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Interventions for palliative symptom control in COVID-19 patients
Marike Andreas1, Vanessa Piechotta1, Nicole Skoetz2
1Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
The Cochrane Database of Systematic Reviews
|August 23, 2021
Summary
Palliative care for COVID-19 patients lacks evidence. This review found very low certainty evidence for pharmacological interventions and no evidence for non-pharmacological ones, highlighting the need for more research.
Area of Science:
- Palliative Care and Symptom Management
- Infectious Diseases and Epidemiology
- Evidence-Based Medicine
Background:
- Individuals with coronavirus disease 2019 (COVID-19) may experience distressing symptoms requiring palliative care.
- Current guidance for COVID-19 palliative symptom management often relies on experience from other illnesses.
- There is a need to understand the effectiveness of interventions for specific COVID-19 symptoms.
Purpose of the Study:
- To assess the efficacy and safety of pharmacological and non-pharmacological interventions for palliative symptom control in COVID-19 patients.
- To identify and synthesize existing evidence on symptom management in end-of-life care for COVID-19.
Main Methods:
- Systematic search of multiple databases including Cochrane COVID-19 Study Register, PubMed, Embase, and ClinicalTrials.gov until March 2021.
- Inclusion of various study designs (RCTs, cohort studies, etc.) evaluating palliative interventions for confirmed COVID-19 cases.
- Assessment of bias using the Newcastle Ottawa Scale and certainty of evidence using the GRADE approach; synthesis via tabulation.
Main Results:
- Four uncontrolled retrospective cohort studies on pharmacological interventions were identified, with high risk of bias.
- Very low certainty evidence suggests pharmacological interventions (opioids, neuroleptics, etc.) may relieve symptoms like dyspnea and delirium.
- No evidence was found regarding the safety of pharmacological interventions or the efficacy/safety of non-pharmacological interventions.
Conclusions:
- The current evidence for palliative symptom control in COVID-19 is insufficient, with very low certainty regarding pharmacological interventions.
- No conclusions can be drawn on the effectiveness or safety of either pharmacological or non-pharmacological interventions.
- Further high-quality research, including prospectively registered studies with active comparators and patient-reported outcomes, is urgently needed.
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