• Peter Strang, Jonas Bergström, Lisa Martinsson, and Staffan Lundström.
• Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden. Electronic address: peter.strang@ki.se.
• J Pain Symptom Manage. 2020 Oct 1; 60 (4): e2-e13.

ContextPreparation for an impending death through end-of-life (EOL) discussions and human presence when a person is dying is important for both patients and families.ObjectivesThe aim was to study whether EOL discussions were offered and to what degree patients were alone at time of death when dying from coronavirus disease 2019 (COVID-19), comparing deaths in nursing homes and hospitals.MethodsThe national Swedish Register of Palliative Care was used. All expected deaths from COVID-19 in nursing homes and hospitals were compared with, and contrasted to, deaths in a reference population (deaths in 2019).ResultsA total of 1346 expected COVID-19 deaths in nursing homes (n = 908) and hospitals (n = 438) were analyzed. Those who died were of a more advanced age in nursing homes (mean 86.4 years) and of a lower age in hospitals (mean 80.7 years) (P < 0.0001). Fewer EOL discussions with patients were held compared with deaths in 2019 (74% vs. 79%, P < 0.001), and dying with someone present was much more uncommon (59% vs. 83%, P < 0.0001). In comparisons between nursing homes and hospital deaths, more patients dying in nursing homes were women (56% vs. 37%, P < 0.0001), and significantly fewer had a retained ability to express their will during the last week of life (54% vs. 89%, P < 0.0001). Relatives were present at time of death in only 13% and 24% of the cases in nursing homes and hospitals, respectively (P < 0.001). The corresponding figures for staff were 52% and 38% (P < 0.0001).ConclusionDying from COVID-19 negatively affects the possibility of holding an EOL discussion and the chances of dying with someone present. This has considerable social and existential consequences for both patients and families.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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