Trends in Palliative Care Research During the COVID-19 Pandemic

Abstract

To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke of the COVID-19 pandemic, the adjustment of palliative care systems is warranted to maintain a high quality of care. The COVID-19 -related palliative care studies account for approximately 4% of all publications on palliative care. However, there is a dearth of research investigating the nature of these studies. A total of 293 studies were included. Of the included studies, those related to system improvement were the most common (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), bereavement support for patients or family members (19/293, 6.5%), and the mental health of frontline practitioners (14/293, 4.8%). From these studies, 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively. The research trends of palliative care demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.

Keywords

palliative care palliative medicine hospice terminal care COVID-19 pandemic

Key message

This review demonstrated the trends of research on palliative care during the COVID-19 pandemic. We discovered that the most popular research topics were those pertaining to system improvement and patient care. The diversity of publications demonstrated that the palliative care system is flexible and responded rapidly to the COVID-19 pandemic.

Introduction

According to the World Health Organization (WHO), only 14% of the more than 40 million people who require palliative care every year receive such care. The COVID-19 pandemic has resulted in an even smaller proportion of people receiving the palliative care they require. Palliative care systems serve a crucial role in the fight against this devastating disease but face several COVID-19-related challenges, including the heavy burden placed on frontline caregivers, social distancing, and rapidly changing policies. The adjustment and evolution of palliative care systems are warranted to maintain a high quality of care.

Numerous studies have investigated strategies for addressing the challenges engendered by the COVID-19 pandemic.^1-4 The most notable strategy entails the implementation of telemedicine to resolve challenges associated with isolation policies.^5-7 Telemedicine not only supports patients but also serves as a tool for maintaining the physical and mental health of a patient’s family members and frontline practitioners and strengthens social connections between various people.^6,8 Among patients with COVID-19, breathlessness, cough, fatigue, and agitation are the most common symptoms and lead to rapid deterioration of the clinical condition and potential death. Besides, spiritual suffering consists of isolation, grief, loneliness, and vulnerability also frequently caused by the pandemic. Timely pharmacologic management, including opioids, benzodiazepines, and antipsychotics combined with spiritual care is vital in palliation of the suffering. Scholars have thus investigated new strategies for relieving the symptoms of COVID-19 and shared their experiences to provide valuable guidance in caring for patients with COVID-19 infection and provide suggestions on how to manage the mental burden of all the frontline practitioners.^9-16

We conducted a review of the literature to demonstrate the variety of research and the trends in research on palliative care since the start of the COVID-19 pandemic. The present study is 1 of the first to review the trends in research on palliative care during the COVID-19 pandemic. Our findings can provide palliative care practitioners with current information and highlight possible future trends.

Methods

Study Design and Setting

We conducted an observational study by reviewing publications and retrieving relevant data (eg, publication titles, publication year, first author’s nationality, Web of Science (WoS) categories, document types, languages, and number of citations) from the WoS database. This study was approved by the Chang Gung Medical Foundation Institutional Review Board, which waived the need for informed consent (IRB Number: 202201605B1).

Literature Search Methods

We conducted a search of the WoS database from 2020 (the entire year), 2021 to August 2022. All articles discussing palliative care associated with the COVID-19 pandemic were included. The key terms are as following: “COVID-19,” “SARS-CoV-2,” “2019 Novel Coronavirus Disease,” “2019-nCoV Disease,” “Coronavirus Disease-19,” and “Coronavirus Disease 2019” combined with “palliative care,” “hospice,” “terminal care,” and “palliative medicine.” The reference lists of the identified articles were also reviewed. No language restrictions were applied during the search.

Selection Criteria and Classification

All articles discussing palliative care associated with the COVID-19 pandemic were included (Figure 1). Articles that did not mention palliative care during the COVID-19 pandemic were excluded. According to the WHO, palliative care is defined as care that is aimed at improving the quality of life of patients and their families when those patients are faced with problems associated with a life-threatening illness. The articles were categorized into the following fields of palliative care research according to the main focus of the study: system improvement, patient care, bereavement support of the patient or family member, and mental health of frontline practitioners. System improvement was divided into the following subcategories: alternative delivery methods, public education, staff training, and effect on the health-care system. Two independent reviewers (CHW and YKC) independently reviewed and classified the included articles. Disagreements were resolved through discussion with a third reviewer (CHL).

