Palliative care conundrums in an Ebola treatment centre

Abstract

We describe the treatment course and last days of a 33-year-old man from Western Africa who died from Ebola-related complications. Specifically, the issues around declaring a patient palliative in a low resource environment while dealing with a largely unknown entity, Ebola viral disease, make this an important discussion-stimulating case. The patient presented as a confirmed Ebola-positive case from a peripheral holding centre and then proceeded to deteriorate under our care. Significant neurological decline was noted and the prognosis was felt to be grim by certain providers. Other providers disagreed and a number of treatment algorithms were started and stopped during the patient's last days. He succumbed to Ebola complications after 17 days under our care.

The Role and Response of Palliative Care and Hospice Services in Epidemics and Pandemics: A Rapid Review to Inform Practice During the COVID-19 Pandemic

“…Policies Require flexibility and rapid changes to systems and policies 5,10 Limiting visitor hours/numbers 5,10 Change in admission criteria 5 Systems of daily telephone support for families 5 Stopping volunteer services 10 Palliative care and hospice care should be part of the national and Local epidemic/pandemic planning 3,4 Training and protocols Palliative care protocols for nonspecialist staff on management of symptoms and psychological support are essential 3,4,6,7 Training for site leads in the use of the protocols 4 Education and training for nonspecialist staff in basics of palliative care, 8 including in communication and bereavement counseling 11 Consider separate guidelines for specific populations such as people in care homes and those with intellectual disabilities 3 Communication and coordination Sharing of protocols, advice, and standards of care within organizations 6 Identification of a decision maker to improve communication, particularly where multiple health professionals may be involved outside their usual practice 8 Rapid triage to assess likelihood of response to treatment 3…”

“…Standardized information collection 9 Continuous monitoring and evaluation to inform operational changes or quality of services 9 Staff Deployment of staff Flexibility of deployment, such as moving staff from acute setting to the community 5,12 Sufficient staff numbers 8 Restricting contact with volunteers for infection control, 5,10 whereas acknowledging volunteers are integral to the interdisciplinary model in palliative care and can make important contributions to psychosocial and bereavement care 10 Skill mix of staff Involving spiritual care and chaplains in the pandemic response 3,4 Involving psychologists with expertise in palliative care 3 Ensuring resilience of staff Facilitating camaraderie among staff important to minimize negative psychosocial effects on staff, which include distress about risks of contracting the disease, grieving relatives, or friends while working 6 Measures to improve connectedness among staff 11 Training in communication and bereavement counseling 11 Measures to help health care workers deal with stress 11 Space Moving to community provision Consider shifting resources from inpatient to community settings where demand may be higher 5,12 Consider the setup of community care centers to expand outside hospital with standardized designs, include monitoring and evaluation instruments, and make use of training and supervision manuals. Community engagement to foster trust is important 9…”

Palliative care in humanitarian medicine

“…The exceptionally high mortality rates associated with the West African Ebola outbreak have prompted further reflection on the role of palliative care in humanitarian crises. 3,4 A similar trend was seen during the height of the HIV/AIDS epidemic in the late 1990s, as health actors were faced with the need to focus on palliative care in the absence of affordable anti-retroviral treatment (ART). In addition to high mortality situations such as the Ebola and pre-ART HIV epidemics, a substantial proportion of medical humanitarian programmes still focus on the treatment of common diseases in protracted crises in settings with limited health infrastructure.…”

Investigating the Correlation Between the Level of Satisfaction of COVID-19 Patients from Nursing Care with the Level of Observing Patient’s Bill of Rights

“…There are specific guidelines that should be followed by both patients and health care provider when a disease epidemic emerges (19)(20)(21)(22)(23). Due to the nature of emerging diseases, one of the most important challenges in these cases is the quality of nursing care (20), and attention to patients' rights (24).…”