The challenges of caring for people dying from COVID-19: a multinational,observational study of palliative and hospice services (CovPall)

Oluyase, A. O.; Hocaoglu, M. B.; Cripps, R. L.; Maddocks, M.; Walshe, C.; Fraser, L. K.; Preston, N.; Dunleavy, L.; Bradshaw, A.; Murtagh, F. E.; Bajwah, S.; Sleeman, K. E.; Higginson, I. J.

Background: Systematic data on the care of people dying with COVID-19 are scarce. We studied the response of and challenges for palliative care services during the COVID-19 pandemic. Methods: We surveyed palliative care and hospice services, contacted via relevant organisations. Multivariable logistic regression identified associations with key challenges. Content analysis explored free text. Findings: 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world (1 country unreported); 81% cared for patients with suspected or confirmed COVID-19, 77% had staff with suspected or confirmed COVID-19; 48% reported shortages of Personal Protective Equipment (PPE), 40% staff shortages, 24% medicines shortages, 14% shortages of other equipment. Services provided direct care and education in symptom management and communication; 91% changed how they worked. Care often shifted to increased community and hospital care, with fewer admissions to inpatient palliative care units. Factors associated with increased odds of PPE shortages were: charity rather than public management (OR 3.07, 95% CI 1.81-5.20),inpatient palliative care unit rather than other setting (OR 2.34, 95% CI 1.46-3.75). Being outside the UK was associated with lower odds of staff shortages (OR 0.44, 95% CI 0.26-0.76). Staff described increased workload, concerns for their colleagues who were ill, whilst expending time struggling to get essential equipment and medicines, perceiving they were not a front-line service. Interpretation: Across all settings palliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics. Funding: MRC grant number MR/V012908/1, Cicely Saunders International and NIHR ARC South London.