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2020 ; 60
(2
): e75-e78
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A Dual-Center Observational Review of Hospital-Based Palliative Care in Patients
Dying With COVID-19
#MMPMID32387139
Turner J
; Eliot Hodgson L
; Leckie T
; Eade L
; Ford-Dunn S
J Pain Symptom Manage
2020[Aug]; 60
(2
): e75-e78
PMID32387139
show ga
The current coronavirus disease 2019 (COVID-19) pandemic has put significant
strain on all aspects of health care delivery, including palliative care
services. Given the high mortality from this disease, particularly in the more
vulnerable members of society, it is important to examine how best to deliver a
high standard of end-of-life care during this crisis. This case series collected
data from two acute hospitals examining the management of patients diagnosed with
COVID-19 who subsequently died (n = 36) and compared this with national and local
end-of-life audit data for all other deaths. Our results demonstrated a shorter
dying phase (38.25 hours vs. 74 hours) and higher rates of syringe driver use
(72% vs. 33% in local audits), although with similar average mediation doses. Of
note was the significant heterogeneity in the phenotype of deterioration in the
dying phase, two distinct patterns emerged, with one group demonstrating severe
illness with a short interval between symptom onset and death and another group
presenting with a more protracted deterioration. This brief report suggests a
spectrum of mode of dying. Overall, the cohort reflects previously described
experiences, with increased frailty (median Clinical Frailty Scale score of 5)
and extensive comorbidity burden. This brief report provides clinicians with a
contemporaneous overview of our experience, knowledge, and pattern recognition
when caring for people with COVID-19 and highlights the value of proactive
identification of patients and risk of deterioration and palliation.