Creating a Palliative Care Inpatient Response Plan for COVID-19—The UW Medicine Experience

Fausto, James A.; Hirano, Lianne; Lam, Daniel; Mehta, Amisha; Mills, Blake D.; Owens, Darrell; Perry, Elizabeth; Curtis, J. Randall

doi:10.1016/j.jpainsymman.2020.03.025

Cited by 104 publications

(158 citation statements)

References 8 publications

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“…This also raises the need for early palliative care intervention and incorporation within treatment plans. Although the capacity for palliative care may be limited at this time due to increased demand, 66 experiences from other institutions do provide a framework to improve delivery of high‐quality palliative care during the pandemic 67,68 . These measures, however, do not specifically address patients with cancer, as of yet.…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

et al. 2020

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Background: In the context of COVID-19, cancer survivors represent a particularly vulnerable population that may be "doubly hit" by both costs of cancer treatment and financial strain imposed by the pandemic. Methods: We performed a review of the literature pertaining to cancer, financial toxicity, and economic challenges. Results: Multiple societies have put forth recommendations to modify delivery of cancer care in order to minimize patient exposure to the virus. Cancer survivors, especially patients with head and neck cancer, have been disproportionately affected by rising unemployment levels and economic recessions in the past, both of which are linked to higher cancer mortality. Patients who rely on employer-provided insurance and do not qualify for Medicaid may lose access to life-saving treatments.Conclusions: It is essential to implement interventions and policy changes in order to mitigate the effects of this pandemic but also to ensure this becomes a nonissue during the next one.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

et al. 2020

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“…Rationale: Family meetings for patients with COVID-19 are often held online to preserve PPE. [25] Communication and breaking difficult news remotely requires other communication skills in which healthcare professionals usually have no previous training. Healthcare professionals rely on in-person and non-verbal cues to facilitate difficult conversations [26], and may be reluctant to discuss sensitive topics during phone or video consultations.…”

Section: Patients With Serious Covid-19 In Palliative Care and Distrementioning

confidence: 99%

COVID-19: guidance on palliative care from a European Respiratory Society international task force

et al. 2020

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BackgroundMany people are dying from COVID-19, but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with increased need of palliative care provided to many patients by clinicians with limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process.MethodsWe invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted.Results68 experts (75.6%) responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58/68 (85.3%) of the first round experts responded, resulting in consensus also for the 14th recommendation.ConclusionsThis multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.

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“…Palliative medicine has risen to the task by creating care plans, disseminating resources, and facing this crisis together. [3][4][5][6][7] Virginia Commonwealth University Health System (VCUHS) is a tertiary referral center located in Richmond, Virginia. The inpatient palliative care system at VCUHS consists of an 11-bed inpatient unit with specialized palliative providers and nursing care as well as a robust consult service.…”

Section: Introductionmentioning

confidence: 99%

Systems Barriers to Assessment and Treatment of COVID-19 Positive Patients at the End of Life

Pahuja

Wojcikewych

2021

Journal of Palliative Medicine

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The Novel Coronavirus SARS-CoV-2 (COVID-19) pandemic is changing how we deliver expert palliative care. We can expect many to die prematurely secondary to COVID-19 across the United States. We present a case of how several hospital systems-based interventions, intended to slow viral spread and to protect health care workers, have inadvertently created barriers to routine palliative interventions in this patient population. Isolation of patients, limitation of visitors and interdisciplinary support, and changes in nursing and provider assessment have all had their impact on how we deliver palliative care. These barriers have altered many aspects of our established workflow and algorithms for care, including changes in communication, goals of care discussions, how providers and nurses are monitoring for symptoms, and end-of-life monitoring. These challenges required real-time solutions such as technology utilization, proposing a change in medical delivery systems, and reducing redundancy to preserve personal protective equipment. To continue to deliver quality care for this patient population, palliative medicine must adapt quickly.We present a case that illustrates how safety precautions implemented for COVID-19 have created unique barriers to assessing and treating symptoms in this patient population at the end of life and changes made within our system to overcome these barriers.

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Creating a Palliative Care Inpatient Response Plan for COVID-19—The UW Medicine Experience

Cited by 104 publications

References 8 publications

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

COVID-19: guidance on palliative care from a European Respiratory Society international task force

Systems Barriers to Assessment and Treatment of COVID-19 Positive Patients at the End of Life

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