Covid-19 and Palliative Care: A Bibliometric Analysis

COVID-19 continues to disrupt the life of people worldwide. One of the most vulnerable sections affected by the pandemic are very old and seriously ill people. The present study provides a detailed analysis of the trends in the global scientific production on COVID-19 and palliative care. An analysis of the documents searched from the Scopus database was interpreted by Biblioshiny, an R-based software for bibliometric analysis. A descriptive examination of sources, authors, and records was done, and network analysis of conceptual, intellectual, and social structures. The research revealed ongoing research on this topic in the recent two years. The United States, the UK, India, and Spain have all done extensive research on the subject. The study's findings may aid medical practitioners and policymakers in focusing on critical sections in palliative care in the context of COVID-19. The study also identifies crucial areas in the chosen issue and guides future researchers on developing themes, contexts, and possible collaborations.

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.

Training interprofessional teamwork in palliative care: A pilot study of online simulation activity for registered nurses and nursing associates

Palliative care promotes quality of life for seriously ill and dying patients and their loved ones. An ageing population with more complex chronic and life-limiting conditions will increase the demand for competence in the field. Interprofessional cooperation will be a critical factor in achieving this. Such cooperation within the field of nursing is critical because of registered nurses' (RNs) role and function in patient- and family-centred care. A project focusing on learning interdisciplinary teamwork using simulation as a learning approach was established. Two groups of students participated in the project: one group consisted of 17 nursing associates who were participating in a 2-year part-time study programme in cancer care and palliative care at a vocational college. The second group was made up of 28 RNs, a social worker and learning disability nurses, all postgraduate students taking part in a part-time interdisciplinary programme in palliative care at master's degree level.Simulation activity is usually conducted with participants physically present, but because of the COVID-19 pandemic situation, this was not possible. A pilot project was conducted where simulation activity was tried out as online learning. RNs and nursing associates (NA) participated, and their cooperation was focused on palliative/end-of-life care. They were all trained clinicians in two different study programmes.In this chapter, we present how simulation activity with participants physically present was transformed into an online learning situation. A brief presentation of students' and teachers' reflections on the pedagogical advantages and disadvantages of such a transition is also included. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

PP13.003 Concordance of the patients' preferences and the actual outcomes in elderly with late-stage dementia in Karunruk advance dementia care program

BackgroundDementia is fatal disease and becomes burden due to increased elderly population. Karunruk Palliative Care Center (KPC) has established a care program for late-stage dementia. Family education on disease trajectory and established advance care plan (ACP), which inform about the preferences on place of care and death and medical treatment. The program provides routine home visit by multidisciplinary palliative care team, 24-hour emergency call and direct admission to palliative unit.MethodsProfiles of 65 patients recruited from October 1, 2020 to September 30, 2022 were: 84.6% were > 80 years, 76.93% were in FAST stage > 7c, and 43.07% retained NG feeding/PEG. Data were analyzed to obtain the concordance between the patients' preferences and the actual outcomes.ResultsOnly 7/65 (10.76%) had an ACP before referral. All patients in our program had an ACP. Place of death of 30 patients who died were 43.33% at home, 43.33% at Palliative unit, 10.0% at medical ward, and 3.34% at nursing home.Concordance of patients' preferences and the actual outcomesPlace of death Preferences Actual outcomes Concordance (%)Home 18 13 72.22Hospital 10 10 100.0Nursing home 2 1 50.0Medical treatmentComfort 30 30 100______________________________________________*Six patients changed place of death to hospital due to COVID-19 infection required admission (2), and care giver burden (4). Overall concordance of place of death was 80% and all patients received comfort care. The mean length of care was 404 days (max 1,794, min 13 days)ConclusionThe patient preferences in our program were well respected. A comprehensive palliative care program is essential to improve outcomes and avoid medical futility in these patients.

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.

PP07.003 Why do some people record place of death preferences and some not? Analysis from an electronic palliative care coordination system

BackgroundConsideration and documentation of where individual patients want to die is an important component of advance care planning and helps facilitate care aligned with patients' wishes.AimTo examine factors associated with recording a preferred place of death in Coordinate My Care, a large Electronic Palliative Care Coordination System in London.MethodsAdults with a Coordinate My Care Record, between 01/01/2018 and 05/03/2021 were included. Logistic regression modelling was used to identify clinical, social and demographic factors associated with documenting preference for place of death. Timing of record creation (pre and during the Covid-19 pandemic) was also included.Results72,591 records were analysed (52,006 (71.6%) with a recorded preferred place of death and 20,585 (28.4%) without). Individuals with a recorded preferred place of death were more likely to be older (Aged 80+ compared to <80) OR: 1.19, CI 1.14 – 1.24), less functionally independent (WHO performance status 4 compared to 1, OR: 1.28, CI 1.19 – 1.37), have a ‘Do Not Attempt Cardio-Pulmonary Resuscitation' status (OR: 1.70, CI 1.60 – 1.80), be from least deprived areas (compared to most deprived, OR: 1.08, CI 1.01 – 1.16), live in a care home (OR:1.42, CI 1.35 – 1.50), create their record in the General Practice setting (compared to at an hospital setting OR: 1.42, CI 1.34 – 1.53) and have created their record during the initial wave of the pandemic (compared to pre-pandemic OR: 1.56, CI 1.49 – 1.63).ConclusionsHealth status, living and socio-economic circumstances and the Covid-19 pandemic were associated with whether or not patients had a documented preference for place of death. This has implications for professional training and patient empowerment in terms of having conversations about what matters most to patients at the end of life and how to provide patient centred end-of-life care.

