Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 100
Filter
1.
PLoS One ; 17(3): e0264260, 2022.
Article in English | MEDLINE | ID: covidwho-1793519

ABSTRACT

BACKGROUND: Reports on medium and long-term sequelae of SARS-CoV-2 infections largely lack quantification of incidence and relative risk. We describe the rationale and methods of the Innovative Support for Patients with SARS-CoV-2 Registry (INSPIRE) that combines patient-reported outcomes with data from digital health records to understand predictors and impacts of SARS-CoV-2 infection. METHODS: INSPIRE is a prospective, multicenter, longitudinal study of individuals with symptoms of SARS-CoV-2 infection in eight regions across the US. Adults are eligible for enrollment if they are fluent in English or Spanish, reported symptoms suggestive of acute SARS-CoV-2 infection, and if they are within 42 days of having a SARS-CoV-2 viral test (i.e., nucleic acid amplification test or antigen test), regardless of test results. Recruitment occurs in-person, by phone or email, and through online advertisement. A secure online platform is used to facilitate the collation of consent-related materials, digital health records, and responses to self-administered surveys. Participants are followed for up to 18 months, with patient-reported outcomes collected every three months via survey and linked to concurrent digital health data; follow-up includes no in-person involvement. Our planned enrollment is 4,800 participants, including 2,400 SARS-CoV-2 positive and 2,400 SARS-CoV-2 negative participants (as a concurrent comparison group). These data will allow assessment of longitudinal outcomes from SARS-CoV-2 infection and comparison of the relative risk of outcomes in individuals with and without infection. Patient-reported outcomes include self-reported health function and status, as well as clinical outcomes including health system encounters and new diagnoses. RESULTS: Participating sites obtained institutional review board approval. Enrollment and follow-up are ongoing. CONCLUSIONS: This study will characterize medium and long-term sequelae of SARS-CoV-2 infection among a diverse population, predictors of sequelae, and their relative risk compared to persons with similar symptomatology but without SARS-CoV-2 infection. These data may inform clinical interventions for individuals with sequelae of SARS-CoV-2 infection.


Subject(s)
COVID-19/complications , COVID-19/therapy , Palliative Care , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , Case-Control Studies , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Palliative Care/methods , Palliative Care/organization & administration , Patient Reported Outcome Measures , Prognosis , Registries , SARS-CoV-2/physiology , Social Determinants of Health , Therapies, Investigational/methods , Time Factors , Young Adult
2.
Inquiry ; 59: 469580211059989, 2022.
Article in English | MEDLINE | ID: covidwho-1784979

ABSTRACT

The coronavirus pandemic has changed the palliative care and clinical medicine narrative to reduce exposure, maintain social distancing, and mitigate in-person consultation risks. Telemedicine during such times has emerged as a critical technology to bring medical care to patients while attempting to reduce the virus transmission. The telemedicine practice remains highly unregulated, raising concerns about its implementation. In this article, we review the worldwide scenario of policy instruments on telemedicine and also discuss the recently published telemedicine guidelines in India in detail. The methodology adopted included data collection from primary sources-key expert interviews-and secondary sources-systematic literature review. It was observed that even though countries have included telemedicine in their national health strategy, its adoption and dissemination remain a challenge. There is a need for exhaustive telemedicine practice guidelines focusing on key parameters for convenient, accessible, and cost-effective care to patients.


Subject(s)
COVID-19 , Telemedicine , Emergencies , Humans , Palliative Care/methods , Pandemics , Telemedicine/methods
3.
Swiss Med Wkly ; 152(9-10)2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1771497

ABSTRACT

BACKGROUND: Telemedicine in palliative care was initially developed in countries where geography or resources limit access to care services. Recently, largely owing to the COVID-19 pandemic, this technology is being increasingly used in highly urbanised countries such as Switzerland. However, there is still scepticism regarding whether these tools can be used effectively in palliative care, a relationship-based speciality that is generally highly dependent on compassion, communication and direct human interaction. The objective of this review was to analyse the needs, elements of feasibility, and reasons for acceptance or possible barriers before the implementation of a telemedicine intervention in Switzerland. METHODS: The method used was a scoping review, following the PRISMA-ScR reporting guidelines. We searched the PubMed, Ovid SP, Medline, Cochrane and Scopus databases for relevant reports. Charting and analyses of the data were done by a single researcher. A total of 520 records were screened and assessed for eligibility. Finally, 27 studies and 4 registry entries were included. Main reasons for exclusion were wrong population and intervention. RESULTS: The prevailing study type was the single-arm intervention study. Most studies originated from countries with geographic barriers to access. Feasibility was good in 69% of all studies. Good acceptability (84.1-100%) was confirmed in the majority of the studies. The needs of the patients or the healthcare professionals were directly addressed in only five (16%) studies. Three needs were consistently reported: communication, coordination and technical reliability. CONCLUSION: Despite a broad range of studies on telemedicine in palliative care, patients' needs are rarely addressed. Therefore, especially in countries such as Switzerland, a needs assessment is recommended before the implementation of a new telemedicine intervention, to guarantee high feasibility and acceptability.


