The impact of Covid-19 pandemic on hospices: A systematic integrated review and synthesis of recommendations for policy and practice

Abstract

Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care.

A bad time to die? Exploring bereaved families/wha-nau experiences of end-of-life care under COVID-19 restrictions: a qualitative interview study

“…10 In addition, findings from this study show that existing wraparound care models such as hospice did support some families well and therefore need to be better resourced to improve accessibility to a wider number of people. 8 Another key finding from this study was people's experiences of culturally-safe palliative and endof-life care during the pandemic. We identified that pandemic policies, such as visiting restrictions to institutional care settings, travel restrictions across borders and regions and limitations on attendance of funeral/tangihanga restrictions, disproportionately impacted Indigenous and families from minoritised ethnic groups.…”

“…21,22 Lack of access to and availability of specialist bereavement care have been identified as barriers in a number of countries. 8 Particular concerns have been raised regarding the increased risk of complex grief among minoritised ethnic communities who have died at higher rates from COVID-19. 23,24 Indeed, while there has been a widespread acknowledgment that the pandemic has exacerbated inequities around health care for Indigenous, migrant and ethnically minoritised communities, 25 very less empirical research relates to endof-life care.…”

“… 7 A systematic review of international evidence reveals that attempts to reduce infection risk have resulted in the reduction of community nursing and hospice involvement. 8 Evidence has also been found that patient and families’ perceptions of health care systems as being under-resourced and sites of virus transmission have led to a reduction in their contact with services 9 , 10 and perceptions of poor clinician communication in this period. 11 This situation has resulted in the intensification of family caregiving responsibilities in terms of both hours provided 12 , 13 and an increase in the number and complexity of tasks, such as decision-making and medication administration.…”

“… 21 , 22 Lack of access to and availability of specialist bereavement care have been identified as barriers in a number of countries. 8 Particular concerns have been raised regarding the increased risk of complex grief among minoritised ethnic communities who have died at higher rates from COVID-19. 23 , 24 …”

Pandemic delay: social implications and challenges for palliative care

“…This is particularly pronounced in the ways that compromises in care – such as delaying care and waiting – were experienced as emotionally and practically necessary at the time. 17 …”