Palliative care guidance for patients with serious COVID-19
A European Respiratory Society taskforce has provided recommendations on end-of-life care for people with COVID-19.1
The European Respiratory Society (ERS) taskforce conducted a survey of 90 international experts in respiratory palliative care to develop a set of recommendations on palliative care for patients with COVID-19. These recommendations were based on their clinical experience and indirect evidence.
The experts completed an online survey stating their agreement, or not, on 14 potential recommendations. At least 70% agreement was needed to provide a consensus recommendation. Most of the participants were experts in palliative care, respiratory medicine or critical care medicine.
The recommendations covered advance care planning (ACP); palliative treatment of breathlessness; clinician–patient and remote clinician–family communication; palliative care involvement; spiritual, psychosocial and bereavement care; and support for healthcare professionals.
Key recommendations included:
- family members/loved ones should be invited and supported (e.g. being provided with personal protection equipment [PPE] if indicated) to visit patients at the end of their life
- at the time of diagnosis of severe COVID-19 clinicians should routinely ask patients and loved ones about ACP
- patients with serious COVID-19 and distressing breathlessness despite optimal treatment of underlying causes should be given palliative treatment with low-dose opioids
- staff caring for patients with serious COVID-19 should receive training to optimise clinician–patient communication while wearing PPE
- family members/loved ones of deceased patients with COVID-19 should be offered bereavement support by healthcare professionals trained in palliative care or bereavement support
- healthcare staff caring for patients with serious COVID-19 should be offered psychological support to cope with their experiences.
The authors noted that future studies were needed to provide empirical evidence for the recommendations.
This paper provides helpful, best practice guidance on the key elements of palliative care that patients with COVID-19 may require. However, it is important to note that this guidance is not evidence based, being instead based on expert opinion. Furthermore, as the European taskforce notes, some recommendations are challenging to implement in practice due to limited availability of resources such as PPE or health professionals with the recommended skills.
In Australia since the start of the pandemic the National COVID-19 Clinical Evidence taskforce has been generating evidence-based, living guidelines, which are updated weekly, to support Australian health professionals to care for people with COVID-19. Importantly, this task force includes multiple primary care clinicians and has a dedicated palliative care and aged care panel, so that general and specific, evidence-based recommendations can include a palliative approach. Furthermore, the Australian and New Zealand Society for Palliative Medicine COVID-19 Special Interest Group (COVID-19 SIG) has generated nine guidance documents which cover multiple aspects of palliative care. The many palliative care guidance documents available (including this paper from the ERS taskforce) are important resources that will enable Australian health professionals to offer an individualised palliative care approach to people with COVOID-19.
The following websites may be of interest: https://covid19evidence.net.au and http://www.anzspm.org.au/c/anzspm?a=da&did= 1005077&pid=1587788101.