Subject(s)
COVID-19 , Telemedicine , COVID-19/therapy , Feasibility Studies , Humans , Palliative Care/methods , Pandemics , Reproducibility of Results
4.
Hepatol Commun ; 6(4): 920-930, 2022 04.
Article in English | MEDLINE | ID: covidwho-1756574

ABSTRACT

Palliative care (PC) benefits patients with serious illness including end-stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self-efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post-course surveys were conducted to determine self-efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12-week online course and spent 1-3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self-efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.


Subject(s)
End Stage Liver Disease , Gastroenterologists , Gastroenterology , Hospice and Palliative Care Nursing , End Stage Liver Disease/psychology , Humans , Palliative Care/methods
5.
Curr Opin Psychiatry ; 34(4): 357-362, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1636164

ABSTRACT

PURPOSE OF REVIEW: Opioid use is prevalent in the United Kingdom and prior to the COVID-19 pandemic it had been recognized that the safety of opioids was an important issue to be monitored by the UK medicines regulatory agency. With the emergence of COVID-19, this requirement has been even greater. This review was undertaken to determine the impact of the pandemic on safety and surveillance of opioids in the United Kingdom. RECENT FINDINGS: During the COVID-19 pandemic, the surveillance of opioids in the United Kingdom continued, although primary research was often conducted with data prior to the pandemic. Of those studies that were conducted while the pandemic was ongoing, access to opioids (or opioid substitution therapy) and the subsequent effect on patient safety was the main theme. SUMMARY: In the United Kingdom, changes in accessibility to the healthcare system and how healthcare providers operated during the COVID-19 pandemic may have had unintended consequences on use and safety of opioids, due to the shift in focus to preventing COVID-19 from overwhelming the healthcare system. The findings from this review support the need to continue surveillance in the United Kingdom, including the impact of the COVID-19 pandemic on opioid utilization and safety.


Subject(s)
Analgesics, Opioid/administration & dosage , COVID-19/prevention & control , Drug Misuse/prevention & control , Opiate Substitution Treatment/methods , Opioid-Related Disorders/prevention & control , Analgesics, Opioid/adverse effects , Health Services Accessibility , Humans , Opioid-Related Disorders/therapy , Palliative Care/methods , Pandemics , SARS-CoV-2 , Terminal Care/methods , United Kingdom/epidemiology
6.
J Med Internet Res ; 23(2): e21615, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1573721

ABSTRACT

BACKGROUND: The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients' values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient's wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. OBJECTIVE: To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center's EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. METHODS: We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab's main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. RESULTS: We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. CONCLUSIONS: It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.


Subject(s)
COVID-19/diagnosis , Electronic Health Records/organization & administration , Medical Informatics/methods , Palliative Care/methods , Quality of Life/psychology , User-Centered Design , Humans
7.
Nurs Stand ; 36(11): 61-65, 2021 11 03.
Article in English | MEDLINE | ID: covidwho-1481194

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in the demand for palliative and end of life care, particularly in the community. Furthermore, palliative and end of life care services face growing pressures due to the increasing number of older people and increasing prevalence of chronic illness. Palliative and end of life care cannot be provided solely by specialists but needs to be integrated into mainstream healthcare. All nurses have a role in supporting patients with life-limiting conditions, and their families, by providing what is termed 'generalist palliative care'. However, some nurses may feel unprepared, unsupported or lacking the confidence and skills for that role. This article explores the definitions of palliative and end of life care, as well as the changes and challenges in service provision brought about by the COVID-19 pandemic. It also considers how nurses who have not specialised in this area of practice can be supported to care effectively for patients with life-limiting conditions, and their families, notably through workforce development initiatives such as training programmes and clinical supervision. This could not only increase the skills of the nursing workforce but also improve patient care.


