Palliative care and covid-19 : acknowledging past mistakes to forge a better future

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RABELO MONTEIRO DE ANDRADE, Camila | TRINDADE LUZ, Fernanda Silva | RAMOS DE OLIVEIRA, Neimy | KOPITTKE, Luciane | MARINHO MOTTA SANTA ROSA, Luiza | GOMIDES DOS REIS GOMES, Angelica | BARTOLAZZI, Frederico | FRANCISCO, Saionara Cristina | DA COSTA, Felicio Roberto | DE OLIVEIRA JORGE, Alzira | CORREA RODRIGUES CIMINI, Christiane | CARNEIRO, Marcelo | RUSCHEL, Karen Brasil | SCHWARZBOLD, Alexandre Vargas | PONCE, Daniela | PIRES FERREIRA, Maria Angélica | GUIMARAES JUNIOR, Milton Henriques | SILVEIRA, Daniel Vitorio | GRACA ARANHA, Fernando | LIMA RODRIGUES DE CARVALHO, Rafael | FRIZZO DE GODOY, Mariana | PEREIRA VIANA, Lucas Macedo | HIRAKATA, Vania Naomi | APARECIDA CAMARGOS BICALHO, Maria | SORIANO MARCOLINO, Milena

CONTEXT: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. OBJECTIVES: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves. METHODS: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG). RESULTS: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves. CONCLUSION: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.

http://dx.doi.org/10.3389/fmed.2024.1390057

Voir la revue «Frontiers in medicine, 11»

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