Lessons Learned from Caring for Patients with COVID-19 at the End of Life

Abstract

Over 140,000 people in the United States have died as a result of infection with COVID-19. These patients have varying death experiences based on their location of death, the availability and utilization of various medical technologies, the amount of strain on the local health care system, the involvement of specialist palliative care (PC) teams, and access to essential medications to alleviate symptoms at the end of life. The objective of this report is to describe the death experiences of four patients cared for in an urban academic medical center who received very different degrees of medical interventions and to examine the interventions of our interdisciplinary PC team. We conclude that PC teams must adapt to this new landscape by creating best practices for ensuring adequate symptom control, modifying approaches for withdrawal of life-sustaining medical technologies, and gaining facility with communication through teleconferencing platforms to meet the challenge of alleviating suffering for people dying from COVID-19.

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

“…Early engagement also gave the palliative care team time to clarify the best practices for communication with each family unit by determining the mode of communication (telephone conference vs video conference) and the best way to incorporate interpreter services when indicated. 25 Some of these functions served to lighten the burdens faced by the ICU staff, who were caring for up to 6 patients on ECMO at one point during a surge of COVID-19 cases. The benefits of an “embedded” palliative care team for hospital units caring for a high number of critically ill patients with COVID-19 may be even greater, as evidenced in one study of emergency department providers.…”

“…Early engagement also gave the palliative care team time to clarify the best practices for communication with each family unit by determining the mode of communication (telephone conference vs video conference) and the best way to incorporate interpreter services when indicated. 25 Some of these functions served to lighten the burdens faced by the ICU staff, who were caring for up to Figure 1. Time-to-event analysis from date of ECMO cannulation to date of death, stratified by age greater than or less than 50 years.…”

“… 20 - 23 Specific palliative care team actions can include symptom management, assistance with complex medical decision making, and patient/family support including spiritual, psychological, and bereavement care. 24 , 25 The need for these actions is particularly evident when patients are critically ill and require advanced medical technologies such as ECMO, arguing for the involvement of palliative care in these situations.…”

Pandemic impact on patients with advanced non-COVID-19 illness and their family carers receiving specialised palliative home care: a qualitative study

“…During the pandemic, much interest has focused on palliative care needs for patients infected with COVID-19. [14][15][16][17] A few studies have also explored how to practically perform and maintain high-quality palliative care for patients who were non-COVID during the pandemic. 18 However, there is a lack of studies focusing on the experiential impact of the COVID-19 pandemic on patients receiving specialised palliative home care for reasons other than COVID-19.…”

Repensando el liderazgo y los cuidados de enfermería en la era pospandemia

“…Las alteraciones incluyeron espacios de trabajo con distancia social (en nuestra profesión eso ha sido realmente difícil), la cancelación de múltiples consultas programadas, el seguimiento y la continuidad de cuidados se ha tenido que reinventar o adaptar con el uso de tecnologías (la teleconsulta a la orden del día), el retraso en el diagnóstico, la restricción de los privilegios de visita de los pacientes hospitalizados, trabajar con nuevos procedimientos y condiciones (jamás olvidaremos el uso de equipos de protección individual [EPIs]), el miedo, la incertidumbre y la inseguridad, el cambio de los patrones de flujo de pacientes, la asignación de personal a centros de trabajo o unidades no familiares, y en definitiva, un cambio casi radical en la forma de comunicarnos con otros profesionales, con los pacientes y con los cuidadores. Todo esto ha tenido un impacto durísimo en la atención a las personas con deterioro cognitivo 4 . Y es en esa área donde las enfermeras han reorganizado la asistencia y el liderazgo de una forma magistral, con pocos recursos y grandes dosis de cohesión profesional 5 .…”