PP07.002 The impact of advance care planning on place of death during the COVID-19 pandemic

BackgroundAt the beginning on the COVID-19 pandemic, advance care planning (ACP) was widely encouraged and endorsed for adults with serious illness to ensure their treatment and care preferences would be honoured, including location of death, often considered a surrogate quality indicator for end-of-life care. Coordinate My Care (CMC) represents the UK's largest Electronic Palliative Care Coordination System that comprises an ACP component.We aimed to examine the impact of ACP on place of death for people who died during the COVID-19 pandemic with a CMC record.MethodsRetrospective cohort analysis of CMC records for people aged over 18 who died between 20/03/20 and 05/03/21 with recorded place of death. Socio-demographic, clinical and ACP-related factors associated with achieving preferred place of death (PPD) were examined using logistic regression.Results11,913 records were included. 76.9% patients died in their preferred place location of death (57.7% Home, 31.4% Care Home, 7.5% Hospice, 3.3% Hospital, 0.1% Other). An increased likelihood of dying in PPD was associated with a ‘Not for resuscitation' (DNACPR) status (OR=1.51, 95% CI 1.17 to 1.93), a Ceiling of Treatment for Symptomatic Treatment (when compared to Full active treatment, OR=3.52, 95% CI 2.77 to 4.50), documented family discussions regarding resuscitation recommendations (OR=1.51, 95% CI 1.33 to 1.72) and 2+ non-urgent care record views in the 30 days before death (OR=1.27, 95% CI 1.13 to 1.43). People from materially deprived areas had a decreased likelihood of dying in their PPD (OR= 0.65, 95% CI 0.54 to 0.79).ConclusionsModifiable elements of ACP significantly influence place of death, even when controlling for socio-economic and demographic determinants. In times of crisis, effective ACP is central to delivering high quality end-of-life care;ACP related factors must be considered in ongoing research on end-of-life outcomes.

PP10.003 The causes of discordant between advanced care plan preference and end-of-life care treatment in patients received conservative kidney management

BackgroundShare decision-making and advance care planning (ACP) is essential for patients with end-stage renal disease (ESRD). Karunrak Palliative Care Center started a Renal Palliative Care Program in 2017, which is the first joint Chronic kidney disease-Palliative care program in Thailand. ESRD patients always received discordant end-of-life care (EOLC).MethodsThe causes of the discordance of EOLC of conservative kidney management (CKM) patients who died during the period of October 1, 2020 to September 30, 2022 were retrospectively reviewed.ResultsThe demographic data of 38 deceased CKM patients were: 78.9% aged ≥75;55.3% Charlson comorbidity index ≥8, 89.5%;Karnofsky Performance status > 40%. Median survival time after entered the program was 409.0 days, IQR= 184.5–602.5 days and 42.1% is greater than 12 months. All patients had ACP documentation, but only 15.8% had advance directive.ConclusionThe causes of discordance between ACP preferences and actual EOLC received majority are from severe symptoms especially dyspnea. Other serious illnesses which led to hospitalization in this report are COVID-19 infection and stroke.

High mortality among patients with severe COVID-19 and Do Not Intubate orders

INTRODUCTION. Moderate to severe respiratory distress among patients with COVID-19 is associated with a high mortality. This study evaluated ventilator support and mortality by Do Intubate (DI) or Do Not Intubate (DNI) orders. METHODS. This was a retrospective study of patients with COVID-19 and a supplemental oxygen requirement of 15 l/min. The patients were divided into two groups corresponding to the first and second wave of COVID-19 and were subsequently further divided according to DI and DNI orders and analysed regarding need of ventilator support and mortality. RESULTS. The study included 178 patients. The mortality was 24% for patients with DI orders (n = 115) and 81% for patients with DNI orders (n = 63) increasing to 98% (n = 46) for patients with DNI orders and very high flow oxygen requirements ( 30 l/min.). From the first to the second wave of COVID-19, the use of constant continuous positive airway pressure (cCPAP) increased from 71% to 91% (p < 0.001), whereas the use of mechanical ventilation decreased from 54% to 28% (odds ratio = 0.38 (95% confidence interval: 0.17-0.85)). CONCLUSION. The mortality was high for patients with DNI orders and respiratory distress with very high levels in supplemental oxygen in both the first and second wave of COVID-19 despite an increase in use of cCPAP and treatment with dexamethasone and remdesivir during the second wave. Hence, careful evaluation on transition to palliative care must be considered for these patients.

