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Objectives: Investigate the utilization of cycled antineoplastic therapies (where dosages vary per monthly supply) for various cancers among Medicare-eligible patients, and medical costs and outcomes associated with discontinuation gaps in monthly adherence. Method(s): This retrospective study used the MarketScan Supplemental and Coordination of Benefits Design databases from 2019-2020. Discontinuations were calculated for 2020 utilizing cycled medications (8 generic products) from 6 therapeutic categories, where discontinuation was defined as the first gap in medication supply during the last 6 months of the year at intervals of >=1.5*prior supply. Continuous enrollment was required, as were ICD oncology diagnosis codes for those at least 65 years of age. New to therapy/diagnosis was inferred from 2019 metric files. Patients were excluded if hospice care and inpatient transplant services were indicated. Models examined adherence level (discontinued or not) and 10 covariates (including COVID-19 indications), with interaction terms, for significant associations with medical costs (inpatient and outpatient), hospitalizations, and length of hospital stay (LOS). Result(s): Patients who met metric criteria (n=1,357;Mean age 73.9) had a discontinuation rate of 16.7%. A total of 64.0% were new to therapy/diagnosis and 5.2% were identified having COVID-19 in 2020. However, COVID-19 was not significantly correlated with a discontinuation. Hospitalization rate was at 30.3% with mean LOS=9.8. Models found significant discontinuation effects with increased total medical costs ($11,977, p<.03), odds of hospitalization (2.7, p<.0001), and LOS (5.4, p<.03). COVID-19 patients had significantly higher total medical costs ($18,145, p<.007), odds of hospitalization (6.3, p<.0001), and non-oncology LOS (4.6, p<.009). Significant covariate interactions are discussed in the poster. Conclusion(s): Medication adherence (fewer gaps in medication coverage) on cycled oral antineoplastics can lead to lower medical costs and fewer hospitalization events or LOS as compared to lower adherence levels. This was independent of COVID-19 indications that were associated with increased costs, hospitalization, and non-cancer LOS.Copyright © 2023
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Introducción: La COVID-19 exacerbó el déficit en la prestación de cuidados paliativos y de fin de vida y aumentó la sobrecarga de los servicios de salud, pero se desconoce la extensión de la literatura sobre dicho tema. Objetivo: Describir la evidencia sobre la prestación de cuidados paliativos y de fin de vida en adultos durante la pandemia de COVID-19. Materiales y métodos: Revisión de alcance según el marco metodológico de Arksey y O'Malley. La búsqueda se realizó en inglés y español; en PubMed, Scielo, la Biblioteca Virtual en Salud, y la base de datos de investigación en Coronavirus. Las publicaciones se filtraron por título, resumen y lectura completa. Los resultados se sintetizaron de acuerdo con la técnica "charting". Resultados: Se incluyeron 51 publicaciones. En total emergieron cinco categorías: 1) caracterización de los cuidados paliativos, 2) planificación avanzada de cuidados, 3) acompañamiento a familiares y seres queridos, 4) telesalud, 5) rol de enfermería en los cuidados paliativos. Discusión:: El coste social de la pandemia se refleja en el aumento en la carga de unidades de cuidados paliativos, mayor porcentaje de mortalidad y la disminución de la edad promedio de fallecimiento. Futuros estudios deben abordar el impacto psicosocial en los seres queridos de los pacientes, así como el impacto a nivel comunitario. Conclusión: Los cuidados paliativos y de fin de vida constituyen una herramienta fundamental para la atención de pacientes con COVID-19. La pandemia potenció el desarrollo de las tecnologías de la información y las comunicaciones para la prestación de cuidados paliativos.
Introduction:COVID-19 exacerbated the deficit of palliative and end-of-life care provision and increased healthcare services' burden, but the extent of the literature on that topic is unknown. Objetive: To describe the evidence of palliative and end-of-life care provision in adults during the COVID-19 pandemic. Materials and Methods:The scoping review was performed according to Arksey and O'Malley's methodological framework. The search was conducted in English and Spanish, in PubMed, SciELO, the Virtual Health Library, and the Coronavirus research database. The articles were filtered by title, abstract, and full text. The results were summarized according to the charting technique. Results: Fifty-one publications were included. A total of five categories emerged: 1) Palliative care characteristics, 2) advanced care planning, 3) support for family members and loved ones, 4) telehealth, and 5) nursing role in palliative care. Discussion:The social cost of the pandemic is reflected in the increased burden of palliative care units, higher mortality rates, and the decreased average age of death. Future studies should address the psychosocial impact of COVID-19 on patients' loved ones, as well as the impact at the community level. Conclusions: Palliative and end-of-life care is an essential tool for COVID-19 patients care. The pandemic has enhanced the development of information and communication technologies to deliver palliative care.
