Palliative care and COVID-19: acknowledging past mistakes to forge a better future

COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had n...

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Published in:	Frontiers in medicine Vol. 11; p. 1390057
Main Authors:	de Andrade, Camila Rabelo Monteiro, Luz, Fernanda Silva Trindade, de Oliveira, Neimy Ramos, Kopittke, Luciane, Santa Rosa, Luiza Marinho Motta, Gomes, Angelica Gomides Dos Reis, Bartolazzi, Frederico, Francisco, Saionara Cristina, da Costa, Felicio Roberto, Jorge, Alzira de Oliveira, Cimini, Christiane Corrêa Rodrigues, Carneiro, Marcelo, Ruschel, Karen Brasil, Schwarzbold, Alexandre Vargas, Ponce, Daniela, Ferreira, Maria Angélica Pires, Guimarães Júnior, Milton Henriques, Silveira, Daniel Vitório, Aranha, Fernando Graça, de Carvalho, Rafael Lima Rodrigues, de Godoy, Mariana Frizzo, Viana, Lucas Macedo Pereira, Hirakata, Vânia Naomi, Bicalho, Maria Aparecida Camargos, Marcolino, Milena Soriano
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 25-07-2024
Subjects:	clinical characteristics COVID-19 frailty hospitalization Medicine outcomes assessment palliative care COVID-19 frailty outcomes assessment hospitalization palliative care clinical characteristics
Online Access:	Get full text
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Summary:	COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves. This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG). Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves. A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Christiane Corrêa Rodrigues Cimini, http://orcid.org/0000-0002-1973-1343 Daniel Vitório Silveira, http://orcid.org/0000-0002-7381-1651 Luiza Marinho Motta Santa Rosa, http://orcid.org/0000-0002-4741-4871 Karen Brasil Ruschel, http://orcid.org/0000-0002-0812-920X Vânia Naomi Hirakata, http://orcid.org/0000-0003-4645-2080 Alzira de Oliveira Jorge, http://orcid.org/0000-0003-1366-1732 ORCID: Camila Rabelo Monteiro de Andrade, http://orcid.org/0009-0005-6869-1076 Alexandre Vargas Schwarzbold, http://orcid.org/0000-0002-5535-6288 Angelica Gomides dos Reis Gomes, http://orcid.org/0000-0002-4568-0738 Milena Soriano Marcolino, http://orcid.org/0000-0003-4278-3771 Reviewed by: Akram Parandeh, Baqiyatallah University of Medical Sciences, Iran Daniela Ponce, http://orcid.org/0000-0002-6178-6938 Neimy Ramos de Oliveira, http://orcid.org/0000-0001-5408-9459 Lucas Macedo Pereira Viana, http://orcid.org/0000-0002-8457-0531 Saionara Cristina Francisco, http://orcid.org/0000-0002-9655-6294 Rafael Lima Rodrigues de Carvalho, http://orcid.org/0000-0003-3576-3748 Fernanda Silva Trindade Luz, http://orcid.org/0000-0003-4309-9998 Frederico Bartolazzi, http://orcid.org/0000-0002-9696-4685 Luciane Kopittke, http://orcid.org/0000-0002-6606-7756 Marcelo Carneiro, http://orcid.org/0000-0003-3603-1987 Sophie Pautex, Hôpitaux universitaires de Genève (HUG), Switzerland Milton Henriques Guimarães Júnior, http://orcid.org/0000-0002-2127-8015 Fernando Graça Aranha, http://orcid.org/0000-0001-9173-8892 Maria Aparecida Camargos Bicalho, http://orcid.org/0000-0001-6298-9377 Edited by: Robbert Gobbens, Inholland University of Applied Sciences, Netherlands Maria Angélica Pires Ferreira, http://orcid.org/0000-0003-0961-524X Mariana Frizzo de Godoy, http://orcid.org/0000-0002-6631-8826 Felicio Roberto da Costa, http://orcid.org/0000-0001-9923-236X
ISSN:	2296-858X 2296-858X
DOI:	10.3389/fmed.2024.1390057