Figure 1.

The flow diagram of the included literature.

Outcomes

The primary outcome was the distribution of palliative care research fields. The secondary outcomes were the number of citations, first author’s nationality, publication year, publication titles, WoS categories, and document types. Other outcomes included the language and the percentage of COVID-19-related palliative care articles among all articles on palliative care since the COVID-19 outbreak in February 2020.

Results

Inclusion and Exclusion Criteria

We conducted a review of published studies. A total of 661 studies were retrieved from the WoS database. Of these studies, 26 were excluded from the review because they were not related to COVID-19-related palliative care and 342 were excluded because they did not focus on palliative care. Finally, 293 studies met the inclusion criteria and were included.

Summary of Outcomes

The primary outcome (Figure 2) was the distribution of research on palliative care. We observed that studies related to system improvement constituted the highest proportion of our sample (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), those related to bereavement support for patients or their family members (19/293, 6.5%), and those related to the mental health of frontline practitioners (14/293, 4.8%).

Figure 2.

The percentage of each research field publications since COVID-19 pandemic. ^aUntil August 1st, 2022.

We noted that 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively (Table 1). The average number of studies related to COVID-19-related palliative care per year was approximately 110. Studies related to COVID-19-related palliative care constituted approximately 3.97% of all studies on palliative care since the start of the COVID-19 pandemic.

Table 1.

Analytic Statistics of the Included Publications.

Variable	2020^a	2021	2022^b
Variable	N = 82	N = 137	N = 74
Research field
System improvement	50 (61.0%)	83 (61.0%)	48 (64.9%)
Alternative delivery methods	19 (23.2%)	18 (13.0%)	13 (17.6%)
Public education	2 (2.4%)	2 (1.4%)	0 (0%)
Staff training	5 (6.1%)	5 (3.6%)	7 (9.5%)
Impact on the healthcare system	24 (29.3%)	58 (42.0%)	28 (37.8%)
Patient care	23 (28.0%)	40 (29.2%)	16 (21.6%)
COVID-19 patients	13 (15.9%)	20 (14.5%)	8 (10.8%)
Pediatric patients	2 (2.4%)	2 (1.4%)	2 (2.7%)
Cancer patients	2 (2.4%)	9 (6.5%)	1 (1.35%)
Others	6 (7.3%)	9 (6.5%)	5 (6.8%)
Bereavement support of the patient or family member	7 (8.5%)	9 (6.5%)	3 (4.1%)
Mental health of the frontline practitioners	2 (2.4%)	5 (3.6%)	7 (9.5%)
Nationality of first authors, n (%)
United States	31 (37.8%)	55 (40.1%)	41 (55.4%)
United Kingdom	15 (18.3%)	19 (13.9%)	9 (12.2%)
Germany	1 (1.2%)	11 (8.0%)	6 (8.1%)
Australia	4 (4.9%)	5 (3.7%)	6 (8.1%)
Italy	3 (3.7%)	5 (3.7%)	1 (1.4%)
Canada	3 (3.7%)	5 (3.7%)	1 (1.4%)
Brazil	1 (1.2%)	3 (2.2%)	2 (2.8%)
Publication titles, n (%)
Journal of pain and symptom management	37 (45.1%)	20 (14.6%)	10 (13.5%)
American journal of hospice and palliative medicine	5 (6.1%)	15 (11.0%)	14 (18.9%)
Palliative medicine	9 (11.0%)	7 (5.1%)	6 (8.1%)
BMJ supportive and palliative care	3 (3.7%)	7 (5.1%)	3 (4.1%)
Journal of hospice and palliative nursing	2 (2.4%)	6 (4.4%)	2 (2.8%)
BMJ open	2 (2.4%)	3 (2.2%)	1 (1.4%)
Type of articles, n (%)
Original article	70 (85.3%)	115 (84.0%)	61 (82.4%)
Review	8 (9.8%)	17 (12.4%)	9 (12.2%)
Editorial material	4 (4.9%)	5 (3.7%)	4 (5.4%)
Languages
English	80 (97.6%)	132 (96.4%)	71 (95.9%)
German	1 (1.2%)	4 (2.9%)	3 (4.1%)
Spanish	1 (1.2%)	1 (.7%)	0 (0%)

^aEntire year.

