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Improving Hospital Palliative Care Between COVID-19 Waves: A Retrospective Cohort Study
Claude Chidiac1, Luigi Sedda2, Catherine Walshe3
1Department of Palliative Care (C.C, M.F., D.F., A.R.), Homerton Healthcare NHS Foundation Trust, London, UK; International Observatory on End-of-Life Care, Division of Health Research, Lancaster University (C.C., C.W., N.P.), Lancaster, LA1 4YG, UK.
Journal of Pain and Symptom Management
|September 19, 2024
Summary
Ethnic disparities in palliative care referrals narrowed during the COVID-19 pandemic. Introduction of new treatments and service changes impacted referral times, but improved equity by the second wave.
Area of Science:
- Palliative Care
- Health Services Research
- Epidemiology
Background:
- Specialist palliative care services in acute hospitals adapted during the COVID-19 pandemic's first wave.
- Delayed referrals were noted for minoritized ethnic groups.
- The second wave saw the introduction of COVID-19 treatments like dexamethasone and anticoagulation, alongside service modifications.
Purpose of the Study:
- To analyze changes in palliative care patterns and trends during COVID-19, considering new treatments.
- To assess ethnic disparities in palliative care referrals between the first and second waves of the pandemic.
Main Methods:
- A retrospective cohort study compared patients with COVID-19 referred to palliative care during the first (W1) and second (W2) waves.
- Statistical analyses included generalized linear mixed models for referral time and survival analysis.
- Demographic, clinical, and outcome data were analyzed.
Main Results:
- Referrals in W1 occurred earlier than in W2. Treatments like dexamethasone/anticoagulants and conditions such as dementia/hypertension were linked to longer referral times.
- Ethnic disparities in referral delays observed in W1 were not present in W2.
- Socioeconomic status did not correlate with care patterns. Performance status and illness phase predicted survival.
Conclusions:
- Findings can guide strategies to enhance palliative care responsiveness and equity.
- The study offers insights for future pandemics and health crises.
- Improved equity in palliative care access was observed by the second wave.
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