Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care

Natasha Lovell; Matthew Maddocks; Simon N. Etkind; Katie Taylor; Irene Carey; Vandana Vora; Lynne Marsh; Irene J. Higginson; Wendy Prentice; Polly Edmonds; Katherine E. Sleeman

doi:10.1016/j.jpainsymman.2020.04.015

Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care

Natasha Lovell, Matthew Maddocks, Simon N. Etkind, Katie Taylor, Irene Carey, Vandana Vora, Lynne Marsh, Irene J. Higginson, Wendy Prentice, Polly Edmonds, Katherine E. Sleeman^*

^*Corresponding author for this work

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation

Research output: Contribution to journal › Article › peer-review

160 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	e77-e81
Journal	Journal of pain and symptom management
Volume	60
Issue number	1
DOIs	https://doi.org/10.1016/j.jpainsymman.2020.04.015
Publication status	Published - Jul 2020

Keywords

coronavirus
COVID-19
end of life
hospice
palliative care
symptom management

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jpainsymman.2020.04.015

Cite this

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. (2020). Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. Journal of pain and symptom management, 60(1), e77-e81. https://doi.org/10.1016/j.jpainsymman.2020.04.015

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abstract = "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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Lovell, N , Maddocks, M , Etkind, SN, Taylor, K, Carey, I, Vora, V, Marsh, L, Higginson, IJ, Prentice, W, Edmonds, P & Sleeman, KE 2020, 'Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care', Journal of pain and symptom management, vol. 60, no. 1, pp. e77-e81. https://doi.org/10.1016/j.jpainsymman.2020.04.015

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AU - Lovell, Natasha

AU - Maddocks, Matthew

AU - Etkind, Simon N.

AU - Taylor, Katie

AU - Carey, Irene

AU - Vora, Vandana

AU - Marsh, Lynne

AU - Higginson, Irene J.

AU - Prentice, Wendy

AU - Edmonds, Polly

AU - Sleeman, Katherine E.

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AB - 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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Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care

Abstract

Keywords

UN SDGs

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