23 Community palliative care and the coronavirus pandemic: a retrospective analysis of symptom burden, advance care planning and survival in 115 newly referred patients ‘suspected Covid-19’ compared with ‘control’

ABSTRACT

BackgroundGiven the symptom burden, complex decision making & communication, and mortality associated with Covid-19, the role of palliative care within the pandemic has been defined. Published data is largely from the hospital setting, and information about community palliative care teams (CPCTs) and Covid-19 is lacking. This study aims to review referrals to a London CPCT during the pandemic and compare suspected Covid-19 with non-Covid-19 referrals, to establish clinical patterns and optimise planning for a second wave.MethodsRetrospective case-note review of 115 consecutive new referrals to a London CPCT between 9th March and 30th April 2020. Demographics, response to referral, symptomatology, Advance Care Planning (ACP) and outcomes were extracted and analysed using descriptive statistics.Results53 patients were categorised as suspected Covid-19, 40 of which were residing within a care home, with 62 as non-Covid-19 controls. End of life care was the commonest referral reason in the suspected Covid-19 group (53%) compared with symptom control (81% in controls). Reduced appetite, fatigue and pain were the most common documented symptoms in all, followed by shortness of breath in the suspected Covid-19 group and nausea/vomiting in the controls.Prior to CPCT assessment, 78% of the suspected Covid-19 patients had comprehensive ACP in place, compared to 31% (controls). Time from referral to death was short in the Covid-19 group median 5 versus 22 days.ConclusionsCare home patients were disproportionately affected by suspected Covid-19, and these patients were symptomatic and deteriorated quickly. The rapid deterioration in suspected Covid-19 patients may highlight a potential difficulty in refers ‘diagnosing dying’ in these patients. It has allowed us to draw recommendations for future practice. These include combining the CPCT triage and first assessment, using video-conferencing as default, and ongoing work to increase ease of access to anticipatory injectable medications when needed.