COVID-19 and Hospital Palliative Care – a service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care

Hetherington, L., Johnston, B. , Kotronoulas, G. , Finlay, F., Keeley, P. and McKeown, A. (2020) COVID-19 and Hospital Palliative Care – a service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care. Palliative Medicine, 34(9), pp. 1256-1262. (doi: 10.1177/0269216320949786) (PMID:32794435) (PMCID:PMC7429909)

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Abstract

Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population. Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a ‘typical’ caseload from 2019. Design: Service evaluation based on a retrospective cohort review of patient records. Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020. Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a ‘typical’ caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced ‘typical’ caseload; overall numbers of referrals were not increased. Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from ‘typical’ caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.

Item Type:Articles
Keywords:Palliative care, pandemics, terminal care, COVID-19, symptom assessment, inpatients.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Finlay, Dr Fiona and Keeley, Dr Paul and Johnston, Professor Bridget and Kotronoulas, Dr Greg and Mckeown, Dr Alistair
Authors: Hetherington, L., Johnston, B., Kotronoulas, G., Finlay, F., Keeley, P., and McKeown, A.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:Palliative Medicine
Publisher:SAGE Publications
ISSN:0269-2163
ISSN (Online):1477-030X
Published Online:14 August 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Palliative Medicine 34(9): 1256-1262
Publisher Policy:Reproduced under a Creative Commons License

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