Subject(s)
Community Health Nursing/organization & administration , Nurse's Role , Nurses/psychology , Nursing Staff/education , Palliative Care/methods , Aged , COVID-19 , Clinical Competence , Hospice Care , Humans , Pandemics , SARS-CoV-2 , Terminal Care
8.
Radiol Med ; 126(12): 1619-1656, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1439752

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has challenged healthcare systems worldwide over the last few months, and it continues to do so. Although some restrictions are being removed, it is not certain when the pandemic is going to be definitively over. Pandemics can be seen as a highly complex logistic scenario. From this perspective, some of the indications provided for palliative radiotherapy (PRT) during the COVID-19 pandemic could be maintained in the future in settings that limit the possibility of patients achieving symptom relief by radiotherapy. This paper has two aims: (1) to provide a summary of the indications for PRT during the COVID-19 pandemic; since some indications can differ slightly, and to avoid any possible contradictions, an expert panel composed of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and the Palliative Care and Supportive Therapies Working Group (AIRO-palliative) voted by consensus on the summary; (2) to introduce a clinical care model for PRT [endorsed by AIRO and by a spontaneous Italian collaborative network for PRT named "La Rete del Sollievo" ("The Net of Relief")]. The proposed model, denoted "No cOmpRoMise on quality of life by pALliative radiotherapy" (NORMALITY), is based on an AIRO-palliative consensus-based list of clinical indications for PRT and on practical suggestions regarding the management of patients potentially suitable for PRT but dealing with highly complex logistics scenarios (similar to the ongoing logistics limits due to COVID-19). MATERIAL AND METHODS: First, a summary of the available literature guidelines for PRT published during the COVID-19 pandemic was prepared. A systematic literature search based on the PRISMA approach was performed to retrieve the available literature reporting guideline indications fully or partially focused on PRT. Tables reporting each addressed clinical presentation and respective literature indications were prepared and distributed into two main groups: palliative emergencies and palliative non-emergencies. These summaries were voted in by consensus by selected members of the AIRO and AIRO-palliative panels. Second, based on the summary for palliative indications during the COVID-19 pandemic, a clinical care model to facilitate recruitment and delivery of PRT to patients in complex logistic scenarios was proposed. The summary tables were critically integrated and shuffled according to clinical presentations and then voted on in a second consensus round. Along with the adapted guideline indications, some methods of performing the first triage of patients and facilitating a teleconsultation preliminary to the first in-person visit were developed. RESULTS: After the revision of 161 documents, 13 papers were selected for analysis. From the papers, 19 clinical presentation items were collected; in total, 61 question items were extracted and voted on (i.e., for each presentation, more than one indication was provided from the literature). Two tables summarizing the PRT indications during the COVID-19 pandemic available from the literature (PRT COVID-19 summary tables) were developed: palliative emergencies and palliative non-emergencies. The consensus of the vote by the AIRO panel for the PRT COVID-19 summary was reached. The PRT COVID-19 summary tables for palliative emergencies and palliative non-emergencies were adapted for clinical presentations possibly associated with patients in complex clinical scenarios other than the COVID-19 pandemic. The two new indication tables (i.e., "Normality model of PRT indications") for both palliative emergencies and palliative non-emergencies were voted on in a second consensus round. The consensus rate was reached and strong. Written forms facilitating two levels of teleconsultation (triage and remote visits) were also developed, both in English and in Italian, to evaluate the patients for possible indications for PRT before scheduling clinical visits. CONCLUSION: We provide a comprehensive summary of the literature guideline indications for PRT during COVID-19 pandemic. We also propose a clinical care model including clinical indications and written forms facilitating two levels of teleconsultation (triage and remote visits) to evaluate the patients for indications of PRT before scheduling clinical visits. The normality model could facilitate the provision of PRT to patients in future complex logistic scenarios.


