Table 1

Suggested palliative care approach for patients with COVID-19 and comparison with other approaches

Palliative care approach for patients with advanced diseaseIntensive care approach for patients with COVID-19Palliative care approach for patients with COVID-19
Assessment of symptoms
  • Face to face during interdisciplinary team rounds.

  • Brief bedside assessment.

  • Video conferencing to minimise exposure and conserve PPE.

Dyspnoea
  • Oxygen not usually given.

  • Opioids.

  • Steroids.

  • Nebulisers.

  • Palliative sedation in refractor cases.

  • Intubation and sedation.

  • Steroids recommended only for patients with ARDS.

  • Nebulisers not recommended.

  • Oxygen by nasal cannula.

  • Opioids.

  • Possible role for steroids.

  • Palliative sedation in refractory cases.

Delirium
  • Minimise psychoactive drugs.

  • Palliative sedation in refractory cases.

  • Sedation while on mechanical ventilation.

  • Psychoactive medications such as haloperidol.

  • Palliative sedation in refractory cases.

Goals of care and DNR
  • Discuss with patients and family members in clinics or during hospitalisation.

  • Usually not discussed and emergency physicians assume every incoming patient is full code.

  • Discuss goals of care and DNR orders with all elderly patients, nursing home residents and patients with advanced disease.

  • Consider having DNR bracelets.

Family support/ family meetings
  • Usually during clinic visit or hospitalisation.

  • No visitation.

  • Family isolated or quarantined.

  • Video visits and conferences.

End-of-life care.
  • Hospice mainly at home.

  • Combination of family members and visiting nurses.

  • Patient dies in the hospital, mainly ICU.

  • Family unable to be at the bedside.

  • Consider inpatient hospice.

  • Equip hospices with easy to instal temporary negative pressure rooms.41

  • Train hospice personnel on telemedicine and telecounselling.

Bereavement
  • Provided to close family members for up to 1 year from patients death.

  • Not routinely done.

  • Telecounseling and bereavement support by trained personnel.

  • Virtual support groups.

  • ARDS, acute respiratory distress syndrome; DNR, do not resuscitate; ICU, intensive care unit; PPE, personal protective equipment.