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A Dual-Center Observational Review of Hospital-Based Palliative Care in Patients Dying With COVID-19

Turner, Jennifer, Hodgson, Luke Eliot, Leckie, Todd, Eade, Lisa and Ford-Dunn, Suzanne (2020) A Dual-Center Observational Review of Hospital-Based Palliative Care in Patients Dying With COVID-19 Journal of Pain and Symptom Management.

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Abstract

The current coronavirus disease 2019 (COVID-19) pandemic has put significant strain on all aspects of health care delivery, including palliative care services. Given the high mortality from this disease, particularly in the more vulnerable members of society, it is important to examine how best to deliver a high standard of end-of-life care during this crisis. This case series collected data from two acute hospitals examining the management of patients diagnosed with COVID-19 who subsequently died (n = 36) and compared this with national and local end-of-life audit data for all other deaths. Our results demonstrated a shorter dying phase (38.25 hours vs. 74 hours) and higher rates of syringe driver use (72% vs. 33% in local audits), although with similar average mediation doses. Of note was the significant heterogeneity in the phenotype of deterioration in the dying phase, two distinct patterns emerged, with one group demonstrating severe illness with a short interval between symptom onset and death and another group presenting with a more protracted deterioration. This brief report suggests a spectrum of mode of dying. Overall, the cohort reflects previously described experiences, with increased frailty (median Clinical Frailty Scale score of 5) and extensive comorbidity burden. This brief report provides clinicians with a contemporaneous overview of our experience, knowledge, and pattern recognition when caring for people with COVID-19 and highlights the value of proactive identification of patients and risk of deterioration and palliation.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
NameEmailORCID
Turner, Jennifer
Hodgson, Luke Eliotluke.hodgson@surrey.ac.uk
Leckie, Todd
Eade, Lisa
Ford-Dunn, Suzanne
Date : 2020
DOI : 10.1016/j.jpainsymman.2020.04.031
Copyright Disclaimer : © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Uncontrolled Keywords : Palliative care; COVID-19; Frailty; Symptom management; End-of-life care
Depositing User : Clive Harris
Date Deposited : 16 Jun 2020 08:35
Last Modified : 16 Jun 2020 08:35
URI: http://epubs.surrey.ac.uk/id/eprint/857984

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