Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
J Pain Symptom Manage. 2021 Sep;62(3):460-470. doi: 10.1016/j.jpainsymman.2021.01.138. Epub 2021 Feb 5.
Systematic data on the care of people dying with COVID-19 are scarce.
To understand the response of and challenges faced by palliative care services during the COVID-19 pandemic, and identify associated factors.
We surveyed palliative care and hospice services, contacted via relevant organizations. Multivariable logistic regression identified associations with challenges. Content analysis explored free text responses.
A total of 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world; 81% cared for patients with suspected or confirmed COVID-19, 77% had staff with suspected or confirmed COVID-19; 48% reported shortages of Personal Protective Equipment (PPE), 40% staff shortages, 24% medicines shortages, 14% shortages of other equipment. Services provided direct care and education in symptom management and communication; 91% changed how they worked. Care often shifted to increased community and hospital care, with fewer admissions to inpatient palliative care units. Factors associated with increased odds of PPE shortages were: charity rather than public management (OR 3.07, 95% CI 1.81-5.20), inpatient palliative care unit rather than other settings (OR 2.34, 95% CI 1.46-3.75). Being outside the UK was associated with lower odds of staff shortages (OR 0.44, 95% CI 0.26-0.76). Staff described increased workload, concerns for their colleagues who were ill, whilst expending time struggling to get essential equipment and medicines, perceiving they were not a front-line service.
Palliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics.
关于 COVID-19 患者护理的系统数据很少。
了解大流行期间姑息治疗服务的应对情况和面临的挑战，并确定相关因素。
我们通过相关组织联系了姑息治疗和临终关怀服务机构，并对其进行了调查。多变量逻辑回归确定了与挑战相关的因素。内容分析探讨了自由文本的回复。
共有 458 家服务机构做出回应；277 家来自英国，85 家来自欧洲其他地区，95 家来自世界其他地区；81%的机构照顾了疑似或确诊 COVID-19 的患者，77%的机构有疑似或确诊 COVID-19 的员工；48%的机构报告个人防护设备短缺，40%的机构员工短缺，24%的机构药品短缺，14%的机构其他设备短缺。服务机构提供了症状管理和沟通方面的直接护理和教育；91%的机构改变了工作方式。护理工作重心通常转移到增加社区和医院护理，减少了住院姑息治疗病房的收治。与个人防护设备短缺相关的因素是：慈善机构而非公共管理（比值比 3.07，95%置信区间 1.81-5.20），住院姑息治疗病房而非其他环境（比值比 2.34，95%置信区间 1.46-3.75）。不在英国的机构与员工短缺的可能性较低相关（比值比 0.44，95%置信区间 0.26-0.76）。员工描述了工作量增加，对生病同事的担忧，同时还要努力获得必要的设备和药品，他们认为自己不是一线服务机构。
姑息治疗服务机构经常不堪重负，但在 COVID-19 应对中却被忽视。在规划和应对未来的疫情/大流行时，姑息治疗需要更好地与医疗保健系统相结合。
