As health care providers across every setting scramble to meet patient needs during the novel coronavirus pandemic, many are starting to recognize the importance of palliative care and are seeking more support from those clinicians.
The outbreak — and associated morbidity and mortality — has underscored the need for clinicians to navigate difficult, often emotional conversations with patients and families about their goals and wishes for the care they receive, including end-of-life and hospice care. Providers that specialize in hospice and palliative care excel at navigating these sensitive conversations and undergo specific training to develop those skills.
Mount Sinai Hospital in New York City has established a hotline to guide health care providers on how to conduct these conversations, particularly for those affected by the novel coronavirus, the Wall Street Journal reported.
“The questions poured in: How do I tell someone that mechanical ventilation may not be effective? How do I tell people that they may die?” according to the Journal. “The inquiries reflect the need for clinicians to have empathetic conversations with patients and families about the prospects for survival, the goals of treatment, and how to comfort or say goodbye to loved ones in isolation. Such services are especially vital, some hospital leaders say, because coronavirus patients are treated away from family or other support systems.”
The hospice and palliative care patient populations are among the most vulnerable to coronavirus disease (COVID-19) infection. Understanding the risk points can be key for providers to minimize the potential risks of COVID-19 on aging and seriously ill patients.
Currently 72% of hospitals in the United States with 50 or more beds have a palliative care program. This is up from 67% in 2015 and 7% in 2001, according to the Center to Advance Palliative Care (CAPC). These institutions care for 87% of all hospitalized patients nationwide. Large nonprofit hospitals in large cities are the most likely to provide palliative care.
Data on the availability of community-based palliative care services are limited, but CAPC numbers show that at least half of the in-home providers of those services in the United States are hospices.
Palliative-care clinicians have been working as long as 16-hours a day since the pandemic took hold, the Journal reported. In addition to easing patients’ suffering and symptom management, these palliative care experts are also hard at work developing educational materials such as practice scripts, videos and other learning aids to help other clinicians improve their skills in regards to these conversations, including discussions about the virus, according to the Journal.
Patients suffering from COVID-19 may be faced with difficult decisions, such as their wishes and goals should the virus become terminal or whether they would choose interventions such as a ventilator.
“Specialists may help explain the reason resources such as ventilators may be rationed, inform family that a patient has the disease or died, and provide a caring presence,” the Journal article said. “Their work can also involve helping family members say goodbye to someone in isolation—or giving them hope, because some patients do well with treatment and recover. These specialists may work with people receiving curative care or provide comfort care when medical treatment is no longer an option.”