‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall)

  1. Lesley Dunleavy
  2. Nancy Preston
  3. Sabrina Bajwah
  4. Andy Bradshaw
  5. Rachel Cripps
  6. Lorna K Fraser
  7. Matthew Maddocks
  8. Mevhibe Hocaoglu
  9. Fliss EM Murtagh
  10. Adejoke O Oluyase
  11. Katherine E Sleeman
  12. Irene J Higginson
  13. Catherine Walshe

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Abstract

Specialist palliative care services have a key role in a whole system response to COVID-19, a disease caused by the SARS-CoV-2 virus. There is a need to understand service response to share good practice and prepare for future care.

Aim:

To map and understand specialist palliative care services innovations and practice changes in response to COVID-19.

Design:

Online survey of specialist palliative care providers (CovPall), disseminated via key stakeholders. Data collected on service characteristics, innovations and changes in response to COVID-19. Statistical analysis included frequencies, proportions and means, and free-text comments were analysed using a qualitative framework approach.

Setting/participants:

Inpatient palliative care units, home nursing services, hospital and home palliative care teams from any country.

Results:

Four hundred and fifty-eight respondents: 277 UK, 85 Europe (except UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient palliative care units and 57% home palliative care teams. The crisis context meant services implemented rapid changes. Changes involved streamlining, extending and increasing outreach of services, using technology to facilitate communication, and implementing staff wellbeing innovations. Barriers included; fear and anxiety, duplication of effort, information overload and funding. Enablers included; collaborative teamwork, staff flexibility, a pre-existing IT infrastructure and strong leadership.

Conclusions:

Specialist palliative care services have been flexible, highly adaptive and have adopted low-cost solutions, also called ‘frugal innovations’, in response to COVID-19. In addition to financial support, greater collaboration is essential to minimise duplication of effort and optimise resource use. ISRCTN16561225 https://doi.org/10.1186/ISRCTN16561225

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  1. Version published to 10.1177/02692163211000660
  2. ScreenIT

    SciScore for 10.1101/2020.10.29.20215996: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Research ethics and approvals: Research ethics committee approval for this study was obtained from King’s College London Research Ethics Committee (21/04/2020, Reference; LRS19/20-18541).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data collection: REDCap was used to securely build and host the online survey with closed and free text survey responses (see supplementary materials for the full survey).
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Data analysis: Anonymised data were exported to SPSS (for quantitative analysis using descriptive statistics, frequencies, proportions and means) and NVivo 12 (for analysis of free-text comments using a qualitative framework analysis approach)23.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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 weaknesses of the study: This study is a large multi-national survey of specialist palliative care services response to the COVID-19 pandemic. Free text responses provided useful insights into how and why services made changes to their routine ways of working in response to the crisis. The survey was completed by service leads so the findings may present an overly positive view of the changes made and may not reflect the views of other practitioners working within the services taking part in this study. Negative aspects of the changes made may also not have been captured due to the wording of questions in the survey. More detailed survey responses were also generally provided by those who were native English speakers. Data were collected at a single time point so how useful and sustainable the changes were has not been captured. A successful frugal innovation or improvisation may be retained but may not be useful unless there is a similar future crisis 27. Changes in practice may lead to unethical practices and negative outcomes as resource scarcity may, in some instances, simply undermine the quality of care 25. The challenge of implementing remote clinical consultations rapidly during the pandemic with limited resources, for example, has been raised 37 and how sustainable changes are beyond the pandemic without the necessary infrastructure being in place has been questioned 38. This issue is particularly pertinent to palliative care where funding for services ...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN16561225NANA

    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

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  3. Version published to 10.1101/2020.10.29.20215996v1 on medRxiv