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Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre...

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Autores principales: Behnke, Jonas, Arndt, Philipp Friedrich, Cekay, Michael John, Berthold, Daniel, Herentin, Birgit, Dumitrascu, Rio, Sibelius, Ulf, Eul, Bastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9371950/
https://www.ncbi.nlm.nih.gov/pubmed/35953820
http://dx.doi.org/10.1186/s12904-022-01035-x
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author Behnke, Jonas
Arndt, Philipp Friedrich
Cekay, Michael John
Berthold, Daniel
Herentin, Birgit
Dumitrascu, Rio
Sibelius, Ulf
Eul, Bastian
author_facet Behnke, Jonas
Arndt, Philipp Friedrich
Cekay, Michael John
Berthold, Daniel
Herentin, Birgit
Dumitrascu, Rio
Sibelius, Ulf
Eul, Bastian
author_sort Behnke, Jonas
collection PubMed
description BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective. METHODS: First, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service. RESULTS: The analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033). CONCLUSIONS: Most COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-022-01035-x.
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spelling pubmed-93719502022-08-12 Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany Behnke, Jonas Arndt, Philipp Friedrich Cekay, Michael John Berthold, Daniel Herentin, Birgit Dumitrascu, Rio Sibelius, Ulf Eul, Bastian BMC Palliat Care Research BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective. METHODS: First, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service. RESULTS: The analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033). CONCLUSIONS: Most COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-022-01035-x. BioMed Central 2022-08-12 /pmc/articles/PMC9371950/ /pubmed/35953820 http://dx.doi.org/10.1186/s12904-022-01035-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Behnke, Jonas
Arndt, Philipp Friedrich
Cekay, Michael John
Berthold, Daniel
Herentin, Birgit
Dumitrascu, Rio
Sibelius, Ulf
Eul, Bastian
Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany
title Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany
title_full Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany
title_fullStr Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany
title_full_unstemmed Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany
title_short Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany
title_sort outpatient palliative care during the covid-19 pandemic: a retrospective single centre analysis in germany
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9371950/
https://www.ncbi.nlm.nih.gov/pubmed/35953820
http://dx.doi.org/10.1186/s12904-022-01035-x
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