Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada. Issue 6 (27th June 2022)

• Record Type: Journal Article
• Authors: Lawlor, Peter; Parsons, Henrique; Adeli, Samantha Rose; Besserer, Ella; Cohen, Leila; Gratton, Valérie; Murphy, Rebekah; Warmels, Grace; Bruni, Adrianna; Kabir, Monisha; Noel, Chelsea; Heidinger, Brandon; Anderson, Koby; Arsenault-Mehta, Kyle; Wooller, Krista; Lapenskie, Julie; Webber, Colleen; Bedard, Daniel; Enright, Paula; Desjardins, Isabelle; Bhimji, Khadija; Dyason, Claire; Iyengar, Akshai; Bush, Shirley H; Isenberg, Sarina; Tanuseputro, Peter; Vanderspank-Wright, Brandi; Downar, James
• Is Part Of: BMJ open. Volume 12:Issue 6(2022)
• Publication Date: 2022-06-27
• Subjects: COVID-19 -- general medicine (see internal medicine) -- quality in health care -- adult intensive & critical care -- adult palliative care -- geriatric medicine; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-062937
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To compare end-of-life in-person family presence, patient–family communication and healthcare team–family communication encounters in hospitalised decedents before and during the COVID-19 pandemic. Design: In a regional multicentre retrospective cohort study, electronic health record data were abstracted for a prepandemic group (pre-COVID) and two intrapandemic (March–August 2020, wave 1) groups, one COVID-19 free (COVID-ve) and one with COVID-19 infection (COVID+ve). Pre-COVID and COVID-ve groups were matched 2:1 (age, sex and care service) with the COVID+ve group. Setting: One quaternary and two tertiary adult, acute care hospitals in Ottawa, Canada. Participants: Decedents (n=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170). Main outcome measures: End-of-life (last 48 hours) in-person family presence and virtual (video) patient–family communication, and end-of-life (last 5 days) virtual team–family communication encounter occurrences were examined using logistic regression with ORs and 95% CIs. End-of-life (last 5 days) rates of in-person and telephone team–family communication encounters were examined using mixed-effects negative binomial models with incidence rate ratios (IRRs) and 95% CIs. Results: End-of-life in-person family presence decreased progressively across pre-COVID (90.6%), COVID-ve (79.4%) and COVID+ve (47.1%) groups: adjusted ORs=0.38 (0.2–0.73) and 0.09 (0.04–0.17) for COVID-ve and COVID+ve groups, respectively. COVID-ve and COVID+ve groups had reduced in-person but increased telephone team–family communication encounters: IRRs=0.76 (0.64–0.9) and 0.61 (0.47–0.79) for in-person, and IRRs=2.6 (2.1–3.3) and 4.8 (3.7–6.1) for telephone communications, respectively. Virtual team–family communication encounters occurred in 17/85 (20%) and 10/170 (5.9%) of the COVID+ve and COVID-ve groups, respectively: adjusted OR=3.68 (1.51–8.95). Conclusions: In hospitalised COVID-19 pandemic wave 1 decedents, in-person family presence and in-person team–family communication encounters decreased at end of life, particularly in the COVID+ve group; virtual modalities were adopted for communication, and telephone use increased in team–family communication encounters. The implications of these communication changes for the patient, family and healthcare team warrant further study.