Journal of pain and symptom management
-
J Pain Symptom Manage · Aug 2020
Bereavement support on the frontline of COVID-19: Recommendations for hospital clinicians.
Deaths due to COVID-19 are associated with risk factors which can lead to prolonged grief disorder, post-traumatic stress, and other poor bereavement outcomes among relatives, as well as moral injury and distress in frontline staff. Here we review relevant research evidence and provide evidence-based recommendations and resources for hospital clinicians to mitigate poor bereavement outcomes and support staff. ⋯ Recommendations include advance care planning; proactive, sensitive, and regular communication with family members alongside accurate information provision; enabling family members to say goodbye in person where possible; supporting virtual communication; providing excellent symptom management and emotional and spiritual support; and providing and/or sign-posting to bereavement services. To mitigate effects of this emotionally challenging work on staff, we recommend an organizational and systemic approach which includes access to informal and professional support.
-
J Pain Symptom Manage · Aug 2020
Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic.
Section 2 of the 2019 World Health Organization Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). ⋯ The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation, and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access.
-
J Pain Symptom Manage · Aug 2020
Development and Implementation of a Clinician-facing Prognostic Communication Tool for Patients with COVID-19 and Critical Illness.
Effective prognostication for a novel disease presents significant challenges, especially given the stress induced during a pandemic. We developed a point-of-care tool to summarize outcome data for critically ill patients with COVID-19 and help guide clinicians through a thoughtful prognostication process. Two authors reviewed studies of outcomes of patients with critical illness due to COVID-19 and created a visual infographic tool based on available data. ⋯ The tool also included prompts for clinician reflection designed to enhance awareness of cognitive biases that may affect prognostic accuracy. This online, open-source COVID-19 Prognostication Tool has been made available to all clinicians at our institution and is updated weekly to reflect evolving data. Our COVID-19 Prognostication Tool may provide a useful approach to promoting consistent and high-quality prognostic communication across a health care system.
-
J Pain Symptom Manage · Aug 2020
Challenges in the Provision of End-of-life and Palliative Care to Ethnic Nepali Refugees.
After over a decade of resettlement of ethnic Nepali refugees in the U. S., a significant population of seriously ill refugees will require palliative care and hospice care. ⋯ Culturally competent care of ethnic Nepali refugees can be accomplished through respectful exploration of patients' and families' preferences regarding the challenges identified. This article presents recommendations that can guide primary and specialist palliative care for this population.