Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey

Sarah Mitchell; Phillip Oliver; Clare Gardiner; Helen Chapman; Dena Khan; Kirsty Boyd; Jeremy Dale; Stephen Barclay; Catriona R Mayland

doi:10.3399/BJGPO.2021.0095

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Figure 1. Changes in professional role in end-of-life care (n = 559)
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Figure 2. Changes in type of consultation conducted

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Table 1. Demographic details of responders and information about provision of care for dying patients during the pandemic (n = 559)

	n	%
Which country do you work in? (n = 559)
England	431	77.1
Scotland	65	11.6
Wales	47	8.4
Northern Ireland	16	2.9
Missing	0
What type of area do you work in mainly? (n = 556)
Mixed urban and rural	222	39.9
Urban	179	32.3
Rural	106	19.0
Inner city	49	8.8
Missing	3
What is your role? (n = 543)
Doctor	156	28.7
GP partner	104	19.1
Sessional GP	45	8.3
Other, for example, GP in training	7	1.3
Community nurse	387	71.3
Community staff nurse	150	27.6
District nurse (including team leaders)	159	29.3
Advanced nurse practitioner	32	5.9
Community matron	24	4.4
Community healthcare assistant	15	2.8
Nurse consultant	7	1.3
Missing	16
Have you cared for any patients in the community who have died with confirmed (by test) COVID-19? (n = 557)
Yes	296	53.1
No	261	46.9
Missing	2
Have you cared for any patients in the community who have died with suspected COVID-19 (untested but with clinical symptoms)? (n = 554)
Yes	371	67.0
No	183	33.0
Missing	5
Have you been involved in providing end-of-life care at home for patients who do not have COVID-19 or suspected COVID-19 through the pandemic? (n = 554)
A lot more than usual	172	31.1
A little bit more than usual	150	27.1
About the same as usual	211	38.1
A little bit less than usual	13	2.3
A lot less than usual	8	1.4
Missing	5
Have your working hours changed in order to deliver end-of-life care during COVID-19? (n = 554)
Yes	189	34.1
No	366	65.9
Missing	4

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Table 2. Comparison between community nurses' and doctors’ responses for their professional role in palliative care activities

	Please state whether your role in the following areas of palliative care has changed during the COVID-19 pandemic^a
Community nurses	GPs	P value^b
Total	387	±95% CI (%)	156	±95% CI ( %)
Advance care planning
Doing less or a lot less^c	24 (7.2%)	4.6 to 10.1	4 (2.6%)	0.6 to 5.3	<0.0001
Stayed the same^c	154 (46.2%)	40.4 to 51.8	49 (31.6%)	24.7 to 38.9
Doing more or a lot more^c	155 (46.5%)	40.9 to 52.2	102 (65.8%)	58.1 to 72.8
Total	333		155
Anticipatory prescribing
Doing less or a lot less	7 (2.9%)	0.9 to 5.4	3 (1.9%)	0.0 to 4.5	0.82
Stayed the same	98 (41.2%)	34.1 to 48.2	65 (41.9%)	34.3 to 50.0
Doing more or a lot more	133 (55.9%)	49.1 to 62.8	87 (56.1%)	48.2 to 63.7
Total	238		155
Symptom management
Doing less or a lot less	5 (1.4%)	0.3 to 2.7	4 (2.6%)	0.6 to 5.3	<0.0001
Stayed the same^c	141 (38.3%)	33.8 to 43.5	108 (69.2%)	62.0 to 76.4
Doing more or a lot more^c	222 (60.3%)	55.0 to 65.0	44 (28.2%)	21.0 to 35.4
Total	368		156
Support for family members and carers
Doing less or a lot less	14 (3.7%)	1.8 to 5.5	8 (5.1%)	1.8 to 8.6	0.01
Stayed the same^c	116 (30.4%)	25.9 to 35.2	73 (46.8%)	39.5 to 54.5
Doing more or a lot more^c	252 (66.0%)	61.2 to 70.5	75 (48.1%)	40.4 to 55.5
Total	382		156
Bereavement support
Doing less or a lot less	31 (8.5%)	5.9 to 11.4	15 (9.7%)	5.2 to 14.6	<0.0001
Stayed the same^c	147 (40.5%)	35.4 to 45.5	96 (61.9%)	54.1 to 69.2
Doing more or a lot more^c	185 (51.0%)	45.7 to 56.0	44 (28.4%)	21.8 to 35.9
Total	363		155
Death verification
Doing less or a lot less^c	11 (3.7%)	1.7 to 6.0	59 (38.1%)	30.5 to 46.1	<0.0001
Stayed the same^c	98 (32.7%)	27.0 to 38.1	69 (44.5%)	36.6 to 52.7
Doing more or a lot more^c	191 (63.7%)	58.1 to 69.6	27 (17.4%)	11.7 to 23.5
Total	300		155
Death certification
Doing less or a lot less	8 (9.5%)	3.8 to 16.7	15 (9.7%)	5.3 to 14.4	0.52
Stayed the same	54 (64.3%)	52.9 to 74.0	88 (57.1%)	49.4 to 64.9
Doing more or a lot more	22 (26.2%)	17.4 to 35.8	51 (33.1%)	26.2 to 41.0
Total	84		154
Palliative care for patients who do not have COVID-19
Doing less or a lot less	9 (2.4%)	1.0 to 4.1	6 (3.8%)	1.2 to 7.2	<0.0001
Stayed the same^c	129 (34.3%)	29.8 to 39.1	113 (72.4%)	64.6 to 79.6
Doing more or a lot more^c	238 (63.3%)	58.5 to 68.2	37 (23.7%)	17.0 to 30.8
Total	376		156
Collaborative working with specialist palliative care teams
Doing less or a lot less	52 (14.1%)	10.5 to 17.7	21 (13.5%)	8.6 to 19.4	<0.0001
Stayed the same^c	148 (40.1%)	35.3 to 45.3	92 (59.0%)	51.0 to 66.5
Doing more or a lot more^c	169 (45.8%)	40.7 to 50.7	43 (27.6%)	20.7 to 34.9
Total	369		156

