The need for early referral to palliative care especially for Black, Asian and minority ethnic groups in a COVID-19 pandemic: Findings from a service evaluation

• Published in: Palliative medicine 2020-10, Vol.34 (9), p.1241-1248
• Main Authors: Chidiac, Claude, Feuer, David, Flatley, Mary, Rodgerson, Anna, Grayson, Kate, Preston, Nancy
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Aged; Aged, 80 and over; Asian Continental Ancestry Group - statistics & numerical data; Betacoronavirus; Black people; Breathlessness; Comorbidity; Computerized medical records; Coronavirus Infections - nursing; Coronaviruses; COVID-19; Ethnic groups; Ethnic Groups - statistics & numerical data; Female; Hospitalization; Humans; Integrated care; London; Male; Medical referrals; Middle Aged; Minority & ethnic groups; Minority groups; Minority Groups - statistics & numerical data; Pain; Palliative care; Palliative Care - statistics & numerical data; Pandemics; Pandemics - statistics & numerical data; Pneumonia, Viral - nursing; Referral and Consultation - statistics & numerical data; Retrospective Studies; SARS-CoV-2; Sleepiness; Time Factors
• ISSN: 0269-2163; 1477-030X
• DOI: 10.1177/0269216320946688

Background: Palliative care services face challenges in adapting and responding to the COVID-19 pandemic. Understanding how palliative care needs and outcomes have changed during the pandemic compared to before the pandemic is crucial to inform service planning and research initiatives. Aim: To evaluate the impact of COVID-19 on symptoms, clinical characteristics, and outcomes for patients referred to a hospital-based palliative care service in a district general hospital in London, UK. Design: A retrospective service evaluation. Data were extracted from the electronic patient records. Setting/participants: The first 60 inpatients with confirmed COVID-19 infection, referred to the hospital palliative care service between 1 March 2020 and 23 April 2020, and another 60 inpatients, referred to the hospital palliative care service between 11 March 2019 and 23 April 2019, were included from a district general hospital in East London, UK. Results: Patients with COVID-19 have lower comorbidity scores, poorer performance status, and a shorter time from referral to death compared to patients without COVID-19. Breathlessness, drowsiness, agitation, and fever are the most prevalent symptoms during COVID-19 compared to pain and drowsiness pre-COVID-19. Time from admission to referral to palliative care is longer for Black, Asian and minority ethnic patients, especially during COVID-19. Conclusion: Early referral to palliative care is essential in COVID-19, especially for Black, Asian and minority ethnic groups. There is urgent need to research why Black, Asian and minority ethnic patients are referred late; how palliative care services have changed; and possible solutions to setting up responsive, flexible, and integrated services.