Medical Costs, Hospitalizations, and Length of Stay Associated with Discontinuations in Cycled Oral Antineoplastics Among Medicare-Eligible Oncology Patients

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

Designing the post-pandemic hospice environment: "The last place"

Where and how people die is a significant concern of human life and society (Worpole, 2009). In these days, people die either in their home or in an end-of-life care facility, such as hospice. Hospice is a place to provide end-of-life care to individuals certified as "terminal." Hospice care or end-of-life care is a multidisciplinary care and support (non-curative) system designed to address the physical, emotional, psychosocial, and spiritual concerns of terminal patients and their families. Thus, the facility design is significantly different in various dimensions. For example, hospice patients are mostly bed-bound, and a patient's family accommodation plays a significant role in the patient's dying experience. Providing a supportive physical environment of hospice has an imperative impact on the patient "quality of life" and the possibility of a "good death." With the COVID-19 challenges, it has become significant to explore the best possible solutions of hospice facility design. This chapter discusses the 11 therapeutic goals of hospice care environment which was developed by Kader and Diaz Moore in 2015 considering dying experiences. The physical settings of hospice along with the carefully designed organizational environment can contribute to the realization of desired therapeutic goals and have a positive effect on the lives of dying patients. This chapter discusses each therapeutic goal and how hospice facility design can support these goals with a few examples and presents six major design-related challenges of post-pandemic (COVID-19) hospice care facilities. Lastly, several prospective design concepts have explored considering pandemic resiliency. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

PROPELLERS OF ORGANISATIONAL SUSTAINABILITY IN HOSPICES IN SOUTH AFRICA

Hospices operating in the non-profit sector are experiencing organisational sustainability pressures, particularly in the wake of the COVID-19 pandemic. Notably, while the population of patients who are terminally ill and requiring palliative care is increasing, the resources required to render this noble service are depleting, so much so that some hospices have closed. The situation raises profound organisational sustainability concerns, and this serves as the motivation for this generic qualitative study to investigate the propellers of organisational sustainability in South African-based hospices operating in the non-profit sector. Data was collected through interviews with twelve senior managers from different hospice organisations. The data was then analysed using Thematic Content Analysis (TCA). Subsequent results reveal that a cocktail of factors, including transparent communication, visionary leadership, a strategic disposition, improved service quality, a strong corporate culture, a diversified revenue base and committed staff, propel organisational sustainability among hospices. Conversely, the COVID-19 pandemicenforced lockdowns and the rampant emergence of many NPOs impede the sustainability prospects of the hospices. With these insights, this study contributes to the organisational sustainability discourse from a uniquely South African perspective, given the dearth of research in this area, particularly in the context of developing economies © Penerbit UMT

Palliative care, end-of-life care, and COVID-19: A scoping review / Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance / Cuidados paliativos, cuidados em fim de vida e COVID-19: uma revisão do escopo

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.

Quality Improvement Evaluation of a Veterans' Palliative Care Telehealth Music Therapy Program

Music therapy is an important psychosocial aspect of hospice and palliative care programs to address pain, grief, and anxiety. The COVID-19 pandemic introduced new challenges to psychosocial therapies in palliative care, including the inability of families to be at the bedside of seriously ill patients, and the need to provide services remotely through video technology. Due to this sudden shift in service delivery, music therapists adapted without research evidence or evaluation of service quality. This evidence-based quality improvement (QI) evaluation examined the program effectiveness of music therapy telehealth services at one Veterans Affairs Medical Center (VAMC) for patients in palliative care, their family members, and VAMC staff during this time of societal grief, anxiety, and isolation. Evaluation metrics included patient (n = 39), staff (n = 27), and family member (n = 3) responses to QI surveys, and analysis of journal entries from key stakeholders (i.e., music therapist, nurse case manager, palliative care physician). We conducted a content analysis of QI surveys and completed the first and second cycle coding of journal entries. Results from the QI survey indicated that music therapy telehealth provided affective and interpersonal benefits, and increased compliance with other therapies. Reflections from key stakeholders included clinical recommendations for service implementation and descriptions of the influence of the telehealth modality on the therapeutic relationship. Findings suggested that music therapy telehealth services can provide psychosocial support for veterans, families, and staff in palliative care. QI research may be utilized to provide helpful ongoing feedback regarding clinical effectiveness.