Subject(s)
COVID-19/prevention & control , Neoplasms/radiotherapy , Palliative Care/methods , Radiation Oncology/methods , Consensus , Humans , Italy , Pandemics , Practice Guidelines as Topic , Societies, Medical
9.
J Infect Dev Ctries ; 15(8): 1094-1103, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1405472

ABSTRACT

INTRODUCTION: About 14% of COVID-19 patients experience severe symptoms and require hospitalization. Managing these patients could be challenging for limited-resource countries, such as Palestine. This study aimed to evaluate hospitalized severe COVID-19 patients' treatment outcomes managed with supportive care and steroids. METHODOLOGY: This was a single-center observational retrospective cohort study that enrolled COVID-19 patients admitted to the "Martyrs medical military complex- COVID Hospital" in Palestine. The managing physicians manually collected data through chart reviews, including patients' characteristics, complications, outcomes, and different management modalities. Continuous and categorical variables between those who were discharged alive and who died were compared using t-test and Chi-squares test, respectively. RESULTS: Overall, 334 patients were included in this study. Median (IQR) age was 62(11) years, 49.1% were males, and 29.6% were ICU status patients. The median (IQR) PaO2/FiO2 ratio was 76 (67), and 67.6% of these patients had moderate to severe acute respiratory distress syndrome, and 4.8% of the patients received invasive mechanical ventilation. Most of the patients (78.7%) had at least one comorbidity, and 18.3% developed at least one complication. The overall mortality was 12.3% (95% CI 8.9-16.2%), and the median (IQR) length of hospital stay was 11 (8) days. Age (aOR 1.05, p = 0.08), smoking (aOR 4.12, p = 0.019), IMV (aOR 27.4, p < 0.001) and PaO2/FiO2 ratio (aOR 1.03, p < 0.001) were found to predict higher mortality. CONCLUSIONS: Supportive care for patients with severe COVID-19 pneumonia in a Palestinian hospital with limited resources was associated with in-hospital mortality of 12.3%.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Developing Countries , Health Resources , Hospital Mortality , Palliative Care/statistics & numerical data , Aged , COVID-19/epidemiology , Comorbidity , Critical Care/methods , Critical Care/standards , Critical Care/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Palliative Care/methods , Palliative Care/standards , Respiration, Artificial , Retrospective Studies
10.
Interface (Botucatu, Online) ; 25(supl.1): e200397, 2021.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1388999

ABSTRACT

A pandemia de Covid-19 (doença do coronavírus) vem impondo grandes desafios. Além dos impactos econômicos e sociais, o crescente número de casos e óbitos, a sobrecarga dos serviços de saúde e a situação de vulnerabilidade a qual estão expostos os trabalhadores da saúde têm gerado uma enorme onda de sofrimento. Nesse contexto, os serviços de saúde, a população atendida e os trabalhadores da saúde podem se beneficiar de uma abordagem de cuidado baseada nos Cuidados Paliativos. Os Cuidados Paliativos visam à promoção, à prevenção e ao alívio do sofrimento; à promoção de dignidade, à melhor qualidade de vida e à adaptação a doenças progressivas. Assim, apresentamos reflexões sobre os desafios impostos pela pandemia e a importância dos Cuidados Paliativos neste momento, compreendendo a necessidade de sua adoção como abordagem transversal, incluídos em todos os serviços da Rede de Atenção à Saúde, bem como inseridos na formação profissional em saúde. (AU)


Covid-19 (Coronavirus Disease) has brought great challenges. Apart from the economic and social impacts, the growing number of cases and deaths, the overburden in health services, and the vulnerability situation to which health workers are exposed have been causing great suffering. In this context, health services, their target population, and health workers can benefit from a Palliative Care approach. The objective of Palliative Care is to foster, prevent, and alleviate suffering; promote dignity; improve quality of life; and adapt to progressive disorders. Therefore, this article reflects on the challenges imposed by the pandemics and on the importance of Palliative Care at this difficult time, understanding the need for its adoption as a transversal approach to be included in all Healthcare Network Services and in health professional education. (AU)


La pandemia de la Covid-19 (enfermedad del Coronavirus) ha impuesto grandes desafíos. Además de los impactos económicos y sociales, el creciente número de casos y fallecimientos, la sobrecarga de los servicios de salud y la situación de vulnerabilidad a la que están expuestos los trabajadores de la salud han generado una enorme ola de sufrimiento. En ese contexto, los servicios de salud, la población atendida y los trabajadores de la salud pueden beneficiarse de un abordaje de cuidado basada en los Cuidados Paliativos. Los Cuidados Paliativos tienen como objetivo la promoción, prevención y alivio del sufrimiento, promoción de la dignidad, mejor calidad de vida y adaptación a enfermedades progresivas. De esa forma, presentamos reflexiones sobre los desafíos impuestos por la pandemia y la importancia de los Cuidados Paliativos en este momento, incluyendo la necesidad de su adopción como abordaje transversal, incluido en todos los servicios de la Red de Atención de la Salud, así como inseridos en la formación profesional en salud. (AU)


