Covid pandemic had major impact on palliative care

Care shifted from inpatient units to the community

Deborah Condon

January 24, 2023

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  • The impact of Covid-19 on the provision of palliative care in Ireland has been immeasurable, doctors have said.

    According to the World Health Organization, the aim of palliative care is to improve the quality of life of patients and their families who are living with life-threatening illnesses by assessing and treating issues such as pain.

    However, the pandemic led to “significant changes in how palliative care has been delivered in Ireland throughout the last two years,” doctors at Marymount University Hospital and Hospice in Cork said.

    The impact on patients and their families was immense, with many distancing themselves from healthcare providers due to concerns around contracting Covid-19 and concerns about restricted visiting. According to the doctors, “a pervasive fear of the unknown was notable”.

    This led to changes in the way services were provided, with care shifting from inpatient units to more care in the community. As a result of this, many community palliative care teams saw an increase in the number of patients they were caring for when compared with pre-pandemic levels.

    Furthermore, the clinical complexity of these patients in the community increased, while patterns of mortality also changed, with an increase in deaths recorded at home.

    In the Cork region, a 158% increase in deaths at home was recorded at the height of the pandemic compared to pre-pandemic times.

    Meanwhile, the way in which palliative care was delivered in acute hospitals also changed. The doctors noted that as some patients were approaching their end of life in isolation, “palliative care teams were a key support to non-specialists providing end-of-life care”. For example, the skills of palliative care teams when it came to conversations around advance care planning were increasingly utilised.

    Communication technology was also increasingly used, including virtual consultations and to enable contact between family members and their loved ones in the face of stringent disease control measures.

    The doctors acknowledged the “complicated grief” that occurred when family members were unable to be with their loved ones when they died. They noted that communities developed innovative ways of mourning within restrictions, “with mourners often lining the roads through which hearses travelled”.

    Caring for people in these circumstances also had a major psychological impact on healthcare professionals, with many experiencing increased stress, distress and anxiety. The mental health of palliative care staff was also impacted even though they had experience of end-of-life care.

    However, the doctors emphasised that while the pandemic threatened some of the key elements of palliative care, “the dynamic workforce was able to evolve to deal with fluid and complex challenges”.

    “Interdisciplinary teamwork was strengthened as the healthcare professionals strove to provide the best palliative care possible in highly challenging circumstances,” the doctors added.

    They made their comments in the Irish Medical Journal.

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