^bUntil August 1st, 2022.

The total number of citations received by all of the included articles was 2132, and the average number of citations received by each article was 9.46. Among the articles, the most-cited 1 had a total of 224 citations.¹⁴ Regarding the nationality of the first authors, American constituted the most common nationality (127/293, 43.3%), followed by British (43/293, 14.7%), German (18/293, 6.1%), and Australian (15/293, 5.1%). English publications accounted for 96.6% of all publications. Furthermore, of the included studies, 84.0% (246/293) were original articles, 4.4% (13/293) were editorial material and 11.6% (34/293) were review articles. Concerning the distribution of the articles in the various WoS categories, those belonging to the Health Care Sciences and Services category constituted the majority of our the included studies (183/293, 62.5%), followed by those belonging to the Medicine, General and Internal category (105/293, 35.8%).

Of the included studies, 22.9% (67/293), 11.6% (34/293), 7.5% (22/293), 4.4% (13/293), 3.4% (10/293), and 2.0% (6/293) were published in the Journal of Pain and Symptom Management, American Journal of Hospice Palliative Medicine, Journal of Palliative Medicine, BMJ Supportive and Palliative Care, Journal of Hospice and Palliative Nursing, and BMJ Open.

Discussion

Trends in Research on COVID-19-Related Palliative Care

The COVID-19 pandemic negatively affected the ability of global health-care systems to provide quality care. As an essential part of global health-care systems, palliative care systems faced challenges during the pandemic; nevertheless, relevant stakeholders have responded rapidly to the challenges and developed strategies for addressing them. Our review revealed that studies related to system improvement (181/293, 61.8%) and patient care (79/293, 27.0%) were the most common in the field of research on COVID-19-related palliative care. It showed the urgent need for innovative palliative care delivery methods and management of relieving distressing symptoms. On the other hand, although studies related to bereavement support for patients or their family members (19/293, 6.5%) and studies related to the mental health of frontline practitioners (14/293, 4.8%) were less common, their importance should not be underestimated. As the pandemic evolve the percentage of publications in these 2 areas didn’t increase rapidly and even inverted between 2020 and 2022 (Table 1). It may be associated with the improvement of spiritual support through generalist-level palliative care and less fear when we have more information about the disease and better treatment options. However, some other emotional stress including isolation, grief, loneliness, or anxiety may still exist in the patient, family, or frontline practitioners, thus further investigation was warranted to figure out the possible lag behind in the mental and spiritual care services throughout the pandemic and beyond. The research trends we identified reflect the hot issues and the challenges associated with palliative care, and such challenges require addressing.

Our review of the most-cited articles (Table 2) revealed that the most prominent research topics were those related to telemedicine. Four studies^2,3,5,6 on system improvement were among the top 10 cited articles, and this demonstrates the urgent need for innovative methods of overcoming the challenges engendered by the COVID-19 pandemic. Notably, a study related to bereavement support received the highest number of citations in our review,¹⁴ and other studies related to bereavement support accounted for nearly half of the top 10 cited publications^14,17-19; a possible explanation for this finding is the complexity of grief amid rapid changes engendered by the COVID-19 pandemic. However, articles related to the mental health of frontline practitioners and patient care received a relatively low number of citations. The majority of the most commonly cited articles were written by authors from the United States and the United Kingdom. Whether the recommendations of authors from the United States or the United Kingdom are applicable to Asia or other countries remains unclear and warrants further research.

Table 2.

