Barriers and facilitators to specialized palliative care integration for patients with COVID-19

ABSTRACT

Background: Specialized palliative care (SPC) teams are well placed to support patients with advanced COVID-19 in Canada, but evidence indicates integration so far has been variable. Aim: To understand barriers and facilitators of SPC integration in the management of patients with COVID-19. Methods: Semi-structured interviews were conducted with physicians across Canada about their experiences providing care to patients with COVID-19. Thematic analysis was used to describe and interpret overarching themes. Results: Twenty-three physicians (12 SPC, 5 intensivists, 6 general internists) were interviewed. Interim analysis of 16 coded interviews demonstrated that facilitators/barriers to providing COVID-19 care fell into 5 main categories patient-related, provider-related, Disease-specific, SPC service, and leadership factors. Patient-related items included age, comorbidities, goals, speed of decline and clustering of patients. Non- SPC provider-related factors included experience providing palliative care and working with the SPC team, time, and motivation. Uncertainty around COVID-19 progression, management and infection control practices were identified disease-specific barriers. SPC service factors included stigma related to palliative care, the accessibility, availability, and readiness of SPC services to meet the perceived needs of patients with COVID-19. Leadership facilitators included institutional mandated or supported integration, and SPC? presence at COVID-19 planning tables. Ways to improve integration included educational initiatives, relationship building, formal integrated structures and presence at institutional COVID-19 planning tables. Conclusion: Preliminary analysis highlights the need for high-level support for formal SPC integrated structures, a SPC role in pandemic planning, and the need for ongoing educational and relationship building initiatives to overcome barriers of SPC integration in COVID-19 care.