Subject(s)
Humans , Palliative Care/methods , COVID-19 , Health Services/trends
13.
CMAJ ; 193(6): E223-E224, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1374163
14.
PLoS One ; 16(7): e0254056, 2021.
Article in English | MEDLINE | ID: covidwho-1327975

ABSTRACT

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic is posing major challenges for health care systems. In Germany, one such challenge has been that adequate palliative care for the severely ill and dying (with and without COVID-19), as well as their loved ones, has not been available at all times and in all settings., the pandemic has underlined the significance of the contribution of general practitioners (GPs) to the care of severely ill and dying patients. OBJECTIVES: To describe GPs' experiences, challenges and perspectives with respect to end-of-life care during the first peak of the pandemic (spring 2020) in Germany. MATERIALS AND METHODS: In November and December 2020, a link to an Unipark online survey was sent to GPs registered on nationwide distribution lists. RESULTS: In total, 410 GPs responded; 61.5% indicated that the quality of their patients' end-of-life care was maintained throughout the pandemic, 36.8% reported a decrease in quality compared to pre-pandemic times. Of the GPs who made home visits to severely ill and dying patients, 61.4% reported a stable number of visits, 28.5% reported fewer visits. 62.7% of the GPs reported increased telephone contact and reduced personal contact with patients; 36.1% offered video consultations in lieu of face-to-face contact. The GPs reported that relatives were restricted (48.5%) or prohibited from visiting (33.4%) patients in nursing homes. They observed a fear of loneliness among patients in nursing homes (91.9%), private homes (87.3%) and hospitals (86.1%). CONCLUSIONS: The present work provides insights into the pandemic management of GPs and supports the development of a national strategy for palliative care during a pandemic. To effectively address end-of-life care, GPs and palliative care specialists should be involved in COVID-19 task forces on micro, meso and macro levels of health care.


Subject(s)
COVID-19/psychology , General Practitioners , Terminal Care/methods , Aged , Attitude of Health Personnel , COVID-19/epidemiology , Female , General Practitioners/psychology , General Practitioners/statistics & numerical data , Germany/epidemiology , Humans , Male , Middle Aged , Palliative Care/methods , Palliative Care/psychology , Palliative Care/trends , Referral and Consultation , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Telephone , Terminal Care/statistics & numerical data
15.
J Soc Work End Life Palliat Care ; 17(2-3): 146-157, 2021.
Article in English | MEDLINE | ID: covidwho-1276065

ABSTRACT

The rise of COVID-19 in March, 2020 led to an urgent and acute need for communication guidelines to help clinicians facing a novel disease, amidst a cacophony of voices and demands, find the words to use in the face of this public health emergency. We identified critical topics that arose at the interface of staff, patient and family to guide the structure and content of a guideline. Organized in an easy to read table, the guide was made available to a wide variety of websites, organizations and schools as a free PDF resource across the country and beyond.


Subject(s)
COVID-19/therapy , Critical Illness/therapy , Palliative Care/methods , Social Workers/psychology , COVID-19/psychology , Communication , Humans , Palliative Care/psychology , Patient Education as Topic/methods , Quality of Life/psychology
16.
Sci Prog ; 104(2): 368504211010626, 2021.
Article in English | MEDLINE | ID: covidwho-1195899

ABSTRACT

The Coronavirus (COVID-19) pandemic had a huge impact on all sectors around the world. In particular, the healthcare system has been subject to an enormous pressure that has surpassed its ability in many instances. Additionally, the pandemic has called for a review of our daily medical practices, including our approach to colorectal cancer management where treatment puts patients at high risk of virus exposure. Given their higher median age, patients are at an increased risk for severe symptoms and complications in cases of infection, especially in the setting of immunosuppression. Therefore, a review of the routine colorectal cancer practices is needed to minimize risk of exposure. Oncologists should weigh risk of exposure versus the patient's oncologic benefits when approaching management. In addition, treatment protocols should be modified to minimize hospital visits and admissions while maintaining the same treatment efficacy. In this review, we will focus on challenges that colorectal cancer patients face during the pandemic, while highlighting the priority in each case. We will also discuss the evidence for potential modifications to existing treatment plans that could reduce infectious exposure without compromising care. Finally, we will discuss the impact of the socio-economic difficulties faced by Lebanese patients due to a poor economy toppled by an unexpected pandemic.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19/prevention & control , Cross Infection/prevention & control , Neoplasms/drug therapy , Pandemics , SARS-CoV-2/pathogenicity , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Disease Management , Fluorouracil/therapeutic use , Humans , Infection Control/organization & administration , Lebanon/epidemiology , Monitoring, Physiologic/methods , Neoplasm Staging , Neoplasms/pathology , Organoplatinum Compounds/therapeutic use , Palliative Care/methods , Personal Protective Equipment/supply & distribution , Pyridines/therapeutic use , Telemedicine/methods
17.
J Soc Work End Life Palliat Care ; 17(2-3): 173-185, 2021.
Article in English | MEDLINE | ID: covidwho-1177220

