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BMJ Supportive & Palliative Care ; 12(Suppl 1):A11-A12, 2022.
Article in English | ProQuest Central | ID: covidwho-1673492


IntroductionPeople are living longer with terminal illness, increasing the need for good palliative care. Projections indicate rising home deaths;accelerated by the COVID-19 pandemic but dying at home is reliant on informal carers.AimsTo identify the impact of the COVID-19 pandemic on hospice services from the perspectives of staff and bereaved carers, exploring decision-making for place-of-care and informal caring.MethodScoping reviews explored (1) place of end of life care, and (2) informal caring during the pandemic. Online interviews are being conducted with healthcare professionals in England (n=10) and Scotland (n=10) and bereaved carers who experienced Marie Curie services during lockdown in England (n=10) and Scotland (n=15-20). Once completed by January 2022 and thematically analysed key findings will drive a ‘knowledge exchange’ discussion with policy makers in England and Scotland.ResultsThe reviews and preliminary interview findings indicate the pandemic has put greater pressures on those accessing palliative care services. Decisions were influenced by the media;‘fear of contracting’ or ‘spreading the virus’ are evident in preferences for ‘home-based care. Social distancing, wearing of PPE and shielding restricted practical and emotional support that carers feel enable a good home death. The literature suggests that many carers adjusted to the altered methods of social connection and communication, but interview data suggests concerns about wellbeing especially where ‘grief’ was put ‘on hold’, delaying the bereavement process.ConclusionFindings will identify key considerations for policy and practice change around the future of hospice services if the move to community continues and how we develop and deliver hospice community based services to meet need.ImpactThis research will seek to inform Government policy and Marie Curie services to enable evidence based change and inform future research priorities.

Palliative Medicine ; 35(1 SUPPL):225, 2021.
Article in English | EMBASE | ID: covidwho-1477132


Aim or goal of the work: The Necessary Discussions project developed a COVID-centric advance care planning (ACP) online training resource for nursing homes, with the aim of improving resident care at the end of life during a COVID-19 outbreak. A bespoke website has been designed to deliver information to residents, family members and nursing home staff, with the aims of increasing awareness and understanding of advance care planning, and to support communication and shared decision-making. Design, methods and approach taken: Development of the website took place between late 2020 and early 2021, and was informed by a rapid review of existing literature and support from members of the project's Expert Reference Group, comprised of practitioners, academics and public involvement representatives. Existing ACP resources were synthesised and tailored for COVID-19. Results: The resulting website is accessible and engaging, offering a COVID-19 specific resource for advance care planning. Distinct modules provide information appropriate for care staff and family members. Supplementary videos were produced offering advice from experts in the field. Further reading and additional resources are linked to from the website, and there is a strategic emphasis on self-care alongside care provision. Conclusion / lessons learned: This project demonstrates how to develop accessible information for care staff and family members in a COVID-19 context. The project also identifies effective methods of virtual team working and group collaboration during COVID-19.

Palliative Medicine ; 35(1 SUPPL):35, 2021.
Article in English | EMBASE | ID: covidwho-1477102


Background: The COVID-19 pandemic has led to excess mortality globally. Understanding change in place of death during the pandemic is needed to help guide resource allocation and support for end-of-life care. Aims: To analyse the patterns of mortality and place of death in UK (England, Wales, Scotland and Northern Ireland) during the COVID-19 pandemic. Methods: Descriptive analysis of UK mortality data between March 2020 and February 2021. The weekly number of deaths in each nation was described by place of death using the following definitions: (1) Average deaths estimated using five years of historical data (2015-19);(2) Baseline deaths up to and including expected deaths but excluding COVID-19 deaths;(3) Deaths where COVID-19 is mentioned on the death certificate;(3) Additional deaths not attributed to COVID-19. Results: During the analysis period, there were 743,172 deaths in the UK, of which 135,716 were COVID-19 related and 17,672 were additional non-COVID deaths. There was variation in mortality between the UK nations with Wales having the highest rate of COVID-19 deaths at 229 per 100,000 population and Northern Ireland the lowest at 141 per 100,000 population. Deaths in care homes increased above baseline levels during the first and second waves of the pandemic but fell below baseline between waves, increasing the most in Wales by 29%. Hospital deaths increased overall by as much as 13% in England but fell by 1% in Scotland. Deaths at home remained above average throughout the study period with an overall increase of between 40-41%. In England and Wales, 15-30% fewer people died in hospices compared to baseline. Discussion: The COVID-19 pandemic has changed where people die in the UK. Notably a sustained increase in deaths at home has been seen, with implications for planning and organisation of palliative care and community services. Examination of place of death in other countries with high COVID-19 mortality is recommended.