Introdução: A COVID-19 exacerbou o déficit na prestação de cuidados paliativos e em fim de vida e aumentou a sobrecarga sobre os serviços de saúde, mas a extensão da literatura sobre tal tópico é desconhecida. Objetivo: Descrever as evidências sobre a prestação de cuidados paliativos e de fim de vida em adultos durante a pandemia da COVID-19. Materiais e Métodos: Revisão do escopo de acordo com a estrutura metodológica de Arksey e O'Malley. A pesquisa foi realizada em inglês e espanhol; PubMed, Scielo, a Biblioteca Virtual de Saúde e o banco de dados de pesquisa do Coronavirus. As publicações foram filtradas por título, resumo e texto completo. Os resultados foram sintetizados de acordo com a técnica gráfica. Resultados: 51 publicações foram incluídas. No total, surgiram cinco categorias: 1) caracterização dos cuidados paliativos, 2) planejamento de cuidados avançados, 3) acompanhamento de parentes e entes queridos, 4) telesaúde, 5) papel de enfermagem nos cuidados paliativos. Discussão: O custo social da pandemia se reflete no aumento da carga sobre as unidades de cuidados paliativos, maiores taxas de mortalidade e uma diminuição da idade média de morte. Estudos futuros devem abordar o impacto psicossocial sobre os entes queridos dos pacientes, bem como o impacto a nível comunitário. Conclusões: Os cuidados paliativos e de fim de vida são uma ferramenta fundamental para o cuidado de pacientes com COVID-19. A pandemia tem melhorado o desenvolvimento das tecnologias de informação e comunicação para o fornecimento de cuidados paliativos.
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Palliative Care , Hospice Care , Coronavirus Infections , PandemicsABSTRACT
The COVID-19 pandemic brought to light significant health disparities in illness and death due to a person's race, ethnicity, and socioeconomic status. Also, those factors cause significant inequities in access to palliative and end-of-life care that remain largely unaddressed. The quality of care people receive once they are given a life-threatening diagnosis or as they approach the end of their life depends upon race, ethnicity, socioeconomic status, and who they love. Such disparities in treatment are unconscionable and must be addressed. They warrant serious attention from policymakers and clinicians as well as focused efforts to find solutions. Copyright 2022 American Society on Aging;all rights reserved.
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OBJECTIVE: Serum 25-hydroxyvitamin D was obtained alongside routine blood tests in all suitable patients admitted to the St Cuthbert's Hospice Inpatient Unit for a period of 12 months. Supplementation was offered to exclude vitamin D insufficiency or deficiency as a contributor to the complex pain and symptom profile of our patients. METHODS: During admission, and alongside routine blood tests, a serum 25-hydroxyvitamin D test was requested for suitable patients. Supplementation was offered to patients with serum 25-hydroxyvitamin D less than 50 nmol/L. RESULTS: This audit identified that 79.73% of patients assessed had a 25-hydroxyvitamin D level less than 50 nmol/L and were therefore insufficient or deficient in vitamin D. The results of the audit were discussed within the clinical team at the hospice and guidance changed to obtain serum 25-hydroxyvitamin D levels in all suitable patients. A reaudit highlighted that some patients were missed from testing and therefore reminders were sent to the clinical team. CONCLUSIONS: Most patients admitted to St Cuthbert's Hospice had either insufficient or deficient levels of vitamin D. It seems reasonable for all suitable palliative care patients to have their vitamin D level checked and to be started on a suitable dose of vitamin D replacement therapy.