ABSTRACT

Comfort care homes are community-run, residential homes that provide end-of-life care to terminally ill individuals who lack safe, secure housing and a reliable caregiver system. As nonprofit, non-medical facilities, these homes have faced both new and magnified challenges due to the COVID-19 pandemic. This article highlights the value of collaborative interagency partnerships and shares reflections on the unique pandemic pressures faced by comfort care homes. Innovative ideas for improving community-based end-of-life care and implications for social work practice are included.


Subject(s)
COVID-19/therapy , Caregivers/psychology , Nursing Homes/organization & administration , Patient Comfort/methods , Terminal Care/methods , COVID-19/psychology , Clinical Competence , Humans , Palliative Care/methods , Terminal Care/psychology
18.
J Soc Work End Life Palliat Care ; 17(2-3): 137-145, 2021.
Article in English | MEDLINE | ID: covidwho-1172611

ABSTRACT

In the context of widespread loss, isolation, and grief due to COVID-19, palliative social workers came together in the fall of 2020 to form an international group named the World Hospice and Palliative Care Social Work Network (WHPCSW). This emerging global network is committed to amplifying the innovative work, nuanced skills, research, and education and training provided by palliative social workers across different settings around the world. This article highlights some of the novel interventions developed by social workers in response to the pandemic and describes this coalescing WHPCSW network along with information about its mission and membership.


Subject(s)
COVID-19/therapy , Palliative Care/methods , Quality of Life/psychology , Social Workers/education , Attitude to Death , COVID-19/psychology , Humans , Palliative Care/psychology , Social Work , Social Workers/psychology
19.
Anticancer Res ; 41(4): 1971-1974, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1168333

ABSTRACT

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.


Subject(s)
COVID-19/epidemiology , Cost of Illness , Neoplasms/radiotherapy , Palliative Care/methods , Pandemics , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/etiology , Bone Neoplasms/epidemiology , Bone Neoplasms/secondary , Cancer Pain/diagnosis , Cancer Pain/epidemiology , Cancer Pain/etiology , Depression/epidemiology , Depression/etiology , Female , Humans , Male , Middle Aged , Neoplasms/complications , Neoplasms/epidemiology , Neoplasms/pathology , Norway/epidemiology , Retrospective Studies , SARS-CoV-2/physiology , Survival Analysis , Symptom Assessment
20.
Support Care Cancer ; 29(5): 2501-2507, 2021 May.
Article in English | MEDLINE | ID: covidwho-757234

ABSTRACT

COVID-19 was first reported in Wuhan, China, in December 2019; it rapidly spread around the world and was declared a global pandemic by the World Health Organization in March 2020. The palliative care program at the Princess Margaret Cancer Centre, Toronto, Canada, provides comprehensive care to patients with advanced cancer and their families, through services including an acute palliative care unit, an inpatient consultation service, and an ambulatory palliative care clinic. In the face of a global pandemic, palliative care teams are uniquely placed to support patients with cancer who also have COVID-19. This may include managing severe symptoms such as dyspnea and agitation, as well as guiding advance care planning and goals of care conversations. In tandem, there is a need for palliative care teams to continue to provide care to patients with advanced cancer who are COVID-negative but who are at higher risk of infection and adverse outcomes related to COVID-19. This paper highlights the unique challenges faced by a palliative care team in terms of scaling up services in response to a global pandemic while simultaneously providing ongoing support to their patients with advanced cancer at a tertiary cancer center.


Subject(s)
COVID-19/epidemiology , Neoplasms/therapy , Canada/epidemiology , Humans , Palliative Care/methods , Pandemics , SARS-CoV-2/isolation & purification , Tertiary Care Centers
SELECTION OF CITATIONS
SEARCH DETAIL