Hospital-Based Palliative and End-of-Life Care in the COVID-19 Pandemic: A Scoping Review

Abstract

Aim: To identify the nature of the evidence reporting hospital-based palliative and end-of-life care during the COVID-19 pandemic. Background: The COVID-19 pandemic has seen an increase in the numbers of seriously ill people being cared for across all health services worldwide. Due to the rapid progression of severe symptoms, the majority of staff working in hospitals and other healthcare centres were providing end-of-life care. Little is known about the level of hospital-based palliative care service provided during the COVID-19 pandemic, particularly during surges in admission rates with an increased number of deaths accruing. Methods: A scoping review was conducted to search and select potential studies. The scoping review was guided by the framework of Arskey and O’Malley and advanced by the use of the methodology of the Joanna Briggs Institute. Results: Eighteen studies published between March 2020 and July 2021 were identified. Three broad categories included overall management strategy and logistics, symptom prevalence and management of patients with COVID-19 and end-of-life care needs within the current pandemic. Conclusions: This review highlights increased awareness and knowledge of palliative and end-of-life care provided in hospitals. The review also highlights the response of hospital-based palliative care teams to an evolving crisis, within the context of developed health systems under sustained and overwhelming pressure. Implications: Newly established clinical links and referral pathways developed during the initial COVID-19 surge between hospital-based palliative care and other healthcare teams, be continued and further enhanced. Understanding of the role of specialist palliative care providers in supporting palliative and end-of-life care within the hospital setting needs further investigation.

Impact of the coronavirus disease 2019 pandemic on delivery of and models for supportive and palliative care for oncology patients

“…Although some hospices and PCUs accepted COVID-19-positive patients, most opted not to [ 49 , 50 ]. In addition, hospice and PCU policies that banned visitors made hospice admission unacceptable for many families, as this would result in their loved one dying alone [ 51 ▪ ]. In the city of Palermo, hospice unit bed occupancy dropped from 95 to 40% [ 49 ].…”

A Multi-Centre COVID-19 Study Examining Symptoms and Medication Use in the Final Week of Life

“…Data suggests our international counterparts have been able to control symptoms in people dying of COVID-19 with greater success ( 17 ), perhaps in part due to increased compliance with consensus guidelines and greater involvement of palliative care expertise. A recent scoping review ( 23 ) on inpatient COVID-19 deaths showed a large increase in palliative care referrals, whose role was similarly to guide goals of care and symptom management. Other authors have also supported the role of early palliative care in patients at high risk of dying from COVID-19 ( 8 , 24 ).…”

Supporting dementia family care partners during COVID-19: Perspectives from hospice staff

“…In response to COVID-19, family care partners utilized hospice services differently ranging from actively refusing home visits and respite care to reduce risk of exposure to increasing telephone support; and emotionally, experienced heightened stress, anxiety, and grief. Heightened stress and anxiety of dementia family care partners during the pandemic has been reported in community 29 and hospice settings. 15 For family care partners of facility patients, particularly, not being able to see their loved ones and receiving regular communication from the facility raised their anxiety and stress levels, which in turn led to family care partners’ reliance on hospice interdisciplinary teams for patient updates and emotional support.…”