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BACKGROUND: Older adults living in long-term care facilities (LTCF) have been severely affected by COVID-19. Hospice care (HC) facilities and palliative care are essential in treating patients dying from COVID-19. In Italy, little is known about the impact of COVID-19 on deaths in LTCF and the care provided in HC to COVID-19 patients. AIM: To assess overall and case-specific mortality in 2020 in LTC and HC facilities in comparison to the previous five years (2015-2019). METHODS: We performed a descriptive study using data derived from the Italian national "Cause of Death" registry-managed by the Italian National Institute of Statistics-on deaths occurred in LTC and HC facilities during 2020 and the period 2015-2019. RESULTS: Number of deaths significantly increased in 2020 compared with 2015-2019 in LTCF (83,062 deaths vs. 59,200) and slightly decreased in hospices (38,788 vs. 39,652). COVID-19 caused 12.5% of deaths in LTCF and only 2% in hospices. Other than COVID-19, in 2020, cancer accounted for 77% of all deaths that occurred in HC, while cardiovascular diseases (35.6%) and psychotic and behavioral disorders (10%) were the most common causes of death in LTCF. Overall, 22% of the excess mortality registered in Italy during 2020 is represented by the deaths that occurred in LTCF. DISCUSSION AND CONCLUSION: LTCF were disproportionally affected by COVID-19, while the response to the pandemic in HC was limited. These data can help plan strategies to limit the impact of future epidemics and to better understand residential care response to COVID-19 epidemic.
Subject(s)
COVID-19 , Hospice Care , Hospices , Humans , Aged , Long-Term Care , Pandemics , Italy/epidemiologyABSTRACT
BACKGROUND: Natural disasters are becoming more frequent and severe, and place additional strains on end-of-life care services and users. Although end-of-life and palliative care are considered essential components of disaster planning and response, there are gaps in understandings about their real-life application, and how natural disasters impact end-of-life care. OBJECTIVE: To synthesise existing evidence of the impacts of natural disasters (eg, bushfires, communicable pandemics, etc) on end-of-life care. METHODS: A systematic review with a narrative synthesis was undertaken. The review was registered on PROSPERO (registration: CRD42020176319). PubMed, Scopus, PsycINFO, Science Direct and Web of Science were searched for studies published in English between 2003 and 2020, with findings explicitly mentioning end-of-life care impacts in relation to a natural disaster. Articles were appraised for quality using a JBI-QARI tool. RESULTS: Thirty-six empirical studies met the inclusion criteria and quality assessment. Findings were synthesised into three key themes: impacts on service provision, impacts on service providers and impacts on service users. This review demonstrates that natural disasters impact profoundly on end-of-life care, representing a stark departure from a palliative care approach. CONCLUSIONS: Clinical practitioners, policy makers and researchers must continue to collaborate for viable solutions to achieve universal access to compassionate and respectful end-of-life care, during natural disasters. Using models, policies and practices already developed in palliative care, involving those most impacted in disaster planning and anticipating barriers, such as resource shortages, enables development of end-of-life care policies and practices that can be rapidly implemented during natural disasters.
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This Special Section broadens and qualifies the terms through which the relationship between home and militarization has been understood. We do this by joining a vibrant and growing field of transdisciplinary scholars who address the militarization of everyday life by attending to domesticity and practices of domestication. We grapple with how the home naturalizes and becomes a catalyst for militarism: How do ordinary and domestic objects, technologies, spaces, and infrastructures make violence feel at home in the world? We are concerned with the domestic life of militarization as oikos: the household, habitat, and milieu of violent material relationships that are both ongoing and latent. The domestic is not just a discrete, private space;it also extends into public spaces like neighborhoods, local businesses, waste disposal infrastructures, hospices, and crop fields. Developed within an editorial process rooted in a feminist ethos, the articles collected here provide critical and alternative methodologies and disciplinary forms for considering militarism's aesthetics, affects, and modes of appearance. This collection resists conventional spatialities, temporalities, and incarnations of war while calling attention to the obscuring of violence through practices of care and marketing operations.
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OBJECTIVES: Few studies have examined whether access to, and quality of, specialised palliative care changed during the COVID-19 pandemic. This study investigated changes in access to and quality of specialised palliative care during the pandemic in Denmark compared to previously. METHODS: An observational study using data from the Danish Palliative Care Database combined with other nationwide registries was conducted, including 69 696 patients referred to palliative care services in Denmark from 2018 to 2022. Study outcomes included number of referrals and admissions to palliative care, and the proportions of patients fulfilling four palliative care quality indicators. The indicators assessed admissions among referred, waiting time from referral to admission, symptom screening using the European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at admission, and discussion at multidisciplinary conference. Logistic regression analysed whether the probability of fulfilling each indicator differed between the pandemic period and pre-pandemic, while adjusting for possible confounders. RESULT: Number of referrals and admissions to specialised palliative care were lower during the pandemic. The odds for being admitted within 10 days of referral was higher during the pandemic (OR: 1.38; 95% CI: 1.32 to 1.45) whereas the odds for answering the EORTC questionnaire (0.88; 95% CI: 0.85 to 0.92) and for being discussed at multidisciplinary conference (0.93; 95% CI: 0.89 to 0.97) were lower compared with pre-pandemic. CONCLUSIONS: Fewer patients were referred to specialised palliative care during the pandemic, and fewer were screened for palliative care needs. In future pandemics or similar scenarios, it is important to pay special attention to referral rates and to maintain the same high level of specialised palliative care.
