Response and role of palliative care during the COVID-19 pandemic: a national telephone survey of hospices in Italy

Background

Palliative care is an important component of healthcare in pandemics, contributing to symptom control, psychological support, and supporting triage and complex decision making.

Aim

To examine preparedness for, and impact of, the COVID-19 pandemic on hospices in Italy to inform the response in other countries.

Design

Cross-sectional telephone survey, carried out in March 2020.

Setting

Sixteen Italian hospices, purposively sampled according to COVID-19 risk into high (more than 25 COVID-19 cases per 100,000 inhabitants), medium (15-25 cases per 100,000), and low risk (fewer than 15 cases per 100,000) regions. A brief questionnaire was developed to guide the interviews. Descriptive analysis was undertaken.

Results

Seven high risk, five medium risk and four low risk hospices provided data. Two high risk hospices had experienced COVID-19 cases among both patients and staff. All hospices had implemented policy changes, and several had rapidly implemented changes in practice including transfer of staff from inpatient to community settings, change in admission criteria, and daily telephone support for families. Concerns included scarcity of personal protective equipment, a lack of hospice-specific guidance on COVID-19, anxiety about needing to care for children and other relatives, and poor integration of palliative care in the acute setting.

Conclusion

The hospice sector is capable of responding flexibly and rapidly to the COVID-19 pandemic. Governments must urgently recognise the essential contribution of hospice and palliative care to the COVID-19 pandemic, and ensure these services are integrated into the health care system response. Availability of personal protective equipment and setting-specific guidance is essential.

What is already known

• The Coronavirus disease 2019 (COVID-19) has estimated global mortality of 3.4%, and numbers of cases are rapidly escalating worldwide.

• Hospice services face unprecedented pressure, with resources rapidly stretched beyond normal bounds.

• No data exist on the response and role of hospice and palliative care teams to COVID-19.

• Within Europe, Italy has been most affected by COVID-19.

What this paper adds

• We surveyed 16 Italian hospices in March 2020, all of which had implemented rapid policy changes in response to COVID-19.

• Changes to practice included moving to more support in community settings, change in admission criteria, and daily telephone support for families.

• Personal protective equipment and guidance were lacking.

• Assessments of risk and potential impact on staff varied greatly.

Implications for policy and practice

• Governments must recognise the hospice and palliative care sector as an essential component of the health care system response to COVID-19.

• The hospice sector is capable of responding rapidly to the COVID-19 pandemic, but the potential of this response will be undermined unless hospices can access personal protective equipment.

• Considerations for hospice services during the COVID-19 pandemic are changes to visitor policies, interruption of volunteering, shifting roles and responsibilities such as greater community working and telephone support for relatives.