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Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications.

ABSTRACT: BACKGROUND:COVID-19 has directly and indirectly caused high mortality worldwide. AIM:To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. DESIGN:Descriptive analysis and population-based modelling of routine data. PARTICIPANTS AND SETTING:All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. RESULTS:During the first 10?weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged???75?years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%-31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. CONCLUSION:The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

SUBMITTER: Bone AE

PROVIDER: S-EPMC7385436 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications.

Bone Anna E AE Finucane Anne M AM Leniz Javiera J Higginson Irene J IJ Sleeman Katherine E KE

Palliative medicine 20200724 9

<h4>Background</h4>COVID-19 has directly and indirectly caused high mortality worldwide.<h4>Aim</h4>To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research.<h4>Design</h4>Descriptive analysis and population-based modelling of routine data.<h4>Participants and setting</h4>All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of de ...[more]

PMID: 32706299

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Project description:ObjectivesPalliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation.Data sourcesWe searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files.Study selectionSelected studies included all English-language articles concerning adult patients using the search terms 'intensive care' or 'critical care' with 'palliative care,' 'supportive care,' 'end-of-life care,' or 'ethics.'Data extraction: After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus.Data synthesisExisting evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care.ConclusionsPalliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.

Dataset Information

Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications.

Publications

Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications.

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