Check Point SOS! A Case of Cemiplimab-Associated Sinusoidal Obstruction Syndrome

Introduction: Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS), is a clinical syndrome characterized by hepatomegaly, right-upper quadrant pain, and ascites that occurs most commonly in the setting of high-dose chemotherapy or hematopoietic stem cell transplantation (HSCT). The diagnosis can be confirmed on biopsy. Cemiplimab is an immune checkpoint inhibitor recently approved for the treatment of cutaneous squamous cell carcinoma. There are currently no known reports of immune checkpoint inhibitor-related VOD/SOS. Case Description/Methods: A 58-year-old female with a history of locally advanced basal cell carcinoma of the left eye treated with six months of Cemipilimab presented with ascites. On admission, labs were notable for a total bilirubin of 1.2, mildly elevated liver function tests, alkaline phosphatase 884, and international normalized ratio 2.1. A diagnostic tap revealed a high SAAG ascites that was negative for infection. A comprehensive serological workup for viral, metabolic and autoimmune causes was unrevealing. A transjugular liver biopsy demonstrated a hepatic venous pressure gradient of 18mmHg, nodular regenerative hyperplasia (NRH), and portal venopathy. The patient was discharged on steroids but returned one month later for recurrent ascites and worsening bilirubin to 12.6 (direct 7.3);COVID PCR was negative. A full rheumatologic and vasculitis workup was unremarkable. Repeat biopsy (Figure 1) demonstrated moderate NRH changes, prominent central vein sclerosis with fibrous obliteration, signs of SOS/ VOD and central venulitis with fibrotic changes with sinusoidal portal hypertension. Discussion(s): VOD occurs most often with hematopoietic stem cell transplantation, and chemotherapeutic agents. Here we present the first case of checkpoint inhibitor-induced VOD/SOS. Despite discontinuation of the offending agent and a trial of steroids, the patient's clinical course continued to deteriorate. She eventually developed refractory ascites and portosystemic encephalopathy. She was deemed not a candidate for liver transplant given her underlying malignancy. She was transitioned to home hospice before further treatment, such as Defibrotide could have been pursued. VOD associated with immune checkpoint inhibition should be considered in the differential of patients who develop new onset liver dysfunction and ascites while receiving these medications (Figure Presented).

Prioritizing Health Equity in Palliative and End-of-Life Care

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.

Infections in Patients With Cirrhosis Have a Changing Profile Over Time and Are Linked to a Higher Risk of Death Compared to Patients Without Cirrhosis

Introduction: Intensive care outcomes in patients with cirrhosis are relatively poor. The comparison between outcomes, especially related to infections, remains unclear in those with and without cirrhosis. With the emergence of resistant and fungal organisms, the changes in infection profiles over time are important to analyze. The aim of this study is to determine the impact of cirrhosis and infections on inpatient death over time in a qSOFA-matched cohort of patients with and without cirrhosis. Method(s): Inpatients admitted to ICUs throughout 2015-2021 were analyzed. Patients with cirrhosis were matched 1:1 by age, gender, and admission qSOFA to patients without;COVID-positive patients were excluded. Admission demographics, labs, the reasons for ICU transfer, infections, and inpatient death or hospice referral were obtained for each patient. Comparisons were made between patients with and without cirrhosis and those who died/referred to hospice versus not. Logistic regression for death/hospice was performed. In patients with cirrhosis, the culture results were compared over the years. Result(s): 1669 patients;833 cirrhosis and 836 non-cirrhosis patients were included. Patients with cirrhosis had higher rates of infection, positive culture, abdominal infection, and bacteremia. They also had higher gram-positive and fungal infections with a higher rate of VRE. They showed a greater organ failure load, death, and hospice referral compared to patients without cirrhosis. Logistic regression showed that cirrhosis (OR 4.0, p< 0.0001), admission qSOFA (1.60, p< 0.0001), WBC (1.02, p=0.003), reasons for ICU (altered mental status 1.69, hypotension 1.79, renal support 2.77, respiratory failure 1.79, CVA 1.96, all p< 0.0001) with Infection (1.77, p< 0.0001, >1 microbe isolated 1.86, p=0.05) were risk factors for death/hospice. The infection trend in the cirrhosis group showed a significant decrease in positive cultures and gram-negative infections and an increase in fungal and gram-positive infections over time. Conclusion(s): Despite matching for demographics and qSOFA, patients with cirrhosis had higher risks of death and organ failures. They were more likely to develop gram-positive and fungal infections with multiple organisms and VRE. Time trends in cirrhosis showed lower rates of positive cultures and gram-negative infections and an increase in fungal and gram-positive infections over time, which should encourage re-evaluation of diagnostic and prophylactic strategies in cirrhosis-related infections. (Figure Presented).

