Article
“It felt like a black hole, great uncertainty, but we have to take care for our patients” – qualitative findings on the effects of the COVID-19 pandemic on specialist palliative home care
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Authors
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Franziska Schade
- Universitätsmedizin Göttingen, Klinik für Palliativmedizin, Göttingen, Deutschland
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Maximiliane Jansky
- Universitätsmedizin Göttingen, Klinik für Palliativmedizin, Göttingen, Deutschland
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Nicola Rieder
- Universitätsmedizin Göttingen, Klinik für Palliativmedizin, Göttingen, Deutschland
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Danica Lohrmann
- Universitätsmedizin Göttingen, Klinik für Palliativmedizin, Göttingen, Deutschland
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Cordula Gebel
- Universitätsklinikum Jena, Abteilung Palliativmedizin, Jena, Deutschland
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Lars Kloppenburg
- Universitätsklinikum Jena, Abteilung Palliativmedizin, Jena, Deutschland
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Ulrich Wedding
- Universitätsklinikum Jena, Abteilung Palliativmedizin, Jena, Deutschland
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Steffen T. Simon
- Uniklinik Köln, Zentrum für Palliativmedizin, Köln, Deutschland
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Claudia Bausewein
- LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München, Deutschland
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Friedemann Nauck
- Universitätsmedizin Göttingen, Klinik für Palliativmedizin, Göttingen, Deutschland
| Published: | September 27, 2021 |
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Outline
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Background and state of research: Effects of the COVID-19 pandemic have an impact on the health care system in Germany. Specialist palliative home care (SPHC) teams enable patients to stay at home or in nursing homes by providing multi-professional care in home visits. In times of the COVID-19 pandemic the German Government restricted social contact (as visits). This led to difficulties in providing adequate palliative home care.
Question and objective: This study aims to explore how specialist palliative home care teams were affected by the COVID-19 pandemic in Germany in the first wave. Research questions were: which challenges did SPHC teams face, and which strategies helped to handle the consequences of the COVID-19 pandemic for providing good palliative home care.
Methods: As a part of the PallPan project (work package 3: specialist palliative home care) 4 focus groups and 5 interviews with stakeholders were conducted and analyzed with qualitative content analysis.
Results: A total of seven key categories emerged from the data. A category in the background shows dependence on organizational characteristics (e.g. sponsorship), which varied by regional factors (as federal state). Information management was a challenge to SPHC teams, as they had to collect, interpret and adapt, and disseminate information. They reported a shift in patient care because of the COVID-19 pandemic due to restricted home visits, visitation bans in nursing homes, and difficulties for hospital, hospice and nursing home admissions. Measures to reduce risk of infection impeded teamwork. Teams relied upon their local networks in crisis management, but felt often overlooked by local health authorities. Their respective state associations supported them in information management and exchange. Some measures, like reduced contacts in the team and with patients during home visits may impede the basic idea of palliative care.
Discussion: The containment measures severely impacted on home care for seriously ill and dying people, which are an especially vulnerable patient group. A good network with local health providers and authorities could help to harmonize local regulations and ensure quality care for all patient groups. SPHC teams play an important role in caring for palliative patients with COVID-19 who cannot be admitted to a hospital due to preferences or resources.
Practical implications: The PallPan study aims to develop a national strategy for palliative care in times of pandemics.
Appeal to practice: In times of pandemic palliative (home) care for seriously ill and dying patients has to be guaranteed.
