Why palliative medicine is an essential part of care during a pandemic

Categories: Care, Featured, and Opinion.

At the height of the COVID-19 pandemic, healthcare providers all over the world sometimes saw patients in need of more care than could be delivered, numerous patient deaths despite maximal medical therapy, and isolation protocols that left patients and families separated from one another. Palliative care can be immensely valuable in these situations by improving symptom control, training general and ICU providers in symptom management skills, providing bereavement care, and facilitating reflection among healthcare workers.

Palliative care is currently not considered an essential service during a pandemic according to the WHO[1]. Access to quality palliative care services during a pandemic and integration of palliative care into pandemic planning are important to advocate for. This was especially pertinent to the COVID-19 pandemic given distressing symptoms like dyspnea, high mortality rates, and the long duration particularly with variants.

Palliative care has shown flexibility in changing and adapting during the pandemic to fit needs. Like other fields, much of this has revolved around technology and virtual care including virtual outpatient visits for services like advanced care planning and using technology to facilitate family communication. In New York City, palliative care specialists embedded into emergency department teams to address goals of care from the onset and emphasized multidisciplinary teams[2].

In Africa, palliative care teams have made similar adaptions to a changing healthcare landscape with severe supply chain disruptions, decrease in resource allocation to other diseases, and disrupted communal bereavement services. Even before the pandemic, only 5-11% of patients who would benefit from palliative care had access. During the pandemic, a survey of African countries found few inclusions of palliative care in COVID-19 guidelines[3]. Community palliative care outreach was severely hindered, normal healthcare delivery was disrupted, and social gathering limitations changed the grieving process. Despite those barriers, many palliative care teams across the continent integrated virtual technology into their service model and developed guidelines for symptom management that could be easily distributed to other providers[4].

To be ready for the next pandemic, palliative care needs to be integrated into pandemic planning. Specific tasks include building primary palliative care, increasing capacity for alternative palliative care delivery methods such as telemedicine, developing decision algorithms for rationing care, ensuring access to essential medications like opioids, and increasing uptake of advanced care planning[5].

Sharing experiences, lessons, and hopes for the future is an important part of learning from the COVID-19 pandemic so the global community can be more ready for the next one. Since most experiences and research are from the Global North, it is particularly important for African narratives to be articulated and heard. This was the goal of the 7th International African Palliative Care Conference where multi-disciplinary stakeholders in palliative and chronic care came together to exchange ideas and continue to advocate for the inclusion of palliative care as an essential service.

[1] https://www.who.int/publications/i/item/WHO-2019-nCoV-essential_health_services-2020.2

[2] https://www.liebertpub.com/doi/epub/10.1089/jpm.2020.0481

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319866/

[4] https://pubmed.ncbi.nlm.nih.gov/32949761/

[5] https://spcare.bmj.com/content/11/1/40

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