Palliative Care for Hospitalists

Palliative care is a medical specialty that provides medical care to individuals living with serious illness. Palliative care has evolved over the past several decades from exclusively providing end-of-life care to serving patients with life-limiting medical conditions by providing supportive, comprehensive care. Palliative care services can and should be sought at all stages of severe illness and are typically provided alongside medically curative treatment. Hospice care, often referred to as end-of-life care, aims at providing comfort for patients with a prognosis of fewer than 6 months to live or patients whose health is demonstrably declining. The rapid, global spread of the COVID-19 virus led to an international pandemic that has caused a rapid rise in the utilization of healthcare services and a surge in demand for palliative care. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Vitamin D levels in hospice in-patients.

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.

Hospices and Emergency Preparedness Planning: A Scoping Review of the Literature.

Objective. Palliative and end-of-life care, as provided by hospices, are important elements of a healthcare response to disasters. A scoping review of the literature was conducted to examine and synthesize what is currently known about emergency preparedness planning by hospices. Methods. A literature search of academic and trade publications was conducted through 6 publication databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines when applicable. Publications were selected and findings were organized into themes. Results. A total of 26 articles were included in the literature review. Six themes of Policies and Procedures; Testing/Training/Education; Integration and Coordination; Mitigation; Risk Assessment/Hazard and Vulnerability Analysis; and Regulations were identified. Conclusions. This review demonstrates that hospices have begun to individualize emergency preparedness features that support their unique role. The review supports all-hazards planning for hospices, and emerging from this review is a developing vision for expanded roles of hospices to help communities in times of disaster. Continued research in this specialized area is needed to improve hospices' emergency preparedness efforts.

Having vision: The role of quality improvement in sustaining rates of corneal donation in a hospice, and the impact of this through the COVID pandemic

Understanding patients' wishes regarding organ and tissue donation is an important aspect of advance care planning (ACP). Many patients with life-limiting illnesses are still eligible to be corneal donors. A quality improvement (QI) approach has promoted a positive change in culture at an inpatient hospice, making the discussion of patients' wishes on corneal donation the norm. This cultural change led to a sustained high rate of such discussions, despite the multitude of challenges presented by the COVID-19 pandemic.Copyright © Royal College of Physicians 2023. All rights reserved.

Internet-based interventions for family carers of people with dementia

There is an urgent global need for accessible, usable, effective and scalable skills training and support programs for carers of people with dementia, particularly in LMICs. WHO's iSupport is filling this gap by providing such a program, accessible for translation and cultural adaptation worldwide. First steps have been undertaken to support the systematic and culturally fair translation and adaptation of the program in several countries. However, while web-based or online programs for dementia carers such as iSupport seem to be promising, the scaling of these programs remains challenging and is a common issue for digital health solutions. In fact, the findings of a first efficacy study from India highlight the need to understand carers' individual situation better and tailor support programs even more to their specific needs. Going forward, iSupport could be improved by adding a mobile phone application to offer more flexibility to users, including an interactive or moderated chat function or more audio-visual materials to the online program to increase its appeal. To assist carers who wish to use more traditional ways of learning, WHO has released the iSupport hardcopy manual, which presents the entire iSupport content in book format. Further robust cultural adaptations and high-quality research investigating the effectiveness of iSupport across different settings and for different groups of carers are required. Finally, in the context of the ongoing COVID-19 pandemic, digital support services such as iSupport are more important than ever and present a real opportunity to build back better, which will help to reach the global target set by WHO that 75% of countries will provide support and training programs for carers and families of people with dementia by 2025. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Website information on visiting policies at specialist in-patient palliative care settings during COVID-19 pandemic across Central and Eastern Europe: a quantitative and qualitative study