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While many cultures worldwide embrace mortality as a natural part of human existence, many in the United States (US) remain death-averse, utilizing ever-advancing medical technology to stave off mortality. Dying, as a result, is less of a human process and more of a mechanical one in which it is increasingly difficult to determine the exact moment of death. End-of-life care is often placed in the hands of healthcare professionals. Within various healthcare systems in the US, there is a widespread movement to increase access for those with serious and terminal illnesses to palliative and hospice care. In many ways, palliative and hospice care are the most holistic care modalities covered by medical health insurance plans. However, most palliative care healthcare professionals are unaware of the unique sexuality-related needs of individuals with serious and terminal illnesses, thus neglecting this important part of the whole person. The goal of this study was to engage in phenomenological interviews with those receiving hospice care to answer the following question: How do individuals receiving hospice care experience their own sexuality? Lead researcher partnered with local nonprofit hospice agency to recruit participants for phenomenological interviews. Due to many challenges, including the COVID-19 pandemic, only one interview occurred, during which the lead researcher dialogued with the participant regarding a broader understanding of sexuality utilizing the Circles of Sexuality model to frame the interview. The researcher used background research, findings from interview, and her own professional experiences to develop in-depth curriculum on sexuality at end of life. Curriculum includes four lesson plans developed for the following audiences: individuals with serious illness, personal caregivers of those with serious illness, and palliative care healthcare professionals. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The high infectivity, severity, and mortality of COVID-19 led to the devastating impact this disease has had on people's lives during the pandemic. The related strict infection controls and restrictions affected how palliative and end-of-life care could be discussed with clients and how family members could deal with their grief afterward. However, the provision of concise and accurate information by healthcare providers was found to help ease anxiety and fear during the COVID-19 pandemic. In the post-pandemic era, nurses should actively facilitate, support, advocate for, and coordinate palliative care communications with long-term care facility residents. Thus, the Understanding, Respect, Planning, Expression, Act, Care, and Education (U-R-PEACE) communication strategy is introduced and suggested in this article for this purpose. Palliative care communications should be commenced by nurses as early as possible. Moreover, nurses may help residents optimize their quality of life and death by understanding their and their family members' expectations and preferences, encouraging them to discuss their care plan with doctors, and respecting their decisions. The care goals of achieving a good death and relief of suffering may also be promoted through care that is delivered using a holistic, person/family-centered care approach.
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Background: Significant structural and normative pressures privilege the ideal of dying at home in Canada. At the same time, the social complexities and meanings associated with dying in particular locations remain critically unexamined. Objective: The aim of this study is to explore how diverse community members, including health and social care stakeholders, talk about preferences for locations of dying, with a particular focus on meanings of dying at home. Design: Semi-structured virtual interviews were conducted with 24 community and practitioner representatives and advocates across Canada during the Covid-19 pandemic. This included compassionate community advocates, palliative care professionals and volunteers, bereaved carers, and members of queer, rural, and immigrant communities. Participants were asked about their own preferences for location of dying and elaborated on these aspects with regard to their client population or community group. Results: Our analysis illuminates how meanings of dying at home are connected to previous experiences and perceptions of institutional care. As such, participants' perspectives are often framed as a rejection of institutional care. Dying at home also often signals potential for preserving ontological security and relational connection in the face of life-threatening illness. However, participants' expertise simultaneously informs a sense that dying at home is often unattainable. At times, this awareness underpins interpretations of both preferences and choices as contingent on considerations of the nature and type of illness, concerns about impacts on families, and available resources. Conclusion: The ideal of dying at home is nuanced by identity, relational, and structural contexts. Knowledge from this study can inform realistic and practical person-centered planning across care settings. It can also help create more representative public policy and health system quality indicators regarding a 'good death' that do not rely on or perpetuate undeveloped and unrealistic assumptions about dying, home, and family care.
