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“Never Waste A Good Crisis”: A Qualitative Study of Programmatic Challenges, Opportunities, and Gaps Illuminated by the COVID-19 Pandemic in Seven Hospital Systems (SCI912)

      Objectives

      • 1.
        Describe how palliative care services of varying maturity at seven diverse hospital systems responded to the COVID-19 epidemic.
      • 2.
        Describe innovative solutions to address the needs of patients, caregivers, and providers during surge and shelter in place scenarios.
      • 3.
        Recognize the care gaps that may extend beyond the early stages of the pandemic for patients and families.

      Background

      During the early stages of the COVID-19 pandemic, a number of opinion pieces were written proclaiming the need for palliative care services, particularly with the prospect of scarce resources.

      Research Objectives

      To understand the response of palliative care services in the early stages of the COVID-19 pandemic and identify potential gaps in care.

      Methods

      Longitudinal in-depth interviews with palliative care implementers at seven hospital systems with varying maturity of inpatient and outpatient services in the San Francisco Bay Area.

      Results

      In the inpatient setting, palliative care was typically included in surge planning, including ethical approaches to care and planning for comfort care in the event of resource scarcity. Anticipating high demand, palliative services put effort into upskilling primary providers and enhancing goals of care communication skills. Both inpatient and outpatient settings employed various forms of virtual care. In inpatient settings, iPads were used widely for provider visits to reduce PPE usage and to connect patients with their families during visitor restrictions. In outpatient settings, visits became nearly 100% virtual, which posed challenges for recently established outpatient clinics to establish trust with new patients and required creative solutions for POLST signing, including different electronic signature vendors and “drive-thru” signing. Chaplaincy services at some systems offered emotional support to help providers and staff cope with stress. Bereavement support, particularly for caregivers experiencing complex grief during COVID, was limited.

      Conclusion

      Palliative care contributed prominently to surge planning and in expanding systemwide capabilities for goals of care communication. Virtual care posed many challenges, especially around POLST completion. Providing bereavement support represented a common challenge.

      Implications for Research, Policy, or Practice

      Ready access to completed POLST forms requires a policy shift. Improving programmatic bereavement support, particularly for complex grief, requires enhanced study and practice innovation.