Introduction: Since the COVID-19 pandemic, visiting policies in various healthcare centres across the world have changed. Visiting patients by relatives and friends have been stopped or significantly limited. New conditions and legal constraints for family visits had to be implemented also at in-patient palliative care settings, even though accompanying a dying person is crucial for the quality of the end of life. The study aimed to identify and review the visiting policies at in-patient specialist palliative care settings across Central and Eastern Europe. Patients and Methods: The study was conducted one year after the COVID-19 pandemic outbreak from May to October 2021. Information about visiting policies, published on official websites of the in-patient specialised palliative care settings (stationary hospices and hospital-based palliative care units) from Central and Eastern European countries, were identified and categorised. The websites which lacked information about visiting policy during the COVID-19 pandemic were excluded. Qualitative and quantitative analysis of the obtained data was conducted by using content analysis techniques and descriptive analysis. The content from websites was translated into Polish with the usage of the Google Translate machine tool. Result(s): Data from 55 in-patient palliative care settings from 8 countries were collected and analysed (83.6% from Poland, and the other from Bulgaria, Czech Republic, Estonia, Lithuania, Romania, Slovakia and Ukraine). In 43.6% of the organisations, visits were stopped and 56.4% of settings published information about the special requirements for visiting arrangements. In 32.7% of all examined units upfront approval from a physician or the head of a department for visiting a patient was required, and 29.1% published information about personal protective equipment. 32.7% of organizations recommended telephone contact with the patient, and 12.7% provided video calls. Conclusion(s): Web information regarding visiting patients in in-patient palliative care settings is limited. There is a need to establish detailed requirements for the visits with better access to the website for the visitors, in case of a global disease outbreak.Copyright © Via Medica, ISSN 2545-0425, e-ISSN: 2545-1359.

Factors associated with COVID-19 infections among a high-risk sample of adults with intellectual and developmental disabilities in Ontario

This brief report describes the demographic and clinical profiles of 190 adult home care users with intellectual and developmental disabilities tested for COVID-19 from March 2020 to May 2021. A cross sectional study design (n = 190) was conducted. Chi- Square tests, Fisher's Exact tests, and odds ratios with 95% confidence intervals are reported. Older age and congregate living increased the odds of having a positive COVID-19 test, while dependence in personal dressing was associated with decreased odds. These findings provide useful data from the first 15 months of the pandemic;trends over time should be investigated. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Ce rapport bref decrit les profils demographiques et cliniques de 190 residents adultes recevant des soins a domicile et ayant un trouble developpemental ou une deficience intellectuelle qui ont ete testes pour la COVID-19 entre mars 2020 et mai 2021. Un devis d'etude transversale (n = 190) a ete mene. Des tests du Chi carre, des tests selon la methode exacte de Fischer, et des rapports des cotes ayant un intervalle de confiance a 95% sont presentes. Un age avance et la vie en habitation collective a augmente la probabilite d'obtenir un resultat positif au test de la COVID- 19, tandis que la dependance pour l'habillage etait associee a une probabilite moins elevee. Ces resultats offrent des donnees utiles issues des 15 premiers mois de la pandemie;les tendances au fil du temps devraient etre etudiees. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Causes of deaths in long-term care and hospice care facilities during the first year of COVID-19 pandemic: a snapshot of Italy during 2020.

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.

