Thousands of people with serious illness from COVID-19 need palliative care at a time when this typically scarce resource is stretched thinner than ever before.
Palliative care professionals held a webinar in the early days of the outbreak in New York City to discuss how their knowledge and resources could be used to help the many people in need.
“How do we deploy expertise for the long haul?” asked Diane E. Meier, MD, FACP, FAAHPM, director of the Center to Advance Palliative Care (CAPC), co-director of Patty and Jay Baker National Palliative Care Center, professor in the department of geriatrics and palliative medicine, Catherine Gaisman professor and chair, Brookdale department of geriatrics and palliative medicine at Icahn School of Medicine at Mount Sinai in New York City. Meier spoke about COVID-19 on March 18 at a CAPC webinar.
Flexibility Is Crucial
Flexibility is crucial during a pandemic that is unprecedented in modern times, said R. Sean Morrison, MD, co-director of the Patty and Jay Baker National Palliative Care Center, Ellen and Howard C. Katz professor, and chair of the Brookdale department of geriatrics and palliative medicine at Icahn School of Medicine. Morrison also spoke at the CAPC webinar.
“We need to be prepared and recognize that we could be wrong, and at times the things we were told or thought are wrong, and we need to move to the next step,” Morrison said.
The nation and communities need to put in place the right public health measures to limit COVID-19’s effect and to prevent worst-case scenarios, he added. But healthcare professionals also must be prepared for a surge in COVID-19 cases.
“We need to be there to support frontline clinicians and provide them with symptom management,” Morrison says. “We may be having very different conversations than we’ve ever had before because the challenge is we don’t have enough ventilators to care for everyone in need.”
Palliative care is not ready for the tens of millions of people who will turn to health systems because of the pandemic, Meier noted. “Whatever expectation or cognitive frame people have about palliative care will be greatly reinforced by this epidemic.”
One major challenge is that conversations with family members of COVID-19 patients will occur by phone because of hospitals closing their doors to visitors. “We need to prepare for those conversations and do symptom management,” Morrison said.
It is important that palliative care and case management professionals understand they are not the ones to make decisions about allocation of resources.
“In communities that have more patients than available resources, decisions will need to be made about who should get those resources, and we should not be making those decisions,” Morrison said. “There should be a clear triage, established by experts in critical care and emergency medicine, and we should adhere to those standards.”
The goal is to support patients who are suffering and their families as much as possible. “We won’t have face-to-face time with our families,” he explains. “We’ll be doing this by telephone or video conference.”
Even as a community recovers from the pandemic’s worst phase, case managers and palliative care professionals will be needed to provide support to their usual patient population.
“Just because we have COVID-19, it doesn’t mean that serious illness will go away,” Morrison says. “All those families still will need us.”