The impact of covid-19 on out-of-hours adult hospice care: an online survey

Abstract

Background Globally COVID-19 has had a profound impact on the provision of healthcare, including palliative care. However, there is little evidence about the impact of COVID-19 on delivery of out-of-hours specialist palliative care services in the United Kingdom. The aim of the study is to investigate the impact of the COVID-19 pandemic on the delivery of out-of-hours community-based palliative care services. Methods A national online census survey of managers of adult hospices in the United Kingdom was undertaken. Survey were emailed to managers of adult hospices (n = 150) who provided out-of-hours community palliative care services. Fifteen questions related specifically to the impact of COVID-19. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using descriptive content analysis. Results Eighty-one responses to the survey were returned (54% response rate); 59 were complete of which 47 contained COVID-19 data. Findings indicated that COVID-19 impacted on out-of-hours community-based palliative care. To meet increased patient need, hospices reconfigured services; redeployed staff; and introduced new policies and procedures to minimize virus transmission. Lack of integration between charitably and state funded palliative care providers was reported. The interconnected issues of the use and availability of Personal Protective Equipment (n = 21) and infection control screening (n = 12) resulted in changes in nursing practices due to fear of contagion for patients, carers and staff. Conclusions Survey findings suggest that due to increased demand for community palliative care services, hospices had to rapidly adapt and reconfigure services. Even though this response to the pandemic led to some service improvements, in the main, out-of-hours service reconfiguration resulted in challenges for hospices, including workforce issues, and availability of resources such as Personal Protective Equipment. These challenges were exacerbated by lack of integration with wider healthcare services. More research is required to fully understand the implications of such changes on the quality of care provided.

The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: An integrative review

“…The research was most frequently located in the United States (Bayly et al 2022;Chua et al 2022;Dhavale et al 2020;Hasson et al 2022;Mitchell et al 2022Mitchell et al , 2021Page et al 2020;Sleeman et al 2022;Sumitha et al 2022) of the included articles, followed by the United Kingdom (20-24). The remainder were conducted in India (Dhavale et al 2020;Page et al 2020;Sumitha et al 2022), Italy (Costantini et al 2020;Franchini et al 2021;Varani et al 2021), Germany (Jansky et al 2021;Tielker et al 2021), Australia (Luckett et al 2021), Canada (Wentlandt et al 2021), New Zealand (Frey and Balmer 2022), Taiwan (Chou et al 2020), and one multinational study (Dunleavy et al 2021).…”

“…The majority of studies utilized survey designs with samples of less than 1000 participants (Bayly et al 2022;Costantini et al 2020;Dunleavy et al 2021;Hasson et al 2022;Jones et al 2022;Kates et al 2021;Luckett et al 2021;Mitchell et al 2022Mitchell et al , 2021Ritchie et al 2021;Rogers et al 2021 (Chou et al 2020). While some of the articles exclusively focused on palliative care delivery in the community (Franchini et al 2021;Frey and Balmer 2022;Page et al 2020;Silva and Schack 2021;Sterling et al 2020;Sumitha et al 2022;Varani et al 2021;Weisse and Melekis 2021) or primary care settings (Mitchell et al 2022(Mitchell et al , 2021Ritchie et al 2021;Tielker et al 2021), the majority included palliative care delivery in other settings as well (Bayly et al 2022;Chou et al 2020;Chua et al 2022;Costantini et al 2020;Dunleavy et al 2021;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Rogers et al 2021;Sleeman et al 2022;Wentlandt et al 2021) (Jansky et al 2021;...…”

“…This increased demand led to challenges to the provision of PPE. Fourteen articles reported both inadequate supplies, including PPE supplies and medicines (Bayly et al 2022;Costantini et al 2020;Dhavale et al 2020;Franchini et al 2021;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Luckett et al 2021;Page et al 2020;Ritchie et al 2021;Rogers et al 2021;Sterling et al 2020;Weisse and Melekis 2021;Wentlandt et al 2021). Staff number reductions due to furloughs and redistribution and staff self-isolating (Bayly et al 2022;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Mitchell et al 2021;Ritchie et al 2021;Rogers et al 2021;Sleeman et al 2022) as well as a decrease in service provision from volunteers and the allied health workforce (Costantini et al 2020;Frey and Balmer 2022;Jansky et al 2021;Jones et al 2022;Luckett et al 2021;Mitchell et al 2021;Ritchie et al 2021;Weisse and Melekis 2021) resulted in increased staff workload (Bayly et al 2022;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;…”

“…Internal messaging in specialist organizations (e.g., reduction in team meetings) also led to limited communication among health professional teams (Bayly et al 2022;Franchini et al 2021;Frey and Balmer 2022;Jansky et al 2021;Jones et al 2022;Rogers et al 2021). A shift to telephone and virtual technology for the delivery of care to reduce the possibility of infection was reported by most studies (Bayly et al 2022;Costantini et al 2020;Dhavale et al 2020;Dunleavy et al 2021;Franchini et al 2021;Frey and Balmer 2022;Hasson et al 2022;Jansky et al 2021;Jones et al 2022;Kates et al 2021;Lalani et al 2022;Luckett et al 2021;Mitchell et al 2022;Page et al 2020;Ritchie et al 2021;Rogers et al 2021;Silva and Schack 2021;Sumitha et al 2022;Tielker et al 2021;Wentlandt et al 2021). However, digital technology used to provide care to patients led to challenges in terms of both technical problems and the availability of equipment (Chua et al 2022;Dunleavy et al 2021;Lalani et al 2022;Luckett et al 2021), as well as equity issues related to patient and family access (the digital divide), including digital literacy and connectivity issues (Bayly et al 2022;Chua et al 2022;Lalani et al 2022;Luckett et al 2021;Page et al 2020;Ritchie et al 2021;…”

“…For health professionals, access to upskilling related to end-of-life care delivery during the pandemic (including infection control) (Bayly et al 2022;Costantini et al 2020;Dhavale et al 2020;Dunleavy et al 2021;Franchini et al 2021;Hasson et al 2022;Jones et al 2022;Luckett et al 2021;Mitchell et al 2022;Page et al 2020;Ritchie et al 2021;Sleeman et al 2022;Sterling et al 2020;Sumitha et al 2022) and training in remote technologies (guidelines and the etiquette involved) were reported (Bayly et al 2022;Dunleavy et al 2021;Lalani et al 2022;Ritchie et al 2021;Wentlandt et al 2021). Educational materials related to COVID-19 and health services available were also disseminated to informal carers, families, and patients with varying levels of success in distribution (Dhavale et al 2020;Dunleavy et al 2021;Franchini et al 2021;Luckett et al 2021).…”