How did the COVID-19 Pandemic Affect Palliative Care Social Work Services? A Scoping Review

SARS-CoV-2 coronavirus (COVID-19) generated life-defining challenges on a global level, which affected the working conditions of all healthcare professionals, who faced the same imminent public health threat as patients and families. Working from home, job loss and requiring access to the Internet illuminated demographic inequalities, poverty, isolation, housing issues and increased financial burdens. Government restrictions around travel bans, social distancing and funerals emphasised feelings of loneliness and isolation. A 600 per cent increase in the number of deaths generated extensive waiting lists for bereavement services and unmet needs. Reduced face-to-face contact, wearing personal protective equipment (PPE) and enforcing visitor restrictions generated moral distress and powerlessness in health and social care professionals who felt unable to provide holistic care. Although telehealth minimised the risk of infection, alleviated transport issues and improved access to health care for some during the pandemic, it highlighted inequalities for people with limited access to Wi-Fi or who were unfamiliar with the information technology required. Restricted visiting left families feeling angry that they were unable to say goodbye in person or that patients died alone. However, transitioning to virtual communication, sharing photos, letters and drawings helped relatives to connect when patients were seriously ill. Some refused inpatient care, despite unmet symptom management and caregiver burden. The SARS-CoV-2 coronavirus-19 (COVID-19) generated life-defining challenges on a global level, affecting healthcare professionals, who faced the same imminent public health threat as patients and families. Reduced face-to-face contact, wearing personal protective equipment and enforcing visitor restrictions generated moral distress in healthcare professionals, unable to provide holistic care. This scoping review explored the impact of the COVID-19 pandemic on palliative care social workers (PCSWs). PubMED, CINAHL and PsycINFO were systematically searched. Empirical studies and reflective articles about palliative care social work during the pandemic were screened. Data extraction used Arksey and O'Malley's framework. Thematic analysis was underpinned by Braun and Clarke for identifying, analysing and reporting patterns. From 706 citations retrieved, 125 were selected for full-text review and 32 were included in the scoping review. Thematic analysis revealed three themes: (i) moral distress, (ii) transitioning and (iii) inequality. Implementing visitor restrictions caused moral distress and raised questions about their justification. Not being present at the time of death generated feelings of anger among bereaved family members. Virtual communication replaced face-to-face contact, yet improved access to Telehealth. Inequalities were illuminated and PCSWs advocated for disadvantaged populations, worked creatively to minimise suffering or stigma and supported peers.

End-of-life care in natural disasters including epidemics and pandemics: a systematic review.

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.

Comparison of Telemedicine with In-Person Outpatient Palliative Care Visits for Children with Cancer (Sch420)

Outcomes: 1. Define quality metrics and health outcomes as they relate to outpatient pediatric palliative oncology care. 2. Analyze differences in palliative interventions delivered in telemedicine versus in-person visits and investigate potential reasons for these differences. Background(s): Contrary to the inpatient focus of most pediatric palliative care (PPC) teams, children with cancer receive the majority of their care in the clinic, highlighting the importance of outpatient PPC for this population. Although many models of care exist, telemedicine use in PPC became nearly universal during the COVID-19 pandemic. While early studies suggest feasibility and acceptability, little is known about the quality of PPC delivered via telemedicine to children with cancer. Objective(s): To compare telemedicine with in-person outpatient palliative care visits in pediatric oncology patients. Method(s): Descriptive retrospective chart review of outpatient PPC visits at a large freestanding children's hospital occurring via telemedicine or in clinic during 2020 and 2021 for children with a primary palliative care diagnosis of cancer. Reason for visit and palliative intervention will be evaluated for telemedicine and in-person visits. Outcomes, including intensive care unit (ICU) and emergency department visits, death in the ICU, and hospice referrals, will be compared among patients with only telemedicine visits, only in-person visits, and both visit types through 2022. Descriptive statistics will be reported. Result(s): Of 394 patients with outpatient PPC visits in 2020 or 2021, 82 were determined to have a primary oncologic diagnosis: 44% solid tumors, 35% leukemia/lymphoma, and 21% CNS tumors. In total, 254 outpatient visits (212 in person, 42 telemedicine) were completed. Five patients had only telemedicine visits, 52 had only in-person visits, and 25 had both visit types. Overall, 72% of patients are deceased to date;of those, 25% (telemedicine 0%, in person 27%, both types 28%) died in the ICU. Additional results are pending. Conclusion(s): Given the small number of patients seen solely via telemedicine, we anticipate difficulty in detecting true differences in health outcomes but are hopeful differences may be more apparent on the encounter level due to a more robust sample size.Copyright © 2023