TY - JOUR
T1 - Symptom Control and Survival for People Severely ill With COVID
T2 - A Multicentre Cohort Study (CovPall-Symptom)
AU - CovPall study team
AU - Higginson, Irene J.
AU - Hocaoglu, Mevhibe B.
AU - Fraser, Lorna K.
AU - Maddocks, Matthew
AU - Sleeman, Katherine E.
AU - Oluyase, Adejoke O.
AU - Chambers, Rachel L.
AU - Preston, Nancy
AU - Dunleavy, Lesley
AU - Bradshaw, Andy
AU - Bajwah, Sabrina
AU - Murtagh, Fliss E.M.
AU - Walshe, Catherine
N1 - Funding Information:
The authors thank staff, patients and families at the following services that took part in this study: Cardiff and Vale University Health Board; Douglas Macmillan Hospice; Hayward House Specialist Palliative Care Unit; Hull University Teaching Hospitals NHS; John Taylor Hospice; King's College Hospital; Lewisham & Greenwich NHS Trust; Loros Hospice; Marie Curie Hospice West Midlands; Northumbria Healthcare NHS Foundation Trust; Poole Hospital NHS Foundation Trust and Forest Holme Hospice; Princess Royal University Hospital; Royal Berkshire Hospital NHS Trust; Royal Marsden Hospital; Royal Trinity Hospice; Salford Royal NHS Foundation Trust; Sheffield Teaching Hospitals NHS Foundation Trust (The Macmillan Palliative Care Unit and the advisory SPC service to 3 hospitals (Weston Park, Royal Hallamshire, and Northern General); St Barnabas Hospice; St Gemma's Hospice; St Giles Hospice; Sue Ryder Leckhampton Court Hospice; University Hospital Southampton NHS Foundation Trust; Nottingham University Hospitals NHS Trust; York Teaching Hospital NHS Foundation Trust: York Hospital, Scarborough Hospital. This study was part of CovPall, a multinational study. This research was primarily supported by Medical Research Council grant number MR/V012908/1. Additional support was from the National Institute for Health Research (NIHR), Applied Research Collaboration, South London, hosted at King's College Hospital NHS Foundation Trust, and Cicely Saunders International (Registered Charity No. 1087195).We thank all collaborators and advisors. We thank all participants, partners, PPI members and our Study Steering Group. We gratefully acknowledge technical assistance from the Precision Health Informatics Data Lab group ( https://phidatalab.org) at National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London for the use of REDCap for data capture. IJH is a National Institute for Health Research (NIHR) Emeritus Senior Investigator and is supported by the NIHR Applied Research Collaboration (ARC) South London (SL) at King's College Hospital National Health Service Foundation Trust. IJH leads the Palliative and End of Life Care theme of the NIHR ARC SL and co-leads the national theme in this. MM is funded by a National Institute for Health Research (NIHR) Career Development Fellowship (CDF-2017-10-009) and NIHR ARC SL. LKF is funded by a NIHR Career Development Fellowship (award CDF-2018-11-ST2-002). KES is the Laing Galazka Chair in palliative care, funded by an endowment from Cicely Saunders International and Kirby Laing. RC is funded by Cicely Saunders International and Marie Curie. FEM is a NIHR Senior Investigator. MBH is supported by the NIHR ARC SL. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care. The authors declare no conflicts of interest.
Funding Information:
IJH is the grant holder and chief investigator; KES, MM, FEM, CW, NP, LKF, SB, MBH and AO are co-applicants for funding. IJH and CW with critical input from all authors wrote the protocol for the CovPall study. MBH co-ordinated data collection and liaised with centres, with input from AO, RC, CW, NP, FM and SB. IJH and MBH analysed the data, with input from LKF. All authors had access to all study data, discussed the interpretation of findings and take responsibility for data integrity and analysis. IJH and MBH drafted the manuscript. All authors contributed to the analysis plan and provided critical revision of the manuscript for important intellectual content. IJH is the guarantor.
Funding Information:
This study was part of CovPall, a multinational study. This research was primarily supported by Medical Research Council grant number MR/V012908/1. Additional support was from the National Institute for Health Research (NIHR), Applied Research Collaboration, South London, hosted at King's College Hospital NHS Foundation Trust, and Cicely Saunders International (Registered Charity No. 1087195).We thank all collaborators and advisors. We thank all participants, partners, PPI members and our Study Steering Group. We gratefully acknowledge technical assistance from the Precision Health Informatics Data Lab group ( https://phidatalab.org ) at National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London for the use of REDCap for data capture.
Publisher Copyright:
© 2022 The Authors
PY - 2022
Y1 - 2022
N2 - Context: Evidence of symptom control outcomes in severe COVID is scant. Objectives: To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival. Methods: Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative care Outcome Scale – COVID version. Results: We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were: breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival. Conclusion: Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.
AB - Context: Evidence of symptom control outcomes in severe COVID is scant. Objectives: To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival. Methods: Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative care Outcome Scale – COVID version. Results: We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were: breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival. Conclusion: Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.
KW - acute hospital ward
KW - COVID
KW - hospice
KW - integrated palliative care outcome scale
KW - palliative care
KW - specialist palliative care
KW - symptom management
KW - Symptom treatment
UR - http://www.scopus.com/inward/record.url?scp=85135472142&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2022.06.009
DO - 10.1016/j.jpainsymman.2022.06.009
M3 - Article
C2 - 35752399
AN - SCOPUS:85135472142
SN - 0885-3924
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
ER -