Summary of the Top 10 Cited Publications

Article title (document type)	Authors (nationality)	Research field	Publication titles (publication year/month)	Times cited
Grief during the COVID-19-19 pandemic: Considerations for palliative care providers (Article)¹⁴	Wallace, CL, et al (United States)	Bereavement support of the patient or family member	Journal of pain and symptom management (2020/07)	224
Telemedicine in the time of Coronavirus (Article)⁵	Calton, B, et al (United States)	System improvement (alternative delivery methods)	Journal of pain and symptom management (2020/7)	181
The role and response of palliative care and hospice services in epidemics and pandemics: A rapid review to inform practice during the COVID-19-19 pandemic (review)²	Etkind, SN, et al (United Kingdom)	System improvement (Impact on healthcare system)	Journal of pain and symptom management (2020/7)	125
Family-centered care during the COVID-19-19 era (Article)¹⁷	Hart, JL, et al (United States)	Bereavement support of the patient or family member	Journal of pain and symptom management (2020/8)	112
Characteristics, symptom management, and outcomes of 101 patients with COVID-19-19 referred for hospital palliative care (Article)¹³	Lovell, N, et al (United Kingdom)	Patient care (COVID-19 patients)	Journal of Pain and Symptom Management (2020/7)	95
Bereavement support on the frontline of COVID-19-19: Recommendations for hospital clinicians (Article)¹⁰	Selman, LE, et al (United Kingdom)	The mental health of the frontline practitioners	Journal of pain and symptom management (2020/8)	90
Rapid implementation of inpatient telepalliative medicine consultations during COVID-19-19 pandemic (Article)⁶	Humphreys, J, et al (United States)	System improvement (Alternative delivery methods)	Journal of pain and symptom management (2020/7)	68
Supporting adults bereaved through COVID-19-19: A rapid review of the impact of previous pandemics on grief and bereavement (review)¹⁸	Mayland, CR, et al (United Kingdom)	Bereavement support of the patient or family member	Journal of pain and symptom management (2020/8)	65
The family caregiving crisis meets an actual pandemic (Article)¹⁹	Kent, EE, et al (United States)	Bereavement support of the patient or family member	Journal of pain and symptom management (2020/7)	62
Response and role of palliative care during the COVID-19-19 pandemic: A national telephone survey of hospices in Italy (Article)³	Costantini, M, et al (Italy)	System improvement (Impact on healthcare system)	Palliative medicine (2020/07)	61

Summary of Each Research Field

System Improvement

A well-designed palliative health-care system is fundamental to effective and efficient patient care. Policies for preventing disease spread, such as visitor restrictions and patient isolation, restrict the abilities of palliative care providers to provide quality care. Therefore, improvement of palliative care delivery methods, education of the public, development of health-care strategies, and implementation of staff training programs are all critical tasks.^1,20 Telemedicine was the most popular research topic, accounting for approximately 17.1% (50/293) of the studies on COVID-19-related palliative care. Many of the telemedicine-related studies provided pieces of advice and information on home-based palliative care.^5,7,21 Studies reported that inpatient video consultations, multidisciplinary team communication, and online family meetings were associated with improvements in the quality of care.^6,8 We also noted a trend toward the increasing digitalization of palliative teaching courses.^22-25 Another study discussed how palliative care systems respond to the challenges of the COVID-19 pandemic.²⁶

Patient Care

Because of the lack of prior experience with COVID-19, providing high-quality palliative care was difficult. Some studies identified the symptoms and characteristics of COVID-19.¹³. Other studies developed recommendations for effectively treating symptoms.^4,27 However, difficulties dealing with patient subgroups, including pediatric patients, older adult patients, patients with cancer, and critically ill patients, were noted. Further research is warranted to develop strategies for addressing these difficulties. To better support patients with cancer, research is warranted on the following issues: ensuring the accessibility of critical drugs such as opioids or targeted therapy medications²⁸ and maintaining cancer treatment such as palliative chemotherapy or palliative radiotherapy for both outpatients and inpatients with a COVID-19 diagnosis.^29,30 A global survey for the provision of pediatric palliative care revealed that changes in patient–family–provider interactions and financial considerations were common problems.¹²

In addition to the challenges related to the treatment of symptoms and the underlying disease, isolation policies associated with the COVID-19 pandemic and the uncertainty of disease progression and treatment were observed to cause spiritual distress. Thus, spiritual care during the COVID-19 pandemic is an urgent, nonnegligible part of palliative care,¹¹ as emphasized in a study by a European Respiratory Society international task force.⁴ Although spiritual care has long been an essential component of quality palliative care, the effect of the pandemic has further highlighted the requirement for quality spiritual assessment and care.¹¹

