Journal Article Annotations
2021, 3rd Quarter
Annotations by Barbara Lubrano, MD and R. Garrett Key, MD
September, 2021
The finding
This study demonstrates the feasibility and effectiveness of providing palliative care consultations virtually. The authors describe a case series of virtual consultations provided by consultants across the United States for COVID-19 patients in New York City at the outset of the pandemic. Among deceased patients, code status was changed in most patients and a decision to withdraw life-sustaining treatments (LSTs) was made in half of those patients, suggesting that palliative care consultation may have helped guide the decision making at the end of life. For patients who survived, however, code status changes were much less frequent and the follow-up duration was longer, suggesting that the decreased use of LSTs was due to improvement in the patients’ clinical condition, and that palliative care consultations were likely oriented towards psychosocial support to the family.
Strength and weaknesses
This study is a promising resource that can help safeguard our health system’s ability to address unmet palliative care needs for critically ill patients, especially during a global pandemic. This is a retrospective study in a single institution. No data on the experience of the virtual consultants who volunteered their time in addition to their duties in their home institutions was collected.
Relevance
The utilization of a virtual consultation-liaison palliative care model in collaboration with volunteer C-L psychiatrists from outside medical institutions could help address the shortage of specialized C-L care in Institutions located in rural and underserved areas or during periods of high demand for services. Despite the sensitive nature of palliative care consultations, these clinical services can be impactful even when provided virtually.
The finding:
The SARS-CoV-2 pandemic has brought unprecedented challenges in alleviation of suffering for patients and healthcare workers (HCW). This article presents a review of best available evidence for caring for patients, their families, and HCW teams to alleviate physical, emotional, and spiritual suffering related to COVID-19. Concise information is presented regarding the 5 stages of COVID-19 illness, demographics of the different aspects of suffering and symptoms, specific guidance for treating the most common symptoms of disease (dyspnea, cough, fever, anxiety/depression, sleep disturbances), spiritual suffering, communication and planning strategies for patients and families, and strategies for HCW team care to mitigate the cumulative distress on our healthcare workforce. Evidence specific to COVID-19, such as communication challenges related to isolation protocols, is presented where it is available.
Strength and weaknesses:
The authors gathered data from a broad array into easily accessible tables as a quick reference for clinicians. The article also helps to categorize and organize challenges specific to COVID-19 that differentiate it from other types of critical or prolonged illness. Weaknesses include limited quality of data sources including lack of randomized controlled trials. There has been no rigorous evaluation of any specific protocols using these collected recommendations.
Relevance:
C-L psychiatrists have been heavily involved in caring for people with COVID-19, their survivors, and their clinical teams. Our role has blended with formal palliative care, and awareness of best practices to treat physiological, psychological, and secondary trauma (both in families and HCW teams) help us maximize our impact on the suffering caused by COVID-19.