^aThose who gave the responses, ‘not my role’ and missing responses were excluded from the analysis.^bχ² test.^cPairwise Z-test with Bonferroni correction, significant at <0.05 level.

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Table 3. Comparison between community nurses' and GPs' responses for the type of consultation conducted

	Please state whether your role in the following areas of palliative care has changed during the COVID-19 pandemic^a
Community nurses	±95% CI for (%)	GPs	±95% CI for (%)	P value^b
Total
Home visits	387		156
Doing less or a lot less^c	97 (44.5%)	38.0 to 50.5	35 (28.9%)	21.0 to 36.9	<0.0001
Stayed the same^c	36 (16.5%)	11.5 to 21.5	66 (54.5%)	45.1 to 63.2
Doing more or a lot more^c	85 (39.0%)	32.6 to 45.9	20 (16.5%)	10.2 to 23.5
Total	218		121
Telephone reviews
Doing less or a lot less^c	93 (37.2%)	31.1 to 42.9	72 (50.7%)	42.1 to 59.0	P = 0.08
Stayed the same^c	7 (2.8%)	0.8 to 5.2	0 (0.0%)	–
Doing more or a lot more^c	150 (60.0%)	54.2 to 66.0	70 (49.3%)	41.0 to 57.9
Total	250		142
Virtual consultations
Doing less or a lot less^c	34 (13.0%)	9.0 to 17.6	42 (34.1%)	25.8 to 43.0	<0.0001
Stayed the same	9 (3.4%)	1.5 to 5.6	2 (1.6%)	0.0 to 4.3
Doing more or a lot more^c	218 (83.5%)	78.8 to 88.1	79 (64.2%)	55.2 to 72.6
Total	261		123
Face-to-face visits
Doing less or a lot less^c	38 (13.9%)	10.0 to 18.2	53 (39.8%)	31.8 to 48.0	<0.0001
Stayed the same^c	25 (9.1%)	5.8 to 12.8	79 (59.4%)	50.8 to 67.6
Doing more or a lot more^c	211 (77.0%)	71.7 to 81.9	1 (0.8%)	0.0 to 2.4
Total	274		133

^aThose who gave the responses, ‘not my role’ and missing responses were excluded from the analysis.^bχ² test. ^cPairwise Z-test with Bonferroni correction, significant at <0.05 level.

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