Bereavement Support of the Patient or Family Member

Grief is a natural human emotion while facing loss. Bereavement care is thus considered a vital component of quality palliative care. During the COVID-19 pandemic, caring for bereaved family members before and after the death of a patient was a major challenge and required much more effort than expected.⁹ An open observational online survey completed by bereaved relatives revealed that respondents who received emotional support under restrictive isolation policies were more likely to consider the place of their family member’s death as appropriate than did respondents who did not receive such support.³¹

Being unable to accompany dying relatives was associated with a higher risk of anxiety and grief disorder. Screening tools were developed to enable palliative care providers to identify those at risk of dysfunctional grief due to the loss of a relative to COVID-19 infection.³² Strategies involving the improvement of communication skills, optimization of symptom management, discussions of care plans in advance, provision of online counseling, and establishment of virtual support groups enabled palliative care providers to facilitate quality care to family members after the loss of a relative, despite the many restrictions.^9,10,18,33

Mental Health of Frontline Practitioners

Repeated empathic engagement with individuals who are in grief may result in varying degrees of emotional stress. One qualitative multiple-case study revealed that having previous experience caring for dying patients does not prevent moral distress from accumulating and worsening.³⁴ A survey in Hong Kong discovered that up to 82% and 43% of palliative care professionals reported being moderately to highly stressed and anxious, respectively, during the pandemic.³⁵ Self-awareness and self-resilience tools are vital for coping with emotional stress. Informal debriefing and peer support facilitated by hospitals or other institutions, rather than single-session psychological courses, are recommended to support the wellbeing of frontline practitioners.¹⁰ Overall, emotional stress should not be underestimated, and early identification and appropriate response are essential for supporting frontline practitioners.

Strength and Limitations

To the best of our knowledge, our study is among the first to analyze research trends in palliative care related to the COVID-19 pandemic. Nevertheless, our study has some limitations. First, our study design prevented us from conducting comprehensive comparisons and descriptions of specific problems. Second, the generalizability of the results of worldwide studies to local populations is unclear. Additional studies in various regions are thus warranted. Third, we noted that the majority of the included studies were conducted in the United States or Europe and that relatively few studies investigated mental health. However, this may be related to publication bias. Hence, the results should be interpreted with caution.

Conclusion

As one of the first studies to review the trends in research on palliative care during the COVID-19 pandemic, the research trends demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.

Footnotes

Acknowledgments

The authors thank the entire team of the Department of Emergency Medicine of Keelung Chang Gang Memorial Hospital for their support of this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Correction (October 2023): The footnote for missing co-first author, Yu-Kai Chen is included below affiliation section.

ORCID iD

Chien-Ho Wang

References

Fausto

Hirano

Lam

, et al. Creating a palliative care inpatient response plan for COVID-19-the UW medicine experience. J Pain Symptom Manage. 2020;60(1):e21-e26. doi:10.1016/j.jpainsymman.2020.03.025.

Etkind

Bone

Lovell

, et al. The role and response of palliative care and hospice services in epidemics and pandemics: A rapid review to inform practice during the COVID-19 pandemic. J Pain Symptom Manage. 2020;60(1):e31-e40. doi:10.1016/j.jpainsymman.2020.03.029.

Costantini

Sleeman

Peruselli

Higginson

. Response and role of palliative care during the COVID-19 pandemic: A national telephone survey of hospices in Italy. Palliat Med. 2020;34(7):889-895. doi:10.1177/0269216320920780.

Janssen

DJA

Ekström

Currow

, et al. COVID-19: guidance on palliative care from a European Respiratory Society international task force. Eur Respir J Suppl. 2020;56(3). doi:10.1183/13993003.02583-2020.

Calton

Abedini

Fratkin

. Telemedicine in the time of Coronavirus. J Pain Symptom Manage. 2020;60(1):e12-e14. doi:10.1016/j.jpainsymman.2020.03.019.

