Missing the human connection: A rapid appraisal of healthcare workers’ perceptions and experiences of providing palliative care during the COVID-19 pandemic

Abstract

Background: During infectious epidemics, healthcare workers are required to deliver traditional care while facing new pressures. Time and resource restrictions, a focus on saving lives and new safety measures can lead to traditional aspects of care delivery being neglected. Aim: Identify barriers to delivering end-of-life care, describe attempts to deliver care during the COVID-19 pandemic, and understand the impact this had on staff. Design: A rapid appraisal was conducted incorporating a rapid review of policies from the United Kingdom, semi-structured telephone interviews with healthcare workers, and a review of mass print media news stories and social media posts describing healthcare worker’s experiences of delivering care during the pandemic. Data were coded and analysed using framework analysis. Setting/Participants: From a larger ongoing study, 22 interviews which mentioned death or caring for patients at end-of-life, eight government and National Health Service policies affecting end-of-life care delivery, eight international news media stories and 3440 publicly available social media posts were identified. The social media analysis centred around 274 original tweets with the highest reach, engagement and relevance. Incorporating multiple workstreams provided a broad perspective of end-of-life care during the COVID-19 pandemic in the United Kingdom. Results: Three themes were developed: (1) restrictions to traditional care, (2) striving for new forms of care and (3) establishing identity and resilience. Conclusions: The COVID-19 pandemic prohibited the delivery of traditional care as practical barriers restricted human connections. Staff prioritised communication and comfort orientated tasks to re-establish compassion at end-of-life and displayed resilience by adjusting their goals.

Smiles behind the masks: A systematic review and narrative synthesis exploring how family members of seriously ill or dying patients are supported during infectious disease outbreaks

“…Grounded in recognition of the family as a social unit connected by blood and/or kinship, emotional and legal relationships, 38 extending care to family is more, not less important in times of crisis 39 and essential to maintaining humanity and compassion in care. 40 Under normal circumstances, when a person is critically ill or dying, family members have social and cultural obligations associated with the family connection 41 ; they want to stay close, 42 keenly observe, protect and comfort.…”

Staff Experience of a Canadian Long-Term Care Home During a COVID-19 Outbreak: A Qualitative Study

“…Working as direct care workers during a global pandemic, like COVID-19, can be very challenging and stressful, with concerning implications for health and wellbeing (5,13),The World Health Organization (2020) has warned about the potential negative impact that the pandemic has had on direct-care staff's mental wellbeing (17). Globally, many health care workers have spoken about the trauma that this pandemic has incurred in their lives, such as the experience of losing patients, and the stress of being at the frontlines (18). Health care workers who have had to make challenging decisions during the pandemic can experience moral injury, which can lead to the development of burnout and other mental health concerns (19,20).…”

What do we know about the impact of the Covid-19 pandemic on hospices? A collaborative multi-stakeholder knowledge synthesis

“…Concerns about the detrimental effect on quality of hospice care were found in the literature (e.g. Mitchinson et al, 2021), as well as being voiced during the stakeholder event and knowledge exchange panel. It may take several years to properly assess the full effect upon the quality of palliative care.…”

“…Hospice at home. Due to the restrictions on usual forms of hospice care (Mitchinson et al, 2021), there has been an increase in the amount of palliative care being carried out in people's homes, particularly for care that previously would see patients admitted to hospices or hospitals (Dunleavy et al, 2021;see also, APPG for Terminal Illness, 2021). Significantly, there has also been an increase in the palliative care and support that family members have been expected to provide at home and in care homes (Sleeman et al, 2021).…”

“…But not all changes were continued with, nor were all adaptations successful. For example, some stakeholders explained that at the start of the pandemic, they had sought to call all their service users to provide reassurance and continuity of care, as they aimed to find ways to maintain human connections and re-establish compassion towards the end of life (Etkind et al, 2020;Mitchinson et al, 2021). But the stakeholders related how, as the weeks progressed, decisions were made to stop these proactive phone calls as they anticipated being overwhelmed.…”