Response and role of palliative care during the COVID-19 pandemic: A national telephone survey of hospices in Italy

  1. Massimo Costantini
  2. Katherine E Sleeman
  3. Carlo Peruselli
  4. Irene J Higginson

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Abstract

Palliative care is an important component of health care in pandemics, contributing to symptom control, psychological support, and supporting triage and complex decision making.

Aim:

To examine preparedness for, and impact of, the COVID-19 pandemic on hospices in Italy to inform the response in other countries.

Design:

Cross-sectional telephone survey, in March 2020.

Setting:

Italian hospices, purposively sampled according to COVID-19 regional prevalence categorised as high (>25), medium (15–25) and low prevalence (<15) COVID-19 cases per 100,000 inhabitants. A brief questionnaire was developed to guide the interviews. Analysis was descriptive.

Results:

Seven high, five medium and four low prevalence hospices provided data. Two high prevalence hospices had experienced COVID-19 cases among both patients and staff. All hospices had implemented policy changes, and several had rapidly implemented changes in practice including transfer of staff from inpatient to community settings, change in admission criteria and daily telephone support for families. Concerns included scarcity of personal protective equipment, a lack of hospice-specific guidance on COVID-19, anxiety about needing to care for children and other relatives, and poor integration of palliative care in the acute planning response.

Conclusion:

The hospice sector is capable of responding flexibly and rapidly to the COVID-19 pandemic. Governments must urgently recognise the essential contribution of hospice and palliative care to the COVID-19 pandemic and ensure these services are integrated into the health care system response. Availability of personal protective equipment and setting-specific guidance is essential. Hospices may also need to be proactive in connecting with the acute pandemic response.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.18.20038448: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: The ethics committee of Reggio Emilia was approached, and we were advised that according to Italian law a formal ethical approval was not necessary.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: The limitations of this study are that it was a rapid telephone survey with a small sample. The opportunity to collect in depth qualitative data was limited due to the extreme pressure services are under. It will be useful to follow up this cross-sectional survey over time as the situation changes. Using our existing clinical-academic networks enabled this survey to be completed rapidly, to provide essential early data of the hospice response. What this study adds: The hospice sector has an important role to play in the response to COVID-19. This includes support with complex decisions and triage, psychological support for patients, carers and professionals, and complex symptom management, particularly for people who are dying.3 However, there is evidence that the hospice sector is underused in epidemics.4 In Italy, and elsewhere, it is likely that the number of people dying with COVID-19 will overwhelm the capacity of the acute sector.6 Integrating hospice and palliative care into acute services may free up resources to optimise survival of others.7 Our data highlights that hospice services in all countries need to act now to prepare for COVID-19. Building on the Critical Care model of providing surge capacity in a crisis, elements essential to implementing a palliative care pandemic plan include (i) medication and equipment for symptom control including kits for use in care homes and at home; (ii) education to frontline staff on symptom management...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1177/0269216320920780
  3. Version published to 10.1101/2020.03.18.20038448v1 on medRxiv