Humphreys

Schoenherr

Elia

, et al. Rapid implementation of inpatient telepalliative medicine consultations during COVID-19 pandemic. J Pain Symptom Manage. 2020;60(1):e54-e59. doi:10.1016/j.jpainsymman.2020.04.001.

Lau

Knudsen

Jackson

, et al. Staying connected in the COVID-19 pandemic: Telehealth at the largest safety-net system in the United States. Health Aff. 2020;39(8):1437-1442. doi:10.1377/hlthaff.2020.00903.

Kuntz

Kavalieratos

Esper

, et al. Feasibility and acceptability of inpatient palliative care E-family meetings during COVID-19 pandemic. J Pain Symptom Manage. 2020;60(3):e28-e32. doi:10.1016/j.jpainsymman.2020.06.001.

Morris

Moment

Thomas

. Caring for bereaved family members during the COVID-19 pandemic: Before and after the death of a patient. J Pain Symptom Manage. 2020;60(2):e70-e74. doi:10.1016/j.jpainsymman.2020.05.002.

10.

Selman

Chao

Sowden

Marshall

Chamberlain

Koffman

. Bereavement support on the frontline of COVID-19: Recommendations for hospital clinicians. J Pain Symptom Manage. 2020;60(2):e81-e86. doi:10.1016/j.jpainsymman.2020.04.024.

11.

Ferrell

Handzo

Picchi

Puchalski

Rosa

. The urgency of spiritual care: COVID-19 and the critical need for whole-person palliation. J Pain Symptom Manage. 2020;60(3):e7-e11. doi:10.1016/j.jpainsymman.2020.06.034.

12.

McNeil

Kaye

Vedaraju

, et al. Global experiences of pediatric palliative care teams during the first 6 Months of the SARS-CoV-2 pandemic. J Pain Symptom Manag. 2021;62(3):e91-e99. doi:10.1016/j.jpainsymman.2021.03.016.

13.

Lovell

Maddocks

Etkind

, et al. Characteristics, symptom management, and outcomes of 101 patients with COVID-19 referred for hospital palliative care. J Pain Symptom Manag. 2020;60(1):e77-e81. doi:10.1016/j.jpainsymman.2020.04.015.

14.

Wallace

Wladkowski

Gibson

White

. Grief during the COVID-19 pandemic: Considerations for palliative care providers. J Pain Symptom Manage. 2020;60(1):e70-e76. doi:10.1016/j.jpainsymman.2020.04.012.

15.

Liberman

Lopez

Roofeh

Izard

Parikh

Burns

. Respiratory distress in hospitalized non-mechanically ventilated COVID-19 adults: A retrospective multicenter cohort study. Am J Hosp Palliat Care. 2022;39(5):584-590. doi:10.1177/10499091211036702.

16.

Ting

Edmonds

Higginson

Sleeman

. Palliative care for patients with severe covid-19. BMJ. 2020;370:m2710. doi:10.1136/bmj.m2710.

17.

Hart

Turnbull

Oppenheim

Courtright

. Family-centered care during the COVID-19 era. J Pain Symptom Manag. 2020;60(2):e93-e97. doi:10.1016/j.jpainsymman.2020.04.017.

18.

Mayland

Harding

AJE

Preston

Payne

. Supporting adults bereaved through COVID-19: A rapid review of the impact of previous pandemics on grief and bereavement. J Pain Symptom Manage. 2020;60(2):e33-e39. doi:10.1016/j.jpainsymman.2020.05.012.

19.

Kent

Ornstein

Dionne-Odom

. The family caregiving crisis meets an actual pandemic. J Pain Symptom Manage. 2020;60(1):e66-e69. doi:10.1016/j.jpainsymman.2020.04.006.

20.

Rosa

Ferrell

Mazanec

. Global integration of palliative nursing education to improve health crisis preparedness. J Contin Educ Nurs. 2021;52(3):130-135. doi:10.3928/00220124-20210216-07.

21.

Ritchey

Foy

McArdel

Gruenewald

. Reinventing palliative care delivery in the era of COVID-19: How telemedicine can support end of life care. Am J Hosp Palliat Care. 2020;37(11):992-997. doi:10.1177/1049909120948235.

