In addition to rising demand for hospice and palliative care among COVID-19 patients themselves, the pandemic is affecting the way clinicians provide those services to people with other conditions, such as cancer, according to a recent editorial in the Journal of the American Medical Association-Oncology.

Palliative care teams have had to reexamine their methods of providing care during the outbreak, whether they are working with patients in a hospital, on an outpatient basis or in the home and community. Providers are devising creative strategies for addressing patients’ palliative needs while balancing the need for social distancing, sheltering-in-place and isolation to prevent the spread of the virus.

“We were finding that a lot of the patients who were getting their cancer treatments in our clinic were really struggling to figure out whether they should come in and continue getting treatments,” Ambereen Mehta, M.D., palliative care physician at University of California, Los Angeles and co-author of the editorial told Hospice News. “They’re immunosuppressed if they get their chemotherapy. We need to weigh the safety concerns of doing that against how much treatments they can afford to miss based on their disease. Those kinds of questions are really what we were facing early on.”

Palliative care providers have been leveraging telemedicine to maintain continuity of care from a distance to limit physical contact with patients and families as to reduce the need for personal protective equipment (PPE) while supplies are scarce.

Audio-video visits address provide a form of face-to-face communication among clinicians, patients and families, and they allow multiple health care professionals to engage patients/families/caregivers simultaneously, which can be a challenge in person, according to the editorial by Mehta and co-author Thomas Smith, M.D., palliative physician with John Hopkins Medicine. Palliative care clinicians are also using telemedicine systems to conduct discussions regarding goals of care, the need for hospice and advance care planning.

“In the beginning of the pandemic, we were asking ourselves a lot of questions. First, there was how we do no harm to our patients in our community. One of the things that we realized is that we do a lot of prescribing or medications for symptom management. For the way COVID develops and presents itself, there’s actually a greater need for aggressive complex symptom management, and that’s something that we’re specialists in,” Mehta said. “We figured out ways in which to really get ahead of that as a consulting team working with the primary team, and one of the ways that we’ve kind of changed how we how we do that is by taking on that a little bit more of a primary role and, and kind of taking on the responsibilities for ourselves.”