IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW Australia.
IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW Australia; Wolfson Palliative Care Research Centre, University of Hull, Hull, England.
Ann Palliat Med. 2021 Mar;10(3):2747-2757. doi: 10.21037/apm-20-1760. Epub 2021 Jan 14.
The corona virus disease 2019 (COVID-19) pandemic has required specialist palliative care (SPC) services to respond by: (I) integrating infection prevention/control measures into care for their usual caseloads and (II) providing consultations and/or care for people dying from a new disease entity. The aim of the current study was to learn about the response of Australian SPC services to COVID-19 and its consequences in order to inform pandemic practice and policy.
A cross-sectional, anonymous survey was administered online from May to July 2020. Email invitations were sent to 160 providers delivering 503 SPC services listed in the Australian Palliative Care Services Directory. Survey questions asked about service responses to COVID-19, impacts on care quality, and perceived benefits/disadvantages for palliative care clients post-pandemic. Open-ended responses were thematically coded using an established framework that classifies SPC pandemic responses under: 'stuff', 'staff', 'space', 'systems', 'separation', 'sedation', 'communication' and 'equity'.
Complete survey responses were received from 28 providers on behalf of 100 SPC services (response rates of 17%/20% respectively): 29 consultative, 25 community home-based, 21 outpatient, 15 inpatient wards/units, eight inpatient hospice and two other services. Responses were reported across all framework categories except 'sedation'. Concerns centred on: inadequate support for self-management, psychosocial needs and bereavement for clients living at home; pressures on staff capacity and wellbeing; and a perceived lack of health system preparedness for a potential future surge. Rapid implementation of telehealth across Australia was perceived to offer potential benefits to palliative care in the longer term, if provided with ongoing support.
Meeting COVID-19-related challenges requires SPC to be agile and responsive. Advocacy is required to ensure the needs of people dying and their families are supported as well as people requiring acute care for COVID-19. Expansion of telehealth during the pandemic presents an opportunity for leveraging to benefit palliative care longer term.
2019 年冠状病毒病（COVID-19）大流行要求专科姑息治疗（SPC）服务做出以下反应：（I）将感染预防/控制措施纳入对其常规病例的护理中，以及（II）为死于新疾病实体的患者提供咨询和/或护理。本研究的目的是了解澳大利亚 SPC 服务对 COVID-19 的反应及其后果，以便为大流行实践和政策提供信息。
2020 年 5 月至 7 月期间，我们通过在线方式进行了横断面、匿名调查。向澳大利亚姑息治疗服务目录中列出的 160 名提供 503 个 SPC 服务的提供者发送了电子邮件邀请。调查问题询问了服务对 COVID-19 的反应、对护理质量的影响，以及对大流行后姑息治疗患者的潜在益处/劣势。使用既定框架对开放式回答进行主题编码，该框架将 SPC 大流行反应分类为：“东西”、“人员”、“空间”、“系统”、“隔离”、“镇静”、“沟通”和“公平”。
共有 28 名提供者代表 100 个 SPC 服务（分别为 17%/20%的应答率）收到完整的调查回复：29 个咨询服务、25 个社区居家护理、21 个门诊、15 个住院病房/病房、8 个住院临终关怀和两个其他服务。除了“镇静”之外，所有框架类别都报告了回应。关注的焦点包括：在家中生活的客户的自我管理、心理社会需求和丧亲问题；工作人员能力和福利的压力；以及对卫生系统为潜在未来激增做好准备的看法不足。澳大利亚迅速实施远程医疗被认为如果得到持续支持，从长期来看对姑息治疗具有潜在益处。
应对与 COVID-19 相关的挑战需要 SPC 具有灵活性和响应能力。需要进行宣传，以确保支持临终和他们的家人的需求，以及需要治疗 COVID-19 的人。在大流行期间扩大远程医疗提供了一个长期利用的机会，以造福姑息治疗。
