References

Arya A, Buchman S, Gagnon B, Downar J. Pandemic palliative care: beyond ventilators and saving lives. CMAJ. 2020; 192:(15)E400-E404 https://doi.org/10.1503/cmaj.200465

Public Health England. Disparities in the risk and outcomes of COVID-19. 2020. https://tinyurl.com/y96kmfvp (accessed 5 June 2020)

Powell VD, Siveira MJ. What should palliative care's response be to the COVID-19 epidemic?. J Pain Symptom Manage.. 2020; https://doi.org/10.1016/j.jpainsymman.2020.03.013

Strengthening palliative care in today's challenges

02 July 2020
Palliative Care
02 July 2020
Volume 25 · Issue 7

It continues to be documented how the COVID-19 pandemic is transforming the way we live and die in this country and around the world (Arya et al, 2020; Powell et al, 2020). Like the 9/11 terrorist attacks in America changed the way we fly and are processed through airport security, the COVID-19 pandemic is destined to change the way we live, die and provide end-of-life nursing care, in particular, for years to come. Health professionals have already started to introduce different ways of teaching and providing palliative care with COVID-19 in mind, so that patient experience and quality of care does not suffer. The pandemic has also highlighted disparities in the risk of COVID-19 among people from black, Asian and minority ethnic (BAME) backgrounds, with the UK witnessing a disproportionate number of deaths among BAME workers within the NHS (Public Health England (PHE), 2020) since the pandemic started. Sadly, the report by PHE fails to fully explain the underlying reasons for these disparities in order to give health professionals and guidance writers better understanding and confidence in developing strategies to reduce the disproportionate deaths going forward. Palliative care is an important set of principles that can be delivered in all places within and without buildings to the benefit of dying patients and those deemed important to them. Given these and many other issues surrounding the pandemic, it is apparent that the way palliative care is provided needs to change fast to reflect these challenges, and it is important to predict the possible impact of COVID-19-related deaths on staff and the bereaved well after the pandemic is over. Palliative care is necessary and can be strengthened to offer support to patients and families by ensuring that some of the following are in place or being planned for:

  • It is paramount that high-quality personal protective equipment (PPE) is readily available to all staff, including maintenance staff, such as cleaners and porters
  • Palliative care training should be offered to new staff, with an emphasis on how the same principles of palliative care can be incorporated with wearing PPE and social distancing for relatives
  • Refresher training should be provided to existing staff and all allied health professionals, including pastoral carers, on the essential holistic issues at the end of life and effective communication skills
  • Pain control should be central for all prescribers, who should also recognise that psychological and emotional concerns may compound any physical pain being reported
  • Social and emotional connection between patient and families should be encouraged through the use of smart technology (e.g. video meetings on smart devices)
  • Use smart technology, where possible, for families to virtually visit and partake in healthcare decisions with loved ones at the end of life to ameliorate perceived universal fear of dying alone
  • The necessary barrier of PPE should be acknowledged, but patients should be reassured that health professionals are close to them, and they should be supported
  • A more detailed report is needed on what makes BAME populations more susceptible to the coronavirus
  • Staff should have the courage to admit when they are not coping with the demands and stresses faced with caring for dying patients
  • It is paramount that support for staff is customised to their needs, with peer or professional counselling and virtual check-ins for staff with an identified contact person or group in place. Some staff may require time out to re-energise and reflect, and these requests should be treated as normal and not as a sign of poor coping skills.

    • Scientists and the Government need to continue to educate staff and the public on new understandings about the coronavirus to ensure public adherence to any guidance. Sharing new understandings helps us to keep the reproduction (r) rate low and, therefore, control COVID-19-related deaths. Staff can then confidently care for patients dying from other causes without being placed at risk themselves. In this way, the quality of care will strengthen the notion of palliative care and result in dignified deaths for all. Families and close friends of the patient will also play their part in remaining physically and emotionally close while offering their own type of support during dying and at death.