Characteristics, symptom management, and outcomes of 101 patients with COVID-19 referred for hospital palliative care
Open accessAbstract
Hospital palliative care is an essential part of the COVID-19 response but data are lacking. We identified symptom burden, management, response to treatment, and outcomes for a case series of 101 inpatients with confirmed COVID-19 referred to hospital palliative care. Patients (64 men, median [interquartile range {IQR}] age 82 [72-89] years, Elixhauser Comorbidity Index 6 [2-10], Australian-modified Karnofsky Performance Status 20 [10-20]) were most frequently referred for end-of-life care or symptom control. Median [IQR] days from hospital admission to referral was 4 [1-12] days. Most prevalent symptoms (n) were breathlessness (67), agitation (43), drowsiness (36), pain (23), and delirium (24). Fifty-eight patients were prescribed a subcutaneous infusion. Frequently used medicines (median [range] dose/24 hours) were opioids (morphine, 10 [5-30] mg; fentanyl, 100 [100-200] mcg; alfentanil, 500 [150-1000] mcg) and midazolam (10 [5-20] mg). Infusions were assessed as at least partially effective for 40/58 patients, while 13 patients died before review. Patients spent a median [IQR] of 2 [1-4] days under the palliative care team, who made 3 [2-5] contacts across patient, family, and clinicians. At March 30, 2020, 75 patients had died; 13 been discharged back to team, home, or hospice; and 13 continued to receive inpatient palliative care. Palliative care is an essential component to the COVID-19 response, and teams must rapidly adapt with new ways of working. Breathlessness and agitation are common but respond well to opioids and benzodiazepines. Availability of subcutaneous infusion pumps is essential. An international minimum data set for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops.
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Among severe COVID-19 cases admitted to palliative care units, about 30% were people with dementia and many presented with agitation and delirium.
“Lovell et al. (18) found that, among the more severe cases of COVID-19 infection admitted to palliative care units, about 30% were people with dementia and many presented with a range of neuropsychiatric symptoms, such as agitation, and delirium.”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [18]
People with dementia who contracted COVID-19 often presented with agitation and altered consciousness.
“Particularly affected were people with dementia, who presented often with agitation (16, 18–20) and altered consciousness (15, 18).”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [18]
There is little published data about cancer patients' specific needs and experiences at end-of-life during the pandemic.
“However, <25% of the patients included in these studies had cancer and there is little published data about cancer patients’ specific needs and experiences at end-of-life during the pandemic.”
From End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19 (2022) · cites this paper as [10]
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Bajgain, K. T., Badal, S., Bajgain, B. B., & Santana, M. J. (2021) · American Journal of Infection Control · doi:10.1016/j.ajic.2020.06.213 · Cited by 328 · see citing works
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End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19
McFarlane, P., Halley, A., Kano, Y., Wade, N., Wilson, S., & Droney, J. (2022) · Journal of Patient Experience · doi:10.1177/23743735221074171 · Cited by 4 · see citing works
“Small studies conducted in the UK described the end-of-life symptoms of patients with COVID-19 (9,10).”
Background
- Authors
- Lovell, N., Maddocks, M., Etkind, S. N., Taylor, K., Carey, I., Vora, V., Marsh, L., Higginson, I. J., Prentice, W., Edmonds, P., & Sleeman, K. E.
- Affiliations
- King's College London (GB)
- King's College Hospital NHS Foundation Trust (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Corresponding author
- Sleeman, Katherine E.
- ORCID
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 60
- Issue
- 1
- Pages
- e77-e81
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC7169932
- OpenAlex
- W3016639848
- Cited by
- 221
- References
- 12
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 9 · 2023: 20 · 2022: 66 · 2021: 70 · 2020: 51
- FWCI
- 38.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- National Institute of Health Research
- NIHR
- Clinician Scientist Fellowship (CS-2015-15-005)
- Career Development Fellowship (CDF-2017-10-009)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, hospital palliative care, symptom management, symptom burden, dyspnea, agitation, delirium, sleepiness, pain, opioids, benzodiazepines, subcutaneous infusion pump, end-of-life care, palliative care outcomes, elderly patients
- MeSH terms
- COVID-19, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Male, Palliative Care, Pneumonia, Viral, Referral and Consultation, Treatment Outcome, Hospice Care, Coronavirus Infections, Disease Management, Pandemics
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