PT - JOURNAL ARTICLE AU - Adejoke Obirenjeyi Oluyase AU - Sabrina Bajwah AU - Katherine E Sleeman AU - Catherine Walshe AU - Nancy Preston AU - Mevhibe Hocaoglu AU - Andy Bradshaw AU - Rachel L Chambers AU - Fliss E M Murtagh AU - Lesley Dunleavy AU - Matthew Maddocks AU - Lorna K Fraser AU - Irene J Higginson TI - Symptom management in people dying with COVID-19: multinational observational study AID - 10.1136/spcare-2022-003799 DP - 2022 Dec 01 TA - BMJ Supportive & Palliative Care PG - 439--447 VI - 12 IP - 4 4099 - http://spcare.bmj.com/content/12/4/439.short 4100 - http://spcare.bmj.com/content/12/4/439.full SO - BMJ Support Palliat Care2022 Dec 01; 12 AB - Objectives To describe multinational prescribing practices by palliative care services for symptom management in patients dying with COVID-19 and the perceived effectiveness of medicines.Methods We surveyed specialist palliative care services, contacted via relevant organisations between April and July 2020. Descriptive statistics for categorical variables were expressed as counts and percentages. Content analysis explored free text responses about symptom management in COVID-19. Medicines were classified using British National Formulary categories. Perceptions on effectiveness of medicines were grouped into five categories; effective, some, limited or unclear effectiveness, no effect.Results 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world, 1 missing country. 358 services had managed patients with confirmed or suspected COVID-19. 289 services had protocols for symptom management in COVID-19. Services tended to prescribe medicines for symptom control comparable to medicines used in people without COVID-19; mainly opioids and benzodiazepines for breathlessness, benzodiazepines and antipsychotics for agitation, opioids and cough linctus for cough, paracetamol and non-steroidal anti-inflammatory drugs for fever, and opioids and paracetamol for pain. Medicines were considered to be mostly effective but varied by patient’s condition, route of administration and dose.Conclusions Services were largely consistent in prescribing for symptom management in people dying with COVID-19. Medicines used prior to COVID-19 were mostly considered effective in controlling common symptoms.Data are available on reasonable request. Applications for use of the survey data can be made for up to 10 years, and will be considered on a case-by-case basis on receipt of a methodological sound proposal to achieve aims in line with the original protocol. The study protocol is available on request. All requests for data access should be addressed to the chief investigator via the details on the CovPall website (https://www.kcl.ac.uk/cicelysaunders/research/evaluating/covpall-study and palliativecare@kcl.ac.uk) and will be reviewed by the Study Steering Group.