Palliative care amidst the COVID-19 pandemic: challenges and contributions

This is a scoping review based on the methodology proposed by the Joanna Briggs Institute. Virtual Health Library, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Embase, PsycInfo^® and Science Direct were analyzed using the descriptors “palliative care” and “coronavirus” and the keyword “COVID-19”. Thirty studies were selected for analysis.

Results:

This review showed strategies for palliative care implementation using protocols and telemedicine, to facilitate communication, and showed how palliative therapy approach has been, revealing the need to promote comfort and welcoming patients and family members in times of pain and grief.

Conclusion:

The palliative care principles contribute to comprehensive care, but its implementation amidst the crisis is a challenge. It is important to provide conditions to apply it in the daily life of health services, even in pandemic scenarios.

Keywords
Palliative care; Coronavírus; Coronavirus infections; COVID-19; Pandemics

Database	Search strategies
Virtual Health Library	(tw: (coronavírus OR coronavirus OR “covid-19” OR “covid 19”)) AND (tw: (“cuidados paliativos” OR “cuidado paliativo” OR “palliative care”))
Web of Science, Science Direct	(coronavirus OR “COVID-19” OR “COVID 19”) AND TOPIC: (“palliative care”)
Scopus	(TITLE-ABS-KEY (coronavirus OR “covid-19” OR “covid 19”) AND TITLE-ABS-KEY (“palliative care”))
EBSCO, CINAHL	(coronavirus OR “covid-19” OR “covid 19”) AND (“palliative care”)
EMBASE	(“coronavirus”/exp OR coronavirus OR “covid-19” OR “covid 19”/exp OR “covid 19”) AND (“palliative care”/exp OR “palliative care”)
PsycInfo	Any Field: coronavirus OR Any Field: “COVID-19” OR Any Field: “COVID 19” AND Any Field: “palliative care”

