Were clinical routines for good end-of-life care maintained in hospitals and nursing homes during the first three months of the outbreak of COVID-19? A national register study.
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Martinsson L, Strang P, Bergström J, Lundström S
J Pain Symptom Manage - (-) - [2020-10-06; online 2020-10-06]
Although the COVID-19 pandemic might affect important clinical routines, few studies have focused on the maintenance of good quality in end-of-life care. The objective was to examine whether adherence to clinical routines for good end-of-life care differed for deaths due to COVID-19 compared to a reference cohort from 2019, and whether they differed between nursing homes and hospitals. Data about five items reflecting clinical routines for persons who died an expected death from COVID-19 during the first three months of the pandemic (March-May 2020) were collected from the Swedish Register of Palliative Care. The items were compared between the COVID-19 group and the reference cohort, and between the nursing home and hospital COVID-19 deaths. 1316 expected deaths were identified in nursing homes and 685 in hospitals. Four of the five items differed for total COVID-19 group compared to the reference cohort: fewer were examined by a physician during the last days before death, pain and oral health were less likely to be assessed, and fewer had had a specialised palliative care team consultation (p < .0001, respectively). Assessment of symptoms other than pain did not differ significantly. The five items differed between the nursing homes and hospitals in the COVID-19 group, most notably regarding the proportion of persons examined by a physician during the last days (nursing homes - 18%, hospitals - 100%). This national register study shows that several clinical routines for end-of-life care did not meet the usual standards during the first three months of the COVID-19 pandemic in Sweden. Higher preparedness for and monitoring of end-of-life care quality should be integrated into future pandemic plans.
PubMed 33035649
DOI 10.1016/j.jpainsymman.2020.09.043
Crossref 10.1016/j.jpainsymman.2020.09.043
pii: S0885-3924(20)30794-6
pmc: PMC7538392