The Unseen Challenges: A Qualitative and Multicentre Study Exploring the Experiences of Palliative Care Professionals...

The COVID-19 pandemic has affected countries at different times and to varying degrees, placing significant pressure on healthcare systems and challenging the delivery of end-of-life care. Palliative care professionals faced unprecedented circumstances, requiring rapid adaptation to maintain the quality of care for vulnerable populations. Thus, the aim of this study was to explore the experiences, challenges, and perspectives of healthcare professionals providing palliative care in Brazil and England during the COVID-19 pandemic. This qualitative multicenter study was conducted with 36 healthcare professionals (18 occupational therapists and 18 nurses) from various palliative care services in Brazil and England. Data were collected remotely through semi-structured interviews and analysed using reflexive thematic analysis. Findings revealed that professionals experienced intense emotional distress and ethical challenges, particularly related to providing care in isolation and managing silent mourning processes. The study also highlighted the rapid adaptation of palliative care services in response to pandemic constraints, such as the implementation of telehealth and restructured workflows. Despite challenges, professionals demonstrated creativity and resilience, with innovations emerging from crisis situations to ensure continuity of care. The COVID-19 pandemic profoundly disrupted palliative care delivery, prompting teams to develop new strategies to support patients, families, and colleagues. The experience fostered reflection on care practices and emphasised the critical role of palliative care in public health emergencies. These findings provide valuable insights for future preparedness and underline the need for stronger integration of palliative care in healthcare systems during pandemics.