The thought of going into hospital for non-emergency interventions during the pandemic can be frightening, for fear of contracting the coronavirus. For people in the palliative care phase, hospitals may be considered to increase the risk of contracting the disease, and therefore, a reluctance to go into hospitals. While the rationale may focus on reducing risk, it can also allow health conditions to deteriorate, with possible fatal consequences. When this happens, most of the palliative care is provided in the community without much recognition or appreciation of the health professionals, such as community nurses, who make a positive impact on people's quality of life. While community palliative care nursing has a number of different models of provision, for example, standard and enhanced community-based palliative care, and delivered in different settings (care homes, nursing homes, hostels and patients' own homes), the central point is that, despite these differences, the outcome of care should address and support patients' pressing needs and the needs of those close to them (National Institute for Health and Care Excellence (NICE), 2018). Community palliative care nursing is set up to coordinate care through honest care planning, underpinned by empathy and holistic appreciation that patients not only come with complex needs, but that finding smart solutions will support and manage their overall wellbeing and quality of life. Offering such a humanistic approach to care does not only recognise the fears inherent in some patients about going into hospital, but reaffirms their safety while ensuring high-quality care for all. More should be done to support and appreciate community palliative care nursing, especially during this pandemic.
There is both clinical and economic evidence to suggest that community-based palliative care has better care outcomes compared with hospital-based palliative care, although the economic argument is less compelling:
On the basis of economic outcomes focused on cost-effectiveness, community-based specialist palliative care had reduced overall costs, but the corresponding impact on quality of life was negligible (NICE, 2018). In terms of cost utility, NICE (2018) concluded that ‘one cost-utility found community-based specialist palliative care to dominate usual care, reducing costs and improving health outcomes’ (p 23). However, this evidence was also reported to have serious limitations, although this was not elaborated on. It can be argued that, despite these limitations, there are more benefits for patients receiving community-based palliative care than those who receive palliative care in hospital.
As the pandemic seems to put more pressure on community palliative care nursing, it is critical that the NHS increases its support for community nurses to deliver the best possible palliative and end-of-life care. The minimum expectation is that community nurses are equipped with the basics necessary to deliver generalist palliative care. Phillips et al (2020) went further and suggested that every nurse should be trained to deliver generalist palliative care, and that this can be achieved through whole-system reform and investment to create sustainable capabilities at the generalist level. At this level, nurses are able to conduct a full assessment and identify and then devise an effective plan to manage both physical and psychological symptoms, such as mild pain and anxiety, while being aware of advanced care planning needs and when to refer to other more experienced clinicians. Undoubtedly, effective communication skills are fundamentally important in palliative care (Phillips et al, 2020), and efforts should, therefore, be directed towards upskilling community nurses so that they can confidently facilitate dialogues with patients and families about treatment options and choices about care and death.