Authorship	Type of study	Population/sample	Data source
Weaver et al.⁽¹⁶16. Weaver MS, Wiener L. Wiener l. Applying palliative care principles to communicate with children about COVID-19. J Pain Symptom Manage. 2020;60(1):e8–11.⁾	Expert recommendations	Children	Literature
Calton et al.⁽¹⁷17. Calton B, Abedini N, Fratkin M. Telemedicine in the time of coronavirus. J Pain Symptom Manage. 2020;60(1):e12–4.⁾	Expert recommendations	Patients in palliative care	Literature
Powell et al.⁽¹⁸18. Powell VD, Silveira MJ. What should palliative care's response be to the COVID-19 epidemic? J Pain Symptom Manage. 2020;60(1):e1–3.⁾	Expert recommendations	Palliative care staff	Literature
Hendin et al.⁽¹⁹19. Hendin A, La Rivière CG, Williscroft DM, O’Connor E, Hughes J, Fischer LM. End-of-life care in the emergency department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19). CJEM. 2020;22(4):414–7.⁾	Expert recommendations	Patients in palliative care	Literature
Nehls et al.⁽²⁰20. Nehls W, Delis S, Haberland B, Maier BO, Sänger K, Tessmer G, et al. Recommendations for treatment of patients with COVID-19 from the palliative care perspective V2.0 [Internet]. Germany: DGP; 2020 [cited 2020 Aug 23];(2):1-10. Available from: https://www.dgpalliativmedizin.de/images/DGP_Handlungsempfehlung_palliative_Therapie_bei_COVID18_V2.0_English_version.pdf https://www.dgpalliativmedizin.de/images... ⁾	Expert recommendation	-	Literature
Fausto et al.⁽²¹21. Fausto J, Hirano L, Lam D, Mehta A, Mills B, Owens D, et al. Creating a palliative care inpatient response plan for COVID-19-the UW medicine experience. J Pain Symptom Manage. 2020;60(1):e21–6.⁾	Experience report	Health professionals	Lived experience
Ferguson et al.⁽²²22. Ferguson L, Barham D. Palliative Care Pandemic Pack: A Specialist Palliative Care Service Response to Planning the COVID-19 Pandemic. J Pain Symptom Manage. 2020;60(1):e18–20.⁾	Updating	Health professionals.	Literature
Borasio et al.⁽²³23. Borasio GD, Gamondi C, Obrist M, Jox R; For the Covid-Task Force of Palliative Ch. COVID-19: decision making and palliative care. Swiss Med Wkly. 2020;150:w20233.⁾	Experience report	Palliative care staff	Lived experience
Rolanda et al.⁽²⁴24. Rolanda K, Markusb M. COVID-19 pandemic: palliative care for elderly and frail patients at home and in residential and nursing homes. Swiss Med Wkly. 2020;24(150):e20235.⁾	Experience report	Elderly in nursing homes	Lived experience
Curtis et al.⁽²⁵25. Curtis JR, Kross EK, Stapleton RD. The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19). JAMA. 2020;323(18):1771–2.⁾	Opinion paper	Health professionals	Literature
The Lancet⁽²⁶26. Palliative care and the COVID-19 pandemic. Lancet. 2020;395(10231):1168.⁾	Editorial	-	Literature and lived experiences
Bajwah et al.⁽²⁷27. Bajwah S, Wilcock A, Towers R, Costantini M, Bausewein C, Simon ST, et al. Managing the supportive care needs of those affected by COVID-19. Eur Respir J. 2020;55(4):2000815.⁾	Literature review	-	Literature
Salako et al.⁽²⁸28. Salako O, Okunade K, Allsop M, Habeebu M, Toye M, Oluyede G, et al. Upheaval in cancer care during the COVID-19 outbreak. Ecancermedicalscience. 2020;14(1):ed97.⁾	Experience report	Cancer patients	Lived experience
Fan⁽²⁹29. Fan J. China's struggles with hospice care. The New Yorker [Internet]. 2020 [cited 2020 Aug 23]. Available from: https://www.newyorker.com/magazine/2020/04/06/chinas-struggles-with-hospice-care https://www.newyorker.com/magazine/2020/... ⁾	Experience report	NI	Lived experience
Etkind et al.⁽³⁰30. Etkind SN, Bone AE, Lovell N, Cripps RL, Harding R, Higginson IJ, et al. The role and response of palliative care and hospice services in epidemics and pandemics: a rapid review to inform practice during the COVID-19 pandemic. J Pain Symptom Manage. 2020; 60(1):e31–40.⁾	Systematic review	Patients, caregivers and health professionals	Literature
Fusi-Schmidhauser et al.⁽³¹31. Fusi-Schmidhauser T, Preston NJ, Keller N, Gamondi C. Conservative management of COVID-19 patients-emergency palliative care in action. J Pain Symptom Manage. 2020;60(1):e27–30.⁾	Descriptive	Patients with COVID-19 not suitable for ventilation	Field research
Tran et al.⁽³²32. Tran DL, Lai SR, Salah RY, Wong AY, Bryon JN, McKenna MC, et al. Rapid de-escalation and triaging patients in community-based palliative care. J Pain Symptom Manage. 2020;60(1):e45–7.⁾	Expert recommendations	-	Literature
Lovell et al.⁽³³33. Lovell N, Maddocks M, Etkind SN, Taylor K, Carey I, Vora V, et al. Characteristics, symptom management, and outcomes of 101 patients with COVID-19 referred for hospital palliative care. J Pain Symptom Manage. 2020;60(1):e77–81.⁾	Cross-sectional	101 patients with COVID-19	Field research
Rosa et al.⁽³⁴34. Rosa WE, Shook A, Acquaviva KD. LGBTQ+ inclusive palliative care in the context of COVID-19: Pragmatic recommendations for clinicians. J Pain Symptom Manage. 2020;60(2):e44–7.⁾	Expert recommendations	LGBTQ+ with COVID-19	Literature
Humphreys et al.⁽³⁵35. Humphreys J, Schoenherr L, Elia G, Saks NT, Brown C, Barbour S, et al. Rapid implementation of inpatient telepalliative medicine consultations during COVID-19 pandemic. J Pain Symptom Manage. 2020;60(1):e54–9.⁾	Experience report	NI	Lived experience
Constantini et al.⁽³⁶36. Costantini M, Sleeman KE, Peruselli C, Higginson IJ. Response and role of palliative care during the COVID-19 pandemic: A national telephone survey of hospices in Italy. Palliat Med. 2020;34(7):889–95.⁾	Cross-sectional	16 Italian health institutions	Contact via phone
Davies et al.⁽³⁷37. Davies A, Hayes J. Palliative care in the context of a pandemic: similar but different. Clin Med (Lond). 2020;20(3):274–7.⁾	Literature review	-	Literature
Sun et al.⁽³⁸38. Sun H, Lee J, Meyer BJ, Myers EL, Nishikawa MS, Tischler JL, et al. Characteristics and Palliative Care Needs of COVID-19 Patients Receiving Comfort-Directed Care. J Am Geriatr Soc. 2020;68(6):1162–4.⁾	Case reports	30 patients with COVID admitted to palliative care unit	Field research
Romanò⁽³⁹39. Romanò M. [Between intensive care and palliative care at the time of CoViD-19]. Recenti Prog Med. 2020;111(4):223–30. Italian.⁾	Literature review	-	Literature
Radbruch et al.⁽⁴⁰40. Radbruch L, Knaul FM, de Lima L, de Joncheere C, Bhadelia A. The key role of palliative care in response to the COVID-19 tsunami of suffering. Lancet. 2020;395(10235):1467–9.⁾	Editorial	-	Literature and lived experiences
Feder et al.⁽⁴¹41. Feder SL, Akgün KM, Schulman-Green D. Palliative care strategies offer guidance to clinicians and comfort for COVID-19 patient and families. Heart Lung. 2020;49(3):227–8.⁾	Editorial	-	Literature and lived experiences
Chidiac et al.⁽⁴²42. Chidiac C, Feuer D, Naismith J, Flatley M, Preston N. Emergency palliative care planning and support in a COVID-19 pandemic. J Palliat Med. 2020;23(6):752–3.⁾	Editorial	-	Literature and lived experiences
PeateI⁽⁴³43. Peate I. COVID-19 and palliative care. Br J Nurs. 2020;29(8):455.⁾	Editorial	-	Literature and lived experiences
Arya et al.⁽⁴⁴44. Arya A, Buchman S, Gagnon B, Downar J. Pandemic palliative care: beyond ventilators and saving lives. CMAJ. 2020;192(15):E400–4.⁾	Literature review	NI	Literature
Wallace et al.⁽⁴⁵45. Wallace CL, Wladkowski SP, Gibson A, White P. Grief during the COVID-19 pandemic:considerations for palliative care providers. J Pain Symptom Manage. 2020;60(1):e70–6.⁾	Reflection	-	Literature

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[1] Corresponding author Raquel Sampaio Florêncio, E-mail: raquelsampy@hotmail.com