The Crucial Role of Nurses and Social Workers in Initiating End-of-Life Communication to Reduce Overtreatment in the Midst of the COVID-19 Pandemic

Abstract

The large scale and rapid spread of the current COVID-19 pandemic has changed the way hospitals and other health services operate. Opportunities for patient-centered decision-making at the end of life are being jeopardized by a scarcity of health system resources. In response, the traditional doctor-initiated advanced care planning (ACP) for critical illness may also need to be readjusted. We propose nurse-led and allied health-led ACP discussions to ensure patient and family inclusion and understanding of the disease prognosis, prevention of overtreatment, and potential outcomes in crisis times. We highlight known barriers and list enablers, long-term and short-term opportunities to assist in the culture change.

Opportunities to improve COVID-19 provider communication resources: A systematic review

“…During the pandemic, less completion of advance care planning (ACP) prior to hospital admission was identified and resulted in prolonged grief because families were not allowed to see their loved ones in the midst of active dying or upon post-mortem [ 95 ]. The fourth communication barrier is an intense emotional impact on patient/family and providers [ 56 , 80 , 86 , 87 , 91 , 99 , 100 , 103 ]. Witnessing high numbers of suffering/deaths in a short period of time brought complicated grief for providers during COVID-19 pandemic [ 103 ].…”

COVID‐19 and difficult conversations in critical units: A practical guide for nurses

“…Nurses help families in many instances during the process of communicating bad news; for example, following up conversations to clarify technical terms and jargon, ensuring understanding of difficult information or clarifying the implications of the diagnosis or potential treatments. In addition, families may have a preference for conversations with nurses because of their proximity in the nurse‐family‐patient relationship and the fragility of the relationship with other professionals from the team 7‐9 …”

“…In addition, families may have a preference for conversations with nurses because of their proximity in the nurse-familypatient relationship and the fragility of the relationship with other professionals from the team. [7][8][9] The task of communicating bad news is a complex skill that requires empathy, appropriate body language, and a welcoming voice tone, among other measures that are impaired in the context of the COVID-19 pandemic. 10 Physical distancing prevents touching or hugging, impedes face-to-face conversations regarding the side effects or symptom evolution, and often makes family farewells unfeasible when the patient dies.…”

“…In the COVID-19 pandemic, such protocols are being rapidly reformulated to a telehealth strategy, which has been useful for several professionals who make up the health team. 8,[10][11][12][13] However, when it comes to clinical situations that involve nurses in critical units, for example, the communication of death of a patient with COVID-19 diagnostic, mostly young people, there is little evidence about the application of bad news protocols.…”

Hearts above water: Palliative care during a pandemic

“…With an emphasis on comfort over curative care, the integration of palliative medicine provides patients and families with the assurance that their holistic needs are acknowledged, with a compassionate team striving to meet their specified end-of-life goals. Palliative medicine social workers and nurses exercise an aptitude to empathically translate patient needs into practice to improve quality outcomes and person-centered care (Raftery et al, 2020). Moreover, social work underscores the coping and resilience strategies necessary for patients and families to persist, while acknowledging the unique, existential distress associated with an unpredictable pandemic.…”