National and international non-therapeutic recommendations for adult palliative and end-of-life care in times of pandemics: A scoping review

Abstract

Objective The care of seriously ill and dying people is an important task, especially in times of pandemics and regardless of the patients’ infection status. Before the SARS-CoV-2 pandemic, healthcare systems were not sufficiently prepared for the challenges of palliative and end-of-life care during a pandemic. The aim was to identify and synthesize relevant aspects and non-therapeutic recommendations of palliative and end-of-life care of seriously ill and dying people, infected and uninfected, and their relatives after one year into the pandemic to outline what actions, practices, and procedures were taken to deal with the pandemic and its consequences. Method A scoping literature review following the methods of the PRISMA-ScR. The electronic literature search was conducted in 09/2020 and updated in 02/2021 using MEDLINE (Pubmed), with no restriction of publication date and eligibility criteria. In addition, a manual search was carried out. Results A total of 280 studies met the inclusion criteria and three main aspects have emerged. The reduction of physical contact due to the risk of infection severely limited the work of palliative care professionals and solutions had to be found to maintain palliative and end-of-life care structures. This has been accompanied by strict visitor restrictions and the need to support patients, relatives, and enable contact. The third relevant aspect is the integration of specialist palliative care expertise into other clinical settings. Significance of results This scoping review demonstrates the need for basic palliative care training for every healthcare professional. It supports the importance of developing a national strategy for palliative care in pandemic times in every country, including the digitalization of the healthcare sector to offer telecommunication/telemedicine.

Strategies Addressing the Challenges of the COVID-19 Pandemic in Long-Term, Palliative and Hospice Care: A Qualitative Study on the Perspectives of Patients’ Family Members

“…Saying goodbye together provides resources of mutual emotional support, which in many cases was not available during the pandemic. The reported needs of the relatives are in line with results from other studies and are also reflected in recommendations in national and international guidelines [3,6,17,26,27].…”

Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews

“…Following the screening process, 58 of the 674 identified studies were considered for inclusion, and subsequently, a further 51 studies were excluded because they were not related to ACP,19–56 not review articles57–64 and encompassed pre-pandemic studies 65–69. Finally, we included seven studies—two systematic reviews,70 71 three scoping reviews,7 72 73 one narrative review74 and one critical realist review 75…”

Specialized palliative care for hospitalized patients with SARS-CoV-2 infection: an analysis of the LEOSS registry

“…A systematic review concluded that visiting restrictions led to increased pain, loneliness, depressive symptoms, agitation, aggression and reduced cognitive ability in patients, as well as to anxiety in family members [ 32 ]. Lonely dying of patients has been described as a major family concern [ 33 ], and it is assumed that it negatively impacts on bereavement [ 34 ]. Supporting patients and relatives during visiting restrictions is, together with working under infection prevention precautions and integration of palliative care in other clinical settings, one of three major aspects identified by a scoping review of palliative care in pandemic settings by Gesell et al, and it has been strongly recommended to enable visits in some way as this is of great importance to the patient and families [ 34 ].…”