COVID-19: Changing Contexts for Health and Social Care Professionals in Palliative Care

Palliative care is an interdisciplinary approach to care of people with active, progressive, far-advanced disease, for whom the focus of care is the relief or prevention of suffering.

It aims to improve pain and symptom management, communication and planning in care of people with serious illness and their family caregivers. Globally, the evolving COVID-19 pandemic is likely to situate palliative care at the forefront of healthcare delivery.

Health and Social Care Professionals (HSCPs) constitute a significant proportion of professionals who work with and deliver services to people in need of palliative care, including for example, symptom management, assistive technology, respite care, advanced care planning, nutrition, end-of-life care, and bereavement care.

The rapidly evolving COVID-19 pandemic has, to this point, changed the immediate context in which HSCPs are operating. The temporary redeployment of many HSCPs in the acute and primary care sector to COVID-19 related duties has significantly restricted the scope of HSCP services.

As COVID-19 restrictions ease and as healthcare services that extend beyond the acute management of the COVID-19 crisis reopen, HSCPs who work with people with life-limiting illness are operating in the most altered context of all – that of palliative care.

The primary challenge for HSCPs in the context of COVID-19 will be to meet the palliative care needs of people when they need it. COVID-19 will increase the need for palliative care among populations for the foreseeable future even though many healthcare systems, including our own, may fall short of funding to support timely and equitable services in palliative care.

Resources will become stretched even though additional resources including equipment are needed to provide ‘safe’ care in palliative care. HSCPs in palliative care will need to demonstrate their efficacy in terms of meaningful outcomes for patients and their family caregivers, to properly sustain delivery of HSCP services in palliative care over the course of the COVID-19 pandemic.

HSCPs who deliver general palliative care are usually members of multidisciplinary teams in the primary, community and mainstream hospital setting who introduce the concept of palliative care, manage patients’ symptoms and co-ordinate care of patients with specialist palliative care services at more advanced stages of patient illness.

HSCPs in specialist palliative care are typically members of specialist, multidisciplinary teams, dedicated entirely to palliative care. They operate in specialist hospital palliative care units, hospices and specialist palliative care community teams, and deal with more complex, unresolving physical symptoms and psycho-social needs of patients and their family caregivers, including for example, end of life and bereavement care.

In the context of COVID-19 recovery, HSCPs in palliative care are now challenged with managing pre-existing palliative care needs of the population together with an anticipated population increase in both general and specialist palliative care needs.

It is possible that HSCPs who provide general palliative care will need to assume some roles and responsibilities normally associated with specialist palliative care.

Navigating the above challenge will require some adjustment to HSCPs’ practice. Adjustment could involve establishing new (or reconfiguring old) care pathways between general palliative care HSCP services and specialist palliative care HSCP services.

New or existing care pathways will need to reconsider and decide on key criteria and triggers for transition of care between both. There may be a need to deploy a proportion of HSCP specialist palliative care clinicians from traditional palliative care settings to the primary care setting where most people who have specialist and general palliative care needs are situated and/or to integrate specialist palliative care community teams further into primary care.

Upskilling of HSCPs in domains of care normally associated with specialist palliative care would be beneficial. In the context of immediate financial constraints, specialist training of HSCPs in general palliative care could be delivered by both specialist palliative care community teams and by clinicians from traditional specialist palliative care settings.

The overall benefit of re configuring services where needed is that more complex palliative care needs in the primary care setting can be addressed as early as possible, and in turn alleviate acute pressure on specialist palliative care settings in the context of COVID-19.

This Blog was written by Geraldine Foley, PhD, Assistant Professor (Occupational Therapy), Trinity College Dublin.

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