Bradshaw Andy, Dunleavy Lesley, Walshe Catherine, Preston Nancy, Cripps Rachel L, Hocaoglu Mevhibe, Bajwah Sabrina, Maddocks Matthew, Oluyase Adejoke O, Sleeman Katherine, Higginson Irene J, Fraser Lorna, Murtagh Fliss
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
International Observatory on End of Life Care, Lancaster University, Lancaster, UK.
Palliat Med. 2021 Jul;35(7):1225-1237. doi: 10.1177/02692163211017387. Epub 2021 May 26.
Specialist palliative care services play an important role in conducting advance care planning during COVID-19. Little is known about the challenges to advance care planning in this context, or the changes services made to adapt.
Describe the challenges that UK specialist palliative care services experienced regarding advance care planning during COVID-19 and changes made to support timely conversations.
Online survey of UK palliative/hospice services' response to COVID-19. Closed-ended responses are reported descriptively. Open-ended responses were analysed using a thematic Framework approach using the Social Ecological Model to understand challenges.
Two hundred and seventy-seven services.
More direct advance care planning was provided by 38% of services, and 59% provided more support to others. Some challenges to advance care planning pre-dated the pandemic, whilst others were specific to/exacerbated by COVID-19. Challenges are demonstrated through six themes: complex decision making in the face of a new infectious disease; maintaining a personalised approach; COVID-19-specific communication difficulties; workload and pressure; sharing information; and national context of fear and uncertainty. Two themes demonstrate changes made to support: adapting local processes and adapting local structures.
Professionals and healthcare providers need to ensure advance care planning is individualised by tailoring it to the values, priorities, and ethnic/cultural/religious context of each person. Policymakers need to consider how high-quality advance care planning can be resourced as a part of standard healthcare ahead of future pandemic waves. In facilitating this, we provide questions to consider at each level of the Social Ecological Model.
专科姑息治疗服务在新冠疫情期间开展预先护理计划方面发挥着重要作用。对于在此背景下预先护理计划所面临的挑战，或服务为适应情况而做出的改变，我们知之甚少。
描述英国专科姑息治疗服务在新冠疫情期间在预先护理计划方面所经历的挑战，以及为支持及时沟通而做出的改变。
对英国姑息治疗/临终关怀服务机构对新冠疫情的应对情况进行在线调查。对封闭式回答进行描述性报告。使用主题框架方法并运用社会生态模型对开放式回答进行分析，以了解挑战。
277个服务机构。
38%的服务机构提供了更直接的预先护理计划，59%的服务机构为其他机构提供了更多支持。预先护理计划面临的一些挑战在疫情之前就已存在，而其他挑战则是新冠疫情所特有的或因疫情而加剧。挑战通过六个主题得以体现：面对新型传染病时的复杂决策；保持个性化方法；与新冠疫情相关的沟通困难；工作量和压力；信息共享；以及恐惧和不确定性的国家背景。有两个主题展示了为提供支持而做出的改变：调整当地流程和调整当地结构。
专业人员和医疗服务提供者需要确保预先护理计划根据每个人的价值观、优先事项以及种族/文化/宗教背景进行个性化定制。政策制定者需要考虑如何在未来疫情浪潮到来之前，将高质量的预先护理计划作为标准医疗保健服务的一部分提供资源支持。在推动此事的过程中，我们提供了在社会生态模型的每个层面都需考虑的问题。
