Call for palliative care to be adapted for severely ill Covid-19 patients

Emergency-style palliative care needs to implemented to meet the needs of Covid-19 patients who wouldn’t benefit from a ventilator say researchers.

This is the first time that palliative care has been examined in the light of the current global pandemic.

The researchers describe the challenges of providing palliative care where resources are stretched and demand is high, based on their experiences at a hospital in Switzerland close to the Italian border where there are high rates of the illness.

Professor Nancy Preston, Co-Director of Lancaster University’s International Observatory on End of Life Care said: “Many patients are too unwell to benefit from ventilation but still need their symptoms managing.”

In a paper published in The Journal of Pain and Symptom Management, the researchers explained how palliative care needs to adapt to an emergency style in order to help make the best decisions and support families.

Professor Preston said: “These people require a conservative approach to their treatment, one which provides maximum support for their physical, emotional and spiritual needs – this is where a recognition that palliative care is required is crucial”.

The team based their recommendation on caring for severely ill patients with Covid-19 in the Swiss hospital where treatment plans have changed dramatically.

This is due to a range of factors including competition for palliative care drugs, which are also used in ICU, as well as healthcare workers untrained in palliative care being re-allocated from their own specialities to care for patients with Covid-19.

“It is emergency style palliative care because patients can deteriorate quickly and need a rapid response from their health care team. It is crucial that patients with a high symptom burden are assessed and treated quickly – the recommendations in this paper based on front line experience can make a difference. This approach is therefore being used across the hospital, and in emergency departments too.”

“Palliative care teams, intensivists and internal medicine specialists all work side by side as palliative care is recognised to be at the forefront of this crisis, as it can offer symptom management, support to families and spiritual care in a timely manner.”

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The paper: “Conservative management of Covid-19 patients – emergency palliative care in action” is by Nancy Preston from the International Observatory on End of Life Care at Lancaster University and Lancaster PhD students Tanja Fusi-Schmidhauser and Claudia Gamondi with Nikola Keller from the Palliative and Supportive Care Clinic, Institute of Oncology of Southern Switzerland and Ente Ospedaliero Cantonale, Switzerland.