Inpatient generalist palliative care during the SARS-CoV-2 pandemic – experiences, challenges and potential solutions from the perspective of health care workers

Abstract

Background The SARS-CoV-2 pandemic has presented major challenges to the health system. Despite high acute case numbers, patients without Covid-19 still need to be cared for. Due to the severity of the disease and a possible stressful overall situation, patients with palliative care needs also require comprehensive care during pandemic times. In addition to specialized palliative care facilities, this also takes place in non palliative care wards. In order to ensure this general palliative care also in pandemic times, the experience of the staff should be used. The aim of this paper is to examine challenges and possible solutions for general palliative care inpatients in relation to the care of seriously ill and dying patients and their relatives. Methods Qualitative semi-structured focus groups were conducted online for the study. Participants were staff from intensive care or isolation wards or from units where vulnerable patients (e.g. with cognitive impairment) are cared for. The focus groups were recorded and subsequently transcribed. The data material was analysed with the content structuring content analysis according to Kuckartz. Results Five focus groups with four to eight health care professionals with various backgrounds were conducted. Fifteen main categories with two to eight subcategories were identified. Based on frequency and the importance expressed by the focus groups, six categories were extracted as central aspects: visiting regulations, communication with relatives, hygiene measures, cooperation, determination of the patients will and the possibility to say good bye. Conclusion The pandemic situation produced several challenges needing specific solutions in order to manage the care of seriously ill and dying patients. Especially visiting needs regulation to prevent social isolation and dying alone. Finding alternative communication ways as well as interprofessional and interdisciplinary cooperation is a precondition for individualised care of seriously ill and dying patients and their relatives. Measures preventing infections should be transparently communicated in hospitals.

Palliative Care e-Learning for Physicians Caring for Critically Ill and Dying Patients during the COVID-19 Pandemic: An Outcome Evaluation with Self-Assessed Knowledge and Attitude

“…In this 2 of 10 situation, university research groups from all over Germany founded a joint project named "National Strategy for Palliative Care of Severely Ill and Dying People and their Relatives in Pandemics" (PallPan) [4]. As part of this research group, the Interdisciplinary Center for Palliative Medicine in Duesseldorf conducted a qualitative study to investigate experiences and challenges related to the care of critically ill and dying patients (with or without COVID-19 infection) and their relatives in general inpatient palliative care (PC) [5]. From this study, six critical categories were identified, addressing the following topics: visiting regulations, communication with relatives, hygiene measures, cooperation, determination of the patients' will, and the possibility of saying goodbye [5,6].…”

“…As part of this research group, the Interdisciplinary Center for Palliative Medicine in Duesseldorf conducted a qualitative study to investigate experiences and challenges related to the care of critically ill and dying patients (with or without COVID-19 infection) and their relatives in general inpatient palliative care (PC) [5]. From this study, six critical categories were identified, addressing the following topics: visiting regulations, communication with relatives, hygiene measures, cooperation, determination of the patients' will, and the possibility of saying goodbye [5,6]. Based on our findings, an electronic learning (e-learning) tool was developed within the framework of PallPan to expand the scope of the results and offer interactive support to a larger number of health care workers [4,6].…”

Specialist Palliative Care Consultations in COVID-19 Patients in the ICU—A Retrospective Analysis of Patient Characteristics and Symptoms at a German University Hospital

“…An investigation of specialist outpatient PC reported changes in the care of patients due to restrictions in visiting hours and highlights the important role of outpatient sPC care in COVID-19 patients not being admitted to hospitals [ 21 ]. Inpatient sPC was also part of the PallPan project [ 23 , 43 , 44 ]. In both general and specialist inpatient PC, the increased hygiene standards with the mandatory personal protective equipment, together with impaired communication, restricted visiting hours and hampered interdisciplinary cooperation, were considered burdensome [ 23 ].…”

“…Inpatient sPC was also part of the PallPan project [ 23 , 43 , 44 ]. In both general and specialist inpatient PC, the increased hygiene standards with the mandatory personal protective equipment, together with impaired communication, restricted visiting hours and hampered interdisciplinary cooperation, were considered burdensome [ 23 ]. Overall, the PallPan project addressed multiple aspects of PC such as the infrastructure, patients with and without COVID-19, the relatives, mourning and the healthcare professionals.…”

“…Right at the beginning of the pandemic, the constant demand for inpatient PC was assessed, and the sPC teams responded to the pandemic situation, e.g., using digital telehealthcare approaches [ 13 , 14 , 15 , 16 , 17 ]. However, the general PC and sPC infrastructure also suffered, e.g., through staff shortages, strict visiting regulations, impaired communication within the team and with patients and their families [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. In addition, some sPC units and hospices were closed [ 13 , 21 ].…”