Palliative Care in a Pandemic

A Retrospective Review of the Impact of Early Palliative Care Consultation During the Coronavirus Disease 2019 Pandemic

Rachel M. Sabolish, MSN; Jennifer M. Wilson, MS; Hollie K. Caldwell, PhD

Journal of Hospice and Palliative Nursing. 2022;24(1):50-56.

Clinical Implications

The results suggest that early PC provided by APRNs during COVID-19 improves elicitation of a medical decision-maker, values-based goals of care, changes in code status, and transition to comfort care.

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Disclaimer
The views expressed in this article are those of the authors and not of Porter Adventist Hospital of Centura Health.

Acknowledgments
The authors thank the nurses who provided comfort care interventions to support a peaceful end of life during this challenging time. They would like to acknowledge the assistance of Davin Dearth, medical librarian, in assisting with a comprehensive literature review.

Table 1. Comparison of Age and Length of Stay
	PUIs, Early PC (n = 174)			PUIs, No PC (n = 152)			t	df	P
	Mean	Range	SD	Mean	Range	SD	t	df	P
Age, y	71.5	29–97	17.0	58.6	18–98	19.7	6.22	298	<.0001
LOS	7.3	0–78	8.9	6.2	0–99	10.3	−4.48	299	<.0001

Abbreviations: df, degrees of freedom; LOS, length of stay; PC, palliative care; PUIs, patients under investigation; t, t test.
Independent t test (2-tailed, significance of .05) was used.

Table 2. Comparison of Other Demographics
	PUIs, Early PC (n = 174)		PUIs, No PC (n = 152)
	n	%	n	%
Sex
Female	89	51.1	84	55.3
Male	85	48.9	68	44.7
Race
American Indian or Alaska Native	3	1.7	1	0.67
Asian	7	4	1	0.67
Black or African American	7	4	7	4.6
Native Hawaiian	1	0.05	0	0
Other	3	1.7	0	0
White	128	73.6	118	77.6
Unknown or declined	1	0.05	3	2
Ethnicity
Hispanic or Latino	24	13.8	22	14.5
Non-Hispanic or Latino	150	86.2	130	85.5
COVID-19 status
Positive or presumed positive	75	43.1	18	11.8
Negative	99	56.9	134	88.2

Abbreviations: COVID-19, coronavirus disease 2019; PC, palliative care; PUIs, patients under investigation.

Table 3. Comparison of Palliative Care Outcomes
	PUIs, Early PC (n = 174)		PUIs, No PC (n = 152)		z Score	P
	n	%	n	%	z Score	P
Identification of decision maker	173	99.4	15	9.9	−16.33	0
Change in code status	80	46	11	7.3	−7.78	0
Initiation of comfort care	80	46	5	3.3	−8.76	0
Change in goals of care	42	24.1	6	4.0	−5.13	0

Abbreviations: PC, palliative care; PUIs, patients under investigation.

Table 4. Comparison of Discharge Dispositions
	PUIs, Early PC (n = 174)		PUIs, No PC (n = 152)
	n	%	n	%
Transferred to ICU during stay	50	28.7	24	15.8
Died as inpatient	30	17.2	5	3.3
Died as inpatient with comfort care	29	16.7	5	3.3
Died inpatient without comfort care	1	0.6	0	0
Inpatient hospice	10	5.7	0	0
Inpatient rehabilitation facility	3	1.7	0	0
Home without services	83	47.7	101	66.4
Home with home health	15	8.6	11	7.2
Home with hospice	7	4	0	0
Skilled nursing facility	20	11.5	11	7.2
Long-term care acute	2	1.1	1	0.7
Transferred to different acute care hospital	0	0	1	0.7
Inpatient psychiatric facility	4	2.3	21	13.8
Against medical advice or other	0	0	5	3.3