Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study)

Masha S Zee; Lotje Bagchus; Yvonne N Becqué; Erica Witkamp; Agnes van der Heide; Liza G G van Lent; Anne Goossensen; Ida J Korfage; Bregje D Onwuteaka-Philipsen; H Roeline Pasman

doi:10.1136/bmjopen-2022-063267

Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study)

BMJ Open. 2023 Mar 6;13(3):e063267. doi: 10.1136/bmjopen-2022-063267.

Authors

Affiliations

¹ Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands m.zee@amsterdamumc.nl.
² Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands.
³ Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands.
⁴ Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Zuid-Holland, Netherlands.
⁵ Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands.
⁶ University of Humanistic Studies, Utrecht, Netherlands.
⁷ Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.

Abstract

Objectives: The objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands.

Methods: An in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis.

Results: Several aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains.

Conclusion: The palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.

Keywords: COVID-19; End-of-life Care; Palliative Care; Qualitative Research; Quality of Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Death
Humans
Pandemics
Qualitative Research
Terminal Care*