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Palliative Care Consultation in Hospitalized Patients with COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs.

Abstract：

CONTEXT:Few studies have described the characteristics and palliative care needs in hospitalized patients with coronavirus disease 2019 (COVID-19). OBJECTIVES:Describing characteristics, consultation demands, patients' needs, and outcomes of hospitalized patients with COVID-19 who received a palliative care evaluation. METHODS:Retrospective chart review of patients (aged 18+ years) with COVID-19 admitted to an academic quaternary center and seen by the geriatrics and palliative medicine team from March 1st to May 11th, 2020. Socio-demographics, operational metrics, severity of illness, goals of care-advanced care planning documentation, and outcomes were analyzed. RESULTS:Three hundred seventy-six (17.6%) out of 2138 COVID-19 admissions were seen by the consultation team. Compared with prepandemic situation (September 1st, 2019, to February 29th, 2020), overall new consults (205 vs. 371, P < 0.001) significantly increased, particularly in the intensive care unit (ICU; 9.5% vs. 36.9%, P < 0.001). For the COVID-19 population, median age was 78 years (interquartile range, 70-87; range, 36-102); 56% were male. LACE score, D-dimer, and C-reactive protein suggested severe disease and increased risk of mortality. Seventy-five percent of consults were for goals of care-advanced care planning, and 9.6% for symptoms. During the index admission, 7.1% had documented advanced directives, and 69.7% became do not resuscitate. Of all deaths, 55.5% were in the ICU, and 87.2% were aged ≥65 years. Underserved minority patients had a disproportionate mortality. Overall consultation mortality (38.3% vs. 70.4%, P < 0.001) and ICU mortality (55.2% vs. 78.1%, P < 0.001) significantly increased compared with those before COVID-19. CONCLUSION:During this pandemic, understanding inpatient specialized palliative care needs and the vulnerable populations driving these causes may encourage health-care agencies and local, state, and federal governments to support the dedicated palliative care workforce.

journal_name

J Pain Symptom Manage

journal_title

Journal of pain and symptom management

authors

Lopez S,Finuf KD,Weiss-Domis S,Marziliano A,Sinvani L,Burns EA

doi

10.1016/j.jpainsymman.2020.12.015

subject

Has Abstract

pub_date

2020-12-21 00:00:00

eissn

0885-3924

issn

1873-6513

pii

S0885-3924(20)30946-5

pub_type

杂志文章

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Palliative Care Consultation in Hospitalized Patients with COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs.