit which includes an e-book with palliative care recommendations, online training opportunities, short webinars and voice over power point presentations. CONCLUSION: Integrated Palliative care should be an essential part of any response to a humanitarian crisis. The e resource tool kit can be adapted for use in other low- and middle-income countries.

31 Effectiveness of a palliative care resource toolkit for COVID 19 for low and middle income countries (LMICs) on health care workers knowledge and confidence levels

BackgroundIntegrated palliative care (PC) has an important role in supporting those affected by the global COVID 19 pandemic. Communication and goals of care, symptom control and holistic support is needed particularly for patients and families living with multi-morbidity and populations in isolation and lockdown. Equipping health care workers (HCW) with core PC competencies is essential and often lacking. Building on models of integrated PC and effective response to humanitarian emergencies in Kerala, we developed and disseminated a Palliative Care in COVID-19 Resource Toolkit for LMICs comprising an e-book, webinars and ECHO platform interactive sessions for HCW.ObjectiveTo evaluate the impact of the Resource Toolkit on the knowledge and confidence levels of HCWs.MethodsParticipants registered for training package completed a pre and post course questionnaire with eighty percent attendance along with giving narrative feedback. Data collected from June to September 2020.ResultsA total of 388 participants from 8 countries including 24 Indian states;27% male;median age 33 (20–65);46% nurses & 27% doctors. There is statistically significant improvement in all factors assessed from pretest to post test. (p=0.000) ) Mean difference in knowledge & confidence in communication, goal setting, physical symptoms management, distress management and EOLC are as follows: 2.57 CI 95% ;(2.21 to 2.93), 2.34 CI 95%;(1.99 to 2.68), 2.72 CI 95%;(2.36 to 3.07), 2.55 CI 95%;(2.20 to 2.90), 2.42 CI 95%;(2.05 to 2.79), 2.38 CI 95%;(2.01 to 2.75), 2.88 CI 95%;(2.51 to 3.24),2.63 CI 95%;(2.27 to 2.99), 3.01 CI 95%;(2.65 to 3.38),2.76 CI 95% (2.39 to 3.13).ConclusionThe Toolkit when combined with online interaction can support the integration of PC competencies in health care workers many of whom have no previous exposure to PC. Narrative feedback also supported the place of a safe forum to share. Further study is planned to assess the educational impact on practice.FundingSelf-funded.

Psychosocial Aspects of COVID-19 in the Context of Palliative Care - A Quick Review.

In a resource-poor country like India, where the health-care systems are difficult to access, overburdened, and unaffordable to many, the impact of the coronavirus disease 2019 (COVID-19) pandemic can be devastating. The increased burden of serious health-related suffering can impact the well-being of health-care workers, patients, and their families alike. The elderly, the frail, the vulnerable, and those with multiple comorbidities are disproportionately affected. Palliative care, with its comprehensive and inclusive approach, has much to offer in terms of alleviating the suffering, particularly those caused by the distressing physical and psycho-socio-spiritual symptoms, the complex medical decision-making, end-of-life care issues, and grief and bereavement, and needs to be integrated into the pathway of care provision in COVID-19. Psychosocial issues contribute to and amplify suffering and are often underestimated and undertreated and not accessible to many. Empowering frontline professionals in the core concepts of psychosocial support and palliative care thus becomes an absolute necessity. This quick review was done by a group of palliative care physicians and mental health experts from India to develop recommendations for physical and psychosocial care in the context of COVID-19. This review was done as part of that process and highlights the role and challenges of the psychosocial domain of palliative care in the context of COVID-19 situation in India.