GUIDES, PROTOCOLS AND RECOMMENDATIONS
Recomendaciones sobre cuidar y acompañar personas en situación de últimos días y a su familia y/o cuidadores. SECPAL
LES CURES PAL·LIATIVES DURANTUNA EMERGÈNCIA DE SALUT –PANDÈMIA COVID 19
Dignificar l’atenció a les persones grans fràgils i en final de vida en l’entorn residencial durant la pandèmia de COVID-19. Document Consell Català de Col.legis de Metges de Catalunya
Palliative care in the time of COVID-19. Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Fausto Giuliana, Lidia Terruso, Tania Piccione. En Journal of pain and symptom management.
“After covid-19 crisis in Italy, serious restrictions have been introduced for relatives, with limitations or prohibitions on hospital visits. To partially overcome these issues “WhatsApp” has been adopted to get family members to participate in clinical rounds. Family members of patients admitted to the acute palliative care unit and hospice were screened for a period of 2 weeks. Four formal questions were posed: 1) Are you happy to virtually attend the clinical round? 2) Are you happy with the information gained in this occasion? 3) Do you think that your loved one was happy to see you during the clinical rounds? 4) This technology may substitute your presence during the clinical rounds? Most family members had a good impression, providing high scores. However, the real presence bedside (forth question) was considered irreplaceable. They perceived that their loved one, when admitted to hospice, had to say good-bye before dying.”
Coronavirus has given doctors a new job: Palliative care. Laura Kolbe.
“Doctors in coronavirus hot spots have witnessed more bewilderment and fear in less than two months than we would typically encounter in years of practice. Especially when hospitals have barred almost all visitors to prevent further infections, patients are rightly terrified of the shut door or the drawn curtain — of the idea that they will languish unseen and unheard by their doctors and the world at large. They understandably fear that they might die both in solitary confinement and in physical agony.
One of doctors’ many urgent jobs — even as many of us relearn the intricacies of ventilators, or the proper care of tracheostomies, or the calculations needed to nourish and hydrate critically debilitated bodies — is to assuage our patients’ fears and physical symptoms, honestly and thoroughly.”
Death and dying during the pandemic. Editorial. Sarah Yardley, Martin Rolph. En BMJ
“Covid-19 has rapidly forced utilitarian priorities to dominate decision making. As basic freedoms are restricted, individuals are being asked to make sacrifices for the collective good, including profound changes in how we care for people who are dying and those they leave behind.
Hospitals have closed their doors to visitors, separating patients from family and friends. For patients with covid-19 there is little time to adjust to the possibility of death since deterioration is rapid and death typically occurs no more than 2-3 days after a decision not to offer or to withdraw intensive care support.
Reports of families denied access to patients dying from covid-19, refusals to release bodies, and restrictions on funerals are widespread.12 Some hospitals are allowing one asymptomatic visitor for patients at the end of life, providing they do not need to self-isolate and can wear appropriate personal protective equipment (PPE). But practice is inconsistent and international consensus is lacking.”
Palliative care and the COVID-19 pandemic. Editorial. The Lancet
“For patients who won't survive, high-quality palliative care needs to be provided at least. But COVID-19 makes this more difficult. Time is short when patients deteriorate quickly, health professionals are overworked, isolation is mandated, and families are advised not to touch or even be in the same room as loved ones. This scenario will be compounded most in low-income and middle-income countries where shortages of both critical care and palliative care services are greatest. Continuing community-based palliative care is also harder to do safely. Many patients who need it are at heightened risk from COVID-19, protective equipment is running short, and surging deaths could overwhelm usual service provision.”
The role and response of palliative care and hospice services in epidemics and pandemics: a rapid review to inform practice during the COVID-19 pandemic. Simon N. Etkind, Anna E. Bone, et al. En Journal of Pain and Symptom Management
“Cases of COVID-19 are escalating rapidly across the globe, with the mortality risk being especially high among those with existing illness and multimorbidity. This study aimed to synthesise evidence for the role and response of palliative care and hospice teams to viral epi/pandemics, to inform the COVID-19 pandemic response”.
The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). J. Randall Curtis, Erin K. Kross, Renee D. Stapleton. En JAMA
“Clinicians should ensure patients receive the care they want, aligning the care that is delivered with patients’ values and goals. The importance of goal-concordant care is not new or even substantially different in the context of this pandemic, but the importance of providing goal-concordant care is now heightened in several ways. Patients most likely to develop severe illness will be older and have greater burden of chronic illness—exactly those who may wish to forgo prolonged life support and who may find their quality of life unacceptable after prolonged life support.”
This article reviews key aspects such as the Advance Care Planning or orders of do-not-resuscitation, and reviews how to improve communication in this situation.
One of the references includes an interesting communication improvement tool: COVID-Ready Communication Skills, A playbook of VitalTalk Tips https://www.vitaltalk.org/guides/covid-19-communication-skills/
Palliating a Pandemic: ‘‘All Patients Must Be Cared For’’. James Downar, Dori Seccareccia on behalf of the Associated Medical Services Inc. Educational Fellows in Care at the End of Life. En Journal of Pain and Symptom Management.
Although all triage systems have guaranteed palliative care for those who aredenied critical care, no jurisdiction has yet developed a plan to accommodate the anticipated‘‘surge’’ in demand for palliative care. The authors present a mathematical and ethicaljustification for a palliative care surge plan and outline some of the key elements that shouldbe included in such a plan.
The Potential Role for Palliative Care in Mass Casualty Events. Anne Wilkinson. En Journal of Palliative Care & Medicine.
Palliative care uses the skills from multiple disciplines to enhance quality of life and address the needs of seriously ill patients and their families based on evidence-based medical treatment, vigorous symptom relief, and humanitarian care when there is nothing else to offer. Palliative care respects the humanity of those who will die soon and assures their comfort while supporting their loved ones. Under normal circumstances, palliative care plays a complementary role to comprehensive medical care focused on cure or control of an underlying life-threatening disease. Under the dire circumstances of an MCE, disaster-related palliative care would, at a minimum, involve the aggressive management of symptoms and the relief of patient suffering, including the obvious humanitarian call to relieve the psycho-social, spiritual, and religious suffering of patients likely to die.
Palliative care in humanitarian crises: a review of the literature. Elysée Nouve, et al. En Journal of International Humanitarian Action.
This review set out to describe palliative care needs, practices, barriers, and recommendations in humanitarian crisis settings.
A Central Role for Palliative Care in an Influenza Pandemic. Philip Rosoff. JOURNAL OF PALLIATIVE MEDICINE
“In planning for a potential influenza pandemic we must anticipate which patients will be affected and how many. In an environment in which the ability to cure is limited by the restricted resources in both kind and amount, we face difficult choices. These choices are not only medical, but also have a uniquely moral dimension. In this way palliative care would assume a major and equal role in meeting the needs of a potentially vast number of patients. To do otherwise would be to abandon those who need us as much, if not more, than those who will be ventilated and receive oseltamivir.”
Sara Pons. VIDEO 1. Acompañar como profesionales sanitarios a los enfermos en esta pandemia. (NEW)
Sara Pons. VIDEO 2. Acompañar serenamente a tu familiar ingresado y duelos en soledad en la pandemia (NEW)
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