Palliative care in the time of Covid-19

Palliative care (PC) is a branch of medicine that focuses on the care of people with serious or life threatening illness. So why would we need it in a situation where 80% of sufferers have mild illness and recover quickly?

The huge challenge of COVID-19 at present is that a large number of people will get serious or life-threatening illness all at the same time which will threatens to completely overwhelm health care resources,  cause a high mortality and a great deal of suffering.

The fundamentals principles of Palliative Care are ideally suited to guide and support us through the Covid-19 pandemic.

What are these principles and how do they apply to the present time?

It is essential to note that Palliative Care intends to neither hasten, nor postpone death. The intention is to improve quality of life.

All patients have a right to compassionate and dignified care at all times.

Even when an illness cannot be cured, the relief of symptoms and suffering is paramount and a great deal can be done.

Palliative Care uses an integrated approach – there are 3 layers of integration:
  • The patient is seen as a whole person. Physical care is considered together with psycho-social and spiritual care.
  • The patient and family/close contacts are regarded as a single integrated unit.
  • The Healthcare team is an integrated unit to ensure that all the needs of the patient and family are considered. PC is provided alongside standard medical care and includes active treatment of reversible condition
Palliative Care can be applied in any setting

This includes intensive care units, hospital wards, emergency departments, out-patient clinics, intermediate care facilities, care homes and most importantly private homes. PC provides skill and experience to people in their own homes.

The right preparation and guidance can ensure that this is possible and preferable, especially in a situation where there are not enough hospital beds.

In this time of high anxiety it is essential that all people need to think more deeply about their health and the health of their loved ones. We need to urgently develop skill for compassionate communication  with our patients, their families and each other.

Planning ahead minimises stress and assists with decision making

Dialogue between  the health care provider and their patients about what lies ahead, their goals and preferences can be respected  and incorporated into an Advance Care Plan(ACP). This is essential for all patients with serious illnesses or who are nearing the end of their lives, but it should be strongly encouraged for all older adults. ACP has been shown to lead to care that is more aligned with patients’ wishes, reduce the rate of futile, aggressive interventions at the end of life and reduce complicated bereavement in family members. PALPRAC forms can be downloaded from under PALPRAC Advance Care Planning 

 It is important to note that ‘palliative care’ does not only describe end-of-life care, but refers to the relief of symptoms and suffering for all, whatever their COVID status or final health outcome.

Dr Shelley Kibel, Palliative Care Clinician, Cape Town

 

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