Objectives
- 1.Describe characteristics of hospitalized patients with COVID-19 requiring PC consultation.
- 2.Describe PC consultation needs and interventions for subject population.
Background
Palliative care (PC) consultation is an important intervention for patients hospitalized with COVID-19. While clinical guidelines are being introduced, data regarding PC practices and outcomes remain lacking.
Research Objectives
To describe PC consultation needs and interventions for hospitalized patients with COVID-19.
Methods
Retrospective analysis of patients admitted to three regional hospitals with diagnosis of COVID-19 between March and June 2020. Electronic health record review was utilized to extract information regarding patient demographics, underlying medical history, hospital course and complications, clinical details of PC reasons for consultation and interdisciplinary interventions.
Results
The analysis included 227 patients (mean age 70 years; 49% women, 73% African American;) with median hospital length of stay 16 days (range 1-31). Predominant comorbidities included CKD (34%), dementia (26%), heart failure (22%), cancer (14%), chronic lung disease (13%), and stroke (11%). Most patients (68%) were admitted from home. Hospital interventions often included intubation (57%) and renal replacement therapy (23%). At time of consult, 33% already had do-not-resuscitate orders. Nearly half (48%) died in hospital; the remainder were discharged to home (19%), facilities (19%), or hospice care (3%). PC was primarily consulted for clarifying goals (75% of cases) but also psychosocial-spiritual support to patients/families (35%) and symptom management (29%). Interdisciplinary PC encounters were conducted by MDs/NPs (46%), social workers (44%), chaplains (11%), and clinical pharmacists (3%). Across all encounters, PC interventions included psychosocial (24%) and spiritual (9%) support, goals-of-care meetings (20%), bereavement calls (7%), as well as pain (9%) and non-pain (22%) symptom management. For symptom management, patients frequently required opioids (77%) and benzodiazepines (42%), compared to antipsychotics (26%).
Conclusion
Hospitalized patients suffering from COVID-19 receive broad interdisciplinary PC interventions with emphasis on non-pain symptom management and supportive counseling to patients/families.
Implications for Research, Policy, or Practice
This study provides initial perspectives with which to begin development of hospital-based PC practices targeting patients suffering from COVID-19 and their families.
Article info
Identification
Copyright
© 2021 Published by Elsevier Inc.
