Clinician Perspectives on Caring for Dying Patients During the Pandemic : A Mixed-Methods Study.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
pubmed:
8
12
2020
medline:
1
5
2021
entrez:
7
12
2020
Statut:
ppublish
Résumé
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff. To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic. Mixed-methods embedded study. (ClinicalTrials.gov: NCT04602520). 3 acute care medical units in a tertiary care hospital from 16 March to 1 July 2020. 45 dying patients, 45 family members, and 45 clinicians. During the pandemic, clinicians continued an existing practice of collating personal information about dying patients and "what matters most," eliciting wishes, and implementing acts of compassion. Themes from semistructured clinician interviews that were summarized with representative quotations. Many barriers to end-of-life care arose because of infection control practices that mandated visiting restrictions and personal protective equipment, with attendant practical and psychological consequences. During hospitalization, family visits inside or outside the patient's room were possible for 36 patients (80.0%); 13 patients (28.9%) had virtual visits with a relative or friend. At the time of death, 20 patients (44.4%) had a family member at the bedside. Clinicians endeavored to prevent unmarked deaths by adopting advocacy roles to "fill the gap" of absent family and by initiating new and established ways to connect patients and relatives. Absence of clinician symptom or wellness metrics; a single-center design. Clinicians expressed their humanity through several intentional practices to preserve personalized, compassionate end-of-life care for dying hospitalized patients during the SARS-CoV-2 pandemic. Canadian Institutes of Health Research and Canadian Critical Care Trials Group Research Coordinator Fund.
Sections du résumé
BACKGROUND
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff.
OBJECTIVE
To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic.
DESIGN
Mixed-methods embedded study. (ClinicalTrials.gov: NCT04602520).
SETTING
3 acute care medical units in a tertiary care hospital from 16 March to 1 July 2020.
PARTICIPANTS
45 dying patients, 45 family members, and 45 clinicians.
INTERVENTION
During the pandemic, clinicians continued an existing practice of collating personal information about dying patients and "what matters most," eliciting wishes, and implementing acts of compassion.
MEASUREMENTS
Themes from semistructured clinician interviews that were summarized with representative quotations.
RESULTS
Many barriers to end-of-life care arose because of infection control practices that mandated visiting restrictions and personal protective equipment, with attendant practical and psychological consequences. During hospitalization, family visits inside or outside the patient's room were possible for 36 patients (80.0%); 13 patients (28.9%) had virtual visits with a relative or friend. At the time of death, 20 patients (44.4%) had a family member at the bedside. Clinicians endeavored to prevent unmarked deaths by adopting advocacy roles to "fill the gap" of absent family and by initiating new and established ways to connect patients and relatives.
LIMITATION
Absence of clinician symptom or wellness metrics; a single-center design.
CONCLUSION
Clinicians expressed their humanity through several intentional practices to preserve personalized, compassionate end-of-life care for dying hospitalized patients during the SARS-CoV-2 pandemic.
PRIMARY FUNDING SOURCE
Canadian Institutes of Health Research and Canadian Critical Care Trials Group Research Coordinator Fund.
Identifiants
pubmed: 33284683
doi: 10.7326/M20-6943
pmc: PMC7747669
doi:
Banques de données
ClinicalTrials.gov
['NCT04602520']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM