Care and creativity may be needed for palliative care in COVID-19

NEW YORK (Reuters Health) -Providing palliative care during a pandemic may be difficult, but experts are looking for new ways to help patients.

The authors wrote in JAMA Oncology that patients with advanced cancers in particular may be more vulnerable to potential exposure to COVID-19 and need a creative approach to palliative care.

“We value the mind, body and spirit of our patients. Like any other serious illness, COVID-19 affects all of this,” said Ambereen Mehta, lead author of UCLA Health in Los Angeles. Says Dr.

“But our traditional way of providing our superior palliative care was not possible at physical distances,” she emailed Reuters Health. “At the same time, more people were seeking palliative care services.”

Instead of spending time at the bedside or meeting with family, we needed new options. Palliative care physicians held a national video call to discuss their concerns. Early studies showed that cancer patients had high mortality from COVID-19 and that patients with immunodeficiency had an uncertain frequency of continuing chemotherapy and radiation.

“While we had to choose between cancer and COVID-19, we felt like we were stuck,” said Mehta, who added, “The patient’s hopes about risk and benefits are increasing.” Active discussions have become even more important. “Cancer treatments and hospitalization guidelines. ”

In the article, Dr. Melita and co-author Dr. Thomas Smith of the Sydney Kimmel Comprehensive Cancer Center of Johns Hopkins Medicine in Baltimore, Maryland, report on three types of potentially affected patients. Hospitals with positive COVID-19 test results and hospitals with negative COVID-19 test results.

They point out that telemedicine has become a key strategy for providing palliative care, and new federal guidelines allow palliative care professionals to write new opioid and replacement prescriptions through the telemedicine process. I can do it. Video bookings also allow specialists to observe the patient’s home. This is usually not available for traditional office visits.

“Existence, verifying emotions, answering questions, and using communication tools should continue to be implemented for virtual visits,” they write.

Palliative care professionals are using telemedicine for inpatients, including those who test positive for COVID-19, due to limited personal protective equipment and restricted caregiver visits. I will. Patients with COVID-19 in particular can decline rapidly, leaving little time for the family to prepare and make decisions. At the same time, the video allows for face-to-face communication, allowing you to talk to multiple healthcare professionals in one call

“A seriously ill patient dies alone, and family / caregivers grieve and suffer from their loved ones,” the authors write.

Another issue is physical existence. Palliative care professionals often provide emotional support through presence and touch, some of which can be provided during telemedicine appointments, but can be difficult, the authors write. ..

“If a computer-savvy family can attend telemedicine, while others can only manage visits over the phone, that can exacerbate the digital divide,” they say.

Ultimately, palliative care professionals can reduce the medical burden on hospitals and hospice by providing patient support, the authors write. They can also provide emotional support to front-line health care workers who are “equally afraid and overworked”. Added by Mehta and Smith. Nurses, pastors, social workers, and pharmacists need help and additional care, and palliative care professionals can intervene to divide patient lists and assist when needed.

“All cancer patients, especially head and neck cancer patients, are particularly vulnerable during this time due to the increased risk of COVID-19 complications,” said Dr. Arun Sharma of the University of Southern Illinois School of Medicine. Springfield, Illinois. Sharma, who was not involved in this paper, writes about the concerns faced by head and neck cancer patients during the COVID-19 outbreak.

“Palliative care services are important for patients with cancer because they balance the hopes of patients and their families with symptom management and coordination of care,” he told Reuters Health by email.

Source: JAMA Oncology, May 7, 2020 Online.