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The COVID-19 pandemic brought to light significant health disparities in illness and death due to a person's race, ethnicity, and socioeconomic status. Also, those factors cause significant inequities in access to palliative and end-of-life care that remain largely unaddressed. The quality of care people receive once they are given a life-threatening diagnosis or as they approach the end of their life depends upon race, ethnicity, socioeconomic status, and who they love. Such disparities in treatment are unconscionable and must be addressed. They warrant serious attention from policymakers and clinicians as well as focused efforts to find solutions.
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Purpose Nurses experience insufficient preparation for dealing with the death of their patients (Ferguson & Cosby, 2017). For proper learning, it is necessary for them to expose to the clinical environment during end-of-life care education. However, It is difficult for students to have sufficient end-of-life care training during the clinical training period because of short clinical practice hours, difficulty to access to patients or caregivers in the dying situation, and hardship to guarantee opportunities to experience dying situations (Randall et al., 2018;Smith et al., 2018). Thus, this study aims to examine the effects of an integrated end-of-life education program for nursing students. Method This is a pretest-posttest quasi-experimental design with two intervention groups and no control group. There were 16 participants in the group 1 while 14 in group 2. Group 1 received both the web-based virtual simulation and a clinical case study seminar on end-of-life care, while group 2 received only the web-based virtual simulation. In order to confirm the effect of the educational program, nursing students' end-of-life care knowledge, attitude toward end-of-life care, and educational self-efficacy were measured and compared through a survey which conducted before and after the program. The analysis included a paired T-test, an independent T-test and a Spearman's rank correlation test in order to compare changes in knowledge, attitude, and self-efficacy of the nursing students. Results and Discussion The mean age of participants was 21.73 (SD=1.57), of which 86.7% were women. The satisfaction with the virtual simulation was 3.93 (SD=0.73) in group 1 and 3.75 (SD=0.86) in group 2. There were significant changes in the end-of-life care knowledge (p=0.003) and attitude (p≤0.001) toward end-of-life care in group 1. There was a significant difference only in end-of-life care knowledge (p=0.037) group 2. Self-efficacy did not change significantly in either group, and each change did not show a significant correlation with satisfaction. Also, among each change, only the change in the end-of-life care attitude showed a significant difference between groups, and there was no significant difference in changes of end-of-life care knowledge and educational self-efficacy between both groups. The findings indicate that web-based virtual simulation alone may improve nursing students' knowledge. In particular, due to COVID-19 pandemic in recent years, it is important for students to access to patients and families and have learning opportunities for clinical practice through innovative ways. Virtual simulation may help them improve their clinical competency such as dealing with dying situations, caring for older patients, and communicating with their caregivers. Further research is necessary to examine the effects of not only virtual simulation but also integrated programs that includes clinical components such as case studies in the area of clinical education of end-of-life care for older adults. © 2022, Gerontechnology. All Rights Reserved.
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The proceedings contain 38 papers. The topics discussed include: impact of COVID-19 on a national serum eyedrops program in the UK;the impact of COVID-19 on corneal transplantation in England;crisis becomes the norm: how a non-profit network withstands the pandemic;new strategies in the Barcelona eye bank to minimize the impact of the COVID-19 pandemic;emergency salvage of time expired clinical corneas during the covid-19 pandemic;supply of non-clinical ocular tissue from a tissue and eye services research tissue bank;the donor of tomorrow: challenges posed by the pandemic, demographic change, and increased transplant requirements;growing together in diversity - Indo-German cooperation enhancing eye donation in north India;eye donation in palliative and hospice care settings: patient views and missed opportunities!;and the potential for eye donation from hospice and palliative care clinical settings in England - a retrospective case notes review of deceased patient records.
