IN COMMUNITY SETTINGS :
- Discussion between clinicians and patients should be held concerning the patient’s values and goals of care, particularly if the patient is older or presents comorbidities.
IN HOSPITALS :
- Clinicians should engage in discussions with hospitalized patients to understand their values and goals. A shared decision should be made concerning code status and advanced cardiac life support (ACLS).
- How to organize the “stuff” :
- Comfort medications (morphine, haloperidol, midazolam and scopolamine), equipment that delivers medications (ex: pumps, syringes) and personal protective equipment should be stockpiled for palliative care professionals in the form of kits;
- Regulations that control and limit the prescription of opioids should be suspended;
- How to organize the staff :
- All health care providers with an expertise in palliative care should be identified and mobilized;
- Frontline clinicians should receive a brief training on the basics of symptom management for acute respiratory illness (e.g. the use of opioid);
- Healthcare workers should be provided with standardized protocols to help them better address their patients symptoms as well as procure end-of-life care.;
- Psychosocial support should be made available to the frontline workers.
- How to organize the space :
- The use of beds in the palliative care units should be adequately optimized;
- Separate wards and non-clinical areas for COVID-19 patients should be identified in palliative care units.
- How to organize the system :
- A triage system should be put in place to identify which patients need specialist palliative care consultation and which patients can be seen virtually.
- Telemedicine should be maximized to increase efficiency and reduce transmission.
- Standardized order sets should be developed.
- Palliative care teams should be formed to encourage coverage and support if providers feel overwhelmed or fall ill.
- Video calling technologies should be made available for patients in palliative care wards in order to break the sense of isolation that some of them may feel.
Whatever the setting, advance care planning prior to serious acute illness and discussions about goals of care at the onset of serious acute illness should be a high priority.
The information comes from 3 different articles that are viewpoints written by medical professionals on the subject of palliative care during a pandemic.
- Arya, A., Buchman, S., Gagnon, B. et al. (March 31, 2020). Pandemic palliative care: beyond ventilators and saving lives. Canadian Medical Association Journal. http://dx.doi.org/10.1503/cmaj.200465.
- Curtis, J. R., Kross, E. K., & Stapleton, R. D. (March 27, 2020). The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA. http://dx.doi.org/10.1001/jama.2020.4894
- Downar, J., & Seccareccia, D. (February 2010). Palliating a Pandemic: “All Patients Must Be Cared For.” Journal of Pain and Symptom Management. http://dx.doi.org/10.1016/j.jpainsymman.2009.11.241.