Palliative care for cancer patients during the COVID-19 pandemic: A narrative synthesis from 36 studies of 16 countries.

BACKGROUND: During the COVID-19 epidemic, palliative care has become even more indispensable for cancer patients. AIM: To identify the changes in palliative care for cancer patients and improvements in palliative care quality during the COVID-19 pandemic. DESIGN: A systematic review and narrative synthesis was conducted in PubMed, Embase and Web of Science. An evaluation tool using mixed methods was used to assess the quality of the study. The main relevant themes identified were used to group qualitative and quantitative findings. RESULTS: A total of 36 studies were identified, primarily from different countries, with a total of 14,427 patients, 238 caregivers and 354 health care providers. Cancer palliative care has been experiencing several difficulties following the COVID-19 pandemic, including increased mortality and infection rates as well as delays in patient treatment that have resulted in poorer prognoses. Treatment providers are seeking solutions such as electronic management of patients and integration of resources to care for the mental health of patients and staff. Telemedicine plays an important role in many ways but cannot completely replace traditional treatment. Clinicians strive to meet patients' palliative care needs during special times and improve their quality of life. CONCLUSIONS: Palliative care faces unique challenges during the COVID-19 epidemic. With adequate support to alleviate care-related challenges, patients in the home versus hospital setting will be able to receive better palliative care. In addition, this review highlights the importance of multiparty collaboration to achieve personal and societal benefits of palliative care. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Serious illness care quality during COVID-19: Identifying improvement opportunities in narrative reports from a National Bereaved Family Survey.

BACKGROUND: COVID-19 significantly impacted care delivery to seriously ill patients, especially around including family and caregivers in patient care. AIM: Based on routinely collected bereaved family reports, actionable practices were identified to maintain and improve care in the last month of life, with potential application to all seriously ill patients. DESIGN: The Veterans Health Administration's Bereaved Family Survey is used nationally to gather routine feedback from families and caregivers of recent in-patient decedents; the survey includes multiple structured items as well as space for open narrative responses. The responses were analyzed using qualitative content analysis with dual review. SETTING/PARTICIPANTS: Between February 2020 and March 2021, there were 5372 responses to the free response questions of which 1000 (18.6%) responses were randomly selected. The 445 (44.5%) responses from 377 unique individuals included actionable practices. RESULTS: Bereaved family members and caregivers identified four opportunities with a total of 32 actionable practices. Opportunity 1: Facilitate the use of video communication, included four actionable practices. Opportunity 2: Provide timely and accurate responses to family concerns, included 17 actionable practices. Opportunity 3: Accommodate family/caregiver visitation, included eight actionable practices. Opportunity 4: Offer physical presence to the patient when family/caregivers are unable to visit, included three actionable practices. CONCLUSION: The findings from this quality improvement project are applicable during a pandemic, but also translate to improving the care of seriously ill patients in other circumstances, such as when family members or caregivers are geographically distant from a loved one during the last weeks of life.

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.

Health professionals' knowledge about ethical criteria in the allocation of resources in the COVID-19 pandemic.

Due to the rapid advance of the pandemic caused by COVID-19, several countries perceived that human and material resources would be insufficient to meet the demand of infected patients. The aim of this study is to analyze the knowledge of health professionals working in the pandemic about the application of ethical criteria in decision-making in situations of resource scarcity. This is a cross-sectional, descriptive, and quantitative survey study, conducted from June to December 2020, with health professionals working in the COVID-19 pandemic in Brazil. We applied a questionnaire to assess the professionals' knowledge about ethical criteria in decision-making in the allocation of scarce resources during the pandemic, containing 14 questions and possible score from 0 to 70, which was developed by researchers from documents and protocols validated by organizations from various countries, available in the first months of the pandemic, a sociodemographic characterization questionnaire and a self-assessment questionnaire regarding knowledge about bioethics. A total of 197 health professionals participated in the study, 37.6% of whom were nurses and 22.8% of whom were physicians, working in the Family Health Unit (28.4%) with a degree at the level of specialization (46.2%). Moreover, (9.5%) of nurses, (18.2%) of dental surgeons and (24.4%) of physicians reported that they have no prior knowledge about bioethics. Physicians and hospital workers scored higher on the knowledge assessment questionnaire. The mean score of the participants was 45.4 (SD = 7.2). Investments in training and professional education in the field of health focused on Bioethics are necessary, considering models and ethical theories that help professionals, managers and society to better position themselves in the face of pandemic contexts.

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.