Context. COVID-19 created unprecedented demand for palliative care at a time when in-person communication was highly restricted, straining efforts to care for patients and families.Objectives. To qualitatively explore the challenges presented by the COVID-19 pandemic from the perspective of palliative care clinicians. Specifically we sought to: 1) Describe the strategies adopted by palliative care clinicians to cope with new challenges including patient and clinician isolation, prognostication of an emergent disease, and rapidly rising numbers of severely ill patients; 2) Identify additions or adjustments to in-person and system-related palliative care training, methods, and tools made during pandemics.Methods. This descriptive qualitative study utilized a thematic approach for data analysis of individual, semi-structured interviews with palliative care clinicians (n = 25). Codes, categories, and emerging themes were identified through an iterative, comparative method. Methods align with the Consolidated Criteria for Reporting Qualitative Research (COREQ)Results. A theme of "Expanding the reach of palliative care for today and the future" was identified with three subthemes: 1) Redefining attitudes and hardship due to collective uncertainty, 2) Breaking with the past towards integrated concept of palliative care, and 3) Building capacity through primary palliative care training.Conclusion. COVID-19 forced hospital systems to consider the inclusion of palliative care in unforeseen ways due to an uncontrollable, unpredictable disease. Faced with unprecedented uncertainty, palliative care clinicians utilized strategies for integration and innovation across hospitals, particularly in intensive care units and emergency departments. A need to build capacity through increased primary palliative care access and training was identified.

No abstract

Purpose: To understand how the COVID-19 pandemic impacted the health behaviors of rural families participating in a healthy lifestyles intervention. Methods: Caregivers of rural children participating in a healthy lifestyles intervention were invited to participate in a structured interview regarding how the COVID-19 pandemic affected their family and family health behaviors. Interviews were transcribed and the research team conducted a rigorous inductive thematic analysis. Findings: Structured qualitative interviews with caregivers (n=30) resulted in 5 saturated themes: (1) caregivers reported new or exacerbated mental health concerns and stress among family members, largely due to social isolation and external stressors, (2) caregivers reported feeling out of control of positive health behaviors for themselves and their children, (3) families reported variability in how they handled reductions in schedule demands, ranging from filling time with positive activities to negative behaviors such as snacking, (4) families continuously re-adjusted their approach to parenting, routines, and health behaviors due to internal and external factors, (5) families ate foods that were accessible and convenient, which impacted the health of the family diet. Conclusions: Despite being asked primarily about lifestyle behavior changes, families reported concerns around mental health. Specifically, families reported the COVID-19 pandemic increased mental health symptoms, such as caregivers and child stress and child behavioral problems. Regarding health behaviors, families reported variability in family meals, increases in unstructured time and increases in family centered activities such as cooking or exercising together. Families also reported challenges unique to their rural status, such as accessibility to fresh groceries.