22.

Hempel

Weissenbacher

Stehr

,[COVID-19: a chance for digitalization of teaching? : Report of experiences and results of a survey on digitalized teaching in the fields of anesthesiology, intensive care, emergency, pain and palliative medicine at the University of Leipzig]. Anaesthesist. 2022;71(5):340-349. COVID-19: eine Chance zur Digitalisierung der Lehre? : Erfahrungsbericht und Ergebnisse einer Umfrage zur digitalen Lehre im Bereich Anästhesiologie, Intensiv-, Notfall-, Schmerz- und Palliativmedizin an der Universität Leipzig. doi:10.1007/s00101-021-01016-4.

23.

Mills

Cioletti

Gingell

Ramani

. Training residents in virtual advance care planning: A new twist in telehealth. J Pain Symptom Manag. 2021;62(4):691-698. doi:10.1016/j.jpainsymman.2021.03.019.

24.

Scherg

Ilse

Elsner

. [Undergraduate palliative care teaching in times of COVID-19]. Schmerz. 2021;35(4):237-241. Palliativmedizinische Lehre im Querschnittsbereich 13 unter dem Einfluss von COVID-19. doi:10.1007/s00482-021-00548-3.

25.

Cassum

Mansoor

Hirji

David

Aijaz

. Challenges in teaching palliative care module virtually during COVID-19 era. Asia Pac J Oncol Nurs. 2020;7(4):301-304. doi:10.4103/apjon.apjon_42_20.

26.

Dunleavy

Preston

Bajwah

, et al. Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall). Palliat Med. 2021;35(5):814-829. doi:10.1177/02692163211000660.

27.

Wong

Demediuk

Tay

, et al. COVID-19 end-of-life care: Symptoms and supportive therapy use in an Australian hospital. Intern Med J. 2021;51(9):1420-1425. doi:10.1111/imj.15300.

28.

Singh

Deodhar

Chaturvedi

. Navigating the impact of COVID-19 on palliative care for head and neck cancer. Head Neck. 2020;42(6):1144-1146. doi:10.1002/hed.26211.

29.

Cheng

HWB

. Palliative care for cancer patients with severe COVID-19: The challenge of uncertainty. Support Care Cancer. 2021;29(3):1153-1155. doi:10.1007/s00520-020-05809-y.

30.

Weber

Tielker

Kamandi

, et al. [Outpatient care of oncological patients in palliative treatment situations and their relatives during the COVID-19 pandemic]. Onkologe (Berl). 2021;27(8):783-789. Ambulante Betreuung onkologischer Patienten in palliativer Behandlungssituation und ihrer Angehörigen in der COVID-19-Pandemie: Erfahrungen, Herausforderungen und Lösungsansätze niedergelassener Onkologen. doi:10.1007/s00761-021-00974-z.

31.

Yildiz

Korfage

Witkamp

, et al. Dying in times of COVID-19: Experiences in different care settings - an online questionnaire study among bereaved relatives (the CO-LIVE study). Palliat Med. 2022;36(4):751-761. doi:10.1177/02692163221079698.

32.

Lee

Neimeyer

Breen

. The utility of the pandemic grief scale in identifying functional impairment from COVID-19 bereavement. J Palliat Med. 2021;24(12):1783-1788. doi:10.1089/jpm.2021.0103.

33.

Fadul

Elsayem

Bruera

. Integration of palliative care into COVID-19 pandemic planning. BMJ Support Palliat Care. 2021;11(1):40-44. doi:10.1136/bmjspcare-2020-002364.

34.

Bradshaw

Dunleavy

Garner

, et al. Experiences of staff providing specialist palliative care during COVID-19: A multiple qualitative case study. J R Soc Med. 2022;115(6):220-230. doi:10.1177/01410768221077366.

35.

Chan

WCH

Woo

RKW

Kwok

CTK

Chiu

. Impact of COVID-19 on mental health of palliative care professionals and services: A mixed-methods survey study. Am J Hosp Palliat Care. 2022;39(10):1227-1235. doi:10.1177/10499091211057043.