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Background/AimsThe Health and Care Act 2022 includes a legal duty to ‘specifically require Integrated Care Boards to commission services or facilities for palliative care, including specialist palliative care, as they consider appropriate for meeting the reasonable requirements of the people for whom they have responsibility’. Many see this, along with the significant and welcome resource provided to hospices by NHS England throughout the Coronavirus pandemic, as a step towards ‘fully funded’ hospice care.Our hospice has worked hard to develop relationships and build connections over many years, which has resulted in an NHS contribution towards our costs well above the national average. We have a mature relationship with CCG commissioners and other local statutory providers and very much see our role as a partnership that aims to improve care for all, regardless of who the provider of that care is.Methods/Results/ConclusionsOur presentation will discuss the risks and benefits of hospice care that is ‘fully funded’ through statutory means and argue that, to achieve real sustainability, hospices need to invest resource, time and skills in commissioner and partner provider relationships in the way that they invest in other aspects of income generation.We will also argue that as independent hospices, our charitable status and independence enables us to remain connected to our communities, and that as precious community assets, not being fully funded allows innovation beyond what the political paymasters of the day specify. In remaining so, we can continue to act as leaders of compassionate care in the integrated care systems and work with partners to improve end of life care for all, acting creatively and investing in new areas to change how we die. The session aims to be provocative, recognising that all hospices have their own challenges and opportunities and that there remains a place for diversity of funding across the sector.
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OBJECTIVES: Religion and spirituality are important aspects of many physicians and patients' lives and may impact their views of death and the way they interact with terminally ill patients, specifically comfort discussing end-of-life care and death and dying. This study explores the religious and spiritual beliefs of resident physicians, if they affect interactions with their patients and if burnout impedes this interaction. METHODS: A 28-item questionnaire was administered to residents and fellows at an urban academic hospital. RESULTS: 65 residents and fellows answered the survey. Religiosity but not spirituality correlated with reported comfort interacting with patients dealing with death or dying. Resident specialty, biological sex and spirituality were not associated with comfort and conversations about religion and end-of-life care. The majority (60%) reported that the pandemic has not affected how they speak to their patients about death and dying. Caring for a higher volume of terminally ill patients was not associated with high levels of burnout though 71% reported increased burnout due to COVID-19. CONCLUSION: Further research can be done to determine whether additional training or resources should be provided to resident physicians to cope with death and dying in the setting of a pandemic.
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Purpose: Organ transplant recipients (OTR) have worse outcomes from COVID-19 and weaker antibody responses to vaccination than do immunocompetent individuals. Data on clinical outcomes among OTR with breakthrough COVID-19 are urgently needed, given decreased vaccine efficacy against the B.1.617.2 (Delta) variant. We compared crude case fatality rates (CFR) between fully vaccinated and unvaccinated kidney transplant recipients (KTR) with COVID-19. Method(s): We identified KTR with COVID-19 at our institution between 3/1/20 and 11/17/21. Multi-organ transplant recipients, KTR who received additional ("booster") doses, and those with partial or unknown vaccination status were excluded due to small numbers. KTR were considered fully vaccinated 2 weeks after receiving either the second dose of an mRNA vaccine series (Moderna, Pfizer-BioNTech) or one dose of the Janssen viral vector vaccine. Demographics, clinical characteristics, and in-hospital or hospice care mortality were extracted from electronic medical records. Result(s): Among 109 KTR with COVID-19, 19 were fully vaccinated at symptom onset. Vaccinated KTR with COVID-19 were older (median: 63.5 vs. 57.5 years, P<0.05) and waited longer to seek care after symptom onset (median: 6 vs. 3 days, P<0.05). Comorbidities and time from transplant were comparable between the two groups. CFR was higher among vaccinated KTR (26% vs. 10%, HR 0.34, 95%CI 0.11-1, P=0.05;Fig. 1), although the difference was not significant after adjustment for age (aHR 0.53, 95%CI 0.17-1.61, P>0.1). All fatal breakthrough infections occurred when the Delta variant accounted for >98% of COVID-19 cases in our HHS region. Conclusion(s): Vaccinated OTR remain at high risk for fatal COVID-19. Younger OTR are likely more immunoprotected than older OTR, which-combined with the emergence of the Delta variant and easing of restrictions-may have contributed to the observed shift toward older age among KTR with breakthrough COVID-19 and the high resultant CFR. Vaccinated OTR may delay seeking care for breakthrough symptoms due to a false sense of security. Our findings highlight the importance of pretransplant vaccination, and, among OTR, the need for ongoing preventive measures (masks, social distancing, vaccination of close contacts, post-vaccine education) and additional vaccine doses. OTR should be linked to care immediately after exposure or onset of symptoms consistent with COVID-19, given the availability of anti-spike monoclonal antibodies for prevention or treatment. (Figure Presented).