Care at the End of Life

As more people are hospitalized due to COVID-19, are health care systems, patients, and families prepared for tough conversations and decisions about health care preferences and medical interventions? Now more than ever, it is important for providers to tap into the core tenets of palliative care to guide patients and their families through uncharted waters.

Palliative care is a medical specialty focused on alleviating stress and suffering for people with serious illness, and it is often provided alongside curative care as an extra layer of support. Some experts worry that a longstanding shortage of palliative care specialists “could leave many COVID-19 patients in distress,” Liz Szabo reported in Kaiser Health News.

“This pandemic means that we will be drawn into countless conversations with families who are suddenly having to make difficult decisions about life and death,” Nathan Gray, MD, a palliative care specialist at Duke University Hospital, wrote in a comic book–style story that he illustrated. “As we take stock of masks, gloves, and ventilators, we must also be ready to dig deep into our reserves of patience, communication, and compassion.”

In a Washington Post commentary, Emily Aaronson, MD, an emergency physician and assistant chief quality officer at Massachusetts General Hospital, encouraged families to engage in conversations about end-of-life wishes now. “It’s important that you understand what would be most important to them if they were in the last phase of their life — and what steps you and others will have to take to ensure those needs are met,” Aaronson wrote. “These are conversations designed to guard against regrets.”

Many resources are available to help families and health care providers alike. Aaronson recommended the Conversation Project …  to facilitate conversations. (Look for a Pennsylvania Link to Aging and Disability Resources Death Cafe to to have those conversations, too.)

The Center to Advance Palliative Care organized a COVID-19 toolkit for clinicians, and VitalTalk, a nonprofit organization dedicated to helping clinicians develop communication skills for serious illness, published a guide to difficult conversations about care of COVID-19 patients.

SOURCE: California Health Care Foundation

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