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Research

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 and Catriona R Mayland
BJGP Open 2021; 5 (4): BJGPO.2021.0095. DOI: https://doi.org/10.3399/BJGPO.2021.0095
Sarah Mitchell
1Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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  • ORCID record for Sarah Mitchell
  • For correspondence: s.j.mitchell@sheffield.ac.uk
Phillip Oliver
2Clinical Lecturer, Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
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Clare Gardiner
3Senior Research Fellow, Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
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Helen Chapman
4Queen's Nurse and Head of Integrated Community Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Dena Khan
5Patient and Public Involvement Representative, University of Warwick, Warwick, UK
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Kirsty Boyd
6Reader in Palliative Care, Usher Institute, University of Edinburgh, Edinburgh, UK
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Jeremy Dale
7Professor of Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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Stephen Barclay
8Senior Lecturer in General Practice and Palliative Care, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Catriona R Mayland
1Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Article Figures & Data

Figures

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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

Tables

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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)
    England43177.1
    Scotland6511.6
    Wales478.4
    Northern Ireland162.9
    Missing0
    What type of area do you work in mainly? (n = 556)
    Mixed urban and rural22239.9
    Urban17932.3
    Rural10619.0
    Inner city498.8
    Missing3
    What is your role? (n = 543)
    Doctor15628.7
    GP partner10419.1
    Sessional GP458.3
    Other, for example, GP in training71.3
    Community nurse38771.3
    Community staff nurse15027.6
    District nurse (including team leaders)15929.3
    Advanced nurse practitioner325.9
    Community matron244.4
    Community healthcare assistant152.8
    Nurse consultant71.3
    Missing16
    Have you cared for any patients in the community who have died with confirmed (by test) COVID-19? (n = 557)
    Yes29653.1
    No26146.9
    Missing2
    Have you cared for any patients in the community who have died with suspected COVID-19 (untested but with clinical symptoms)? (n = 554)
    Yes37167.0
    No18333.0
    Missing5
    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 usual17231.1
    A little bit more than usual15027.1
    About the same as usual21138.1
    A little bit less than usual132.3
    A lot less than usual81.4
    Missing5
    Have your working hours changed in order to deliver end-of-life care during COVID-19? (n = 554)
    Yes18934.1
    No36665.9
    Missing4
    • View popup
    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 pandemica
    Community nursesGPsP valueb
    Total387±95% CI (%)156±95% CI ( %)
    Advance care planning
    Doing less or a lot lessc24 (7.2%)4.6 to 10.14 (2.6%)0.6 to 5.3<0.0001
    Stayed the samec154 (46.2%)40.4 to 51.849 (31.6%)24.7 to 38.9
    Doing more or a lot morec155 (46.5%)40.9 to 52.2102 (65.8%)58.1 to 72.8
    Total333155
    Anticipatory prescribing
    Doing less or a lot less7 (2.9%)0.9 to 5.43 (1.9%)0.0 to 4.50.82
    Stayed the same98 (41.2%)34.1 to 48.265 (41.9%)34.3 to 50.0
    Doing more or a lot more133 (55.9%)49.1 to 62.887 (56.1%)48.2 to 63.7
    Total238155
    Symptom management
    Doing less or a lot less5 (1.4%)0.3 to 2.74 (2.6%)0.6 to 5.3<0.0001
    Stayed the samec141 (38.3%)33.8 to 43.5108 (69.2%)62.0 to 76.4
    Doing more or a lot morec222 (60.3%)55.0 to 65.044 (28.2%)21.0 to 35.4
    Total368156
    Support for family members and carers
    Doing less or a lot less14 (3.7%)1.8 to 5.58 (5.1%)1.8 to 8.60.01
    Stayed the samec116 (30.4%)25.9 to 35.273 (46.8%)39.5 to 54.5
    Doing more or a lot morec252 (66.0%)61.2 to 70.575 (48.1%)40.4 to 55.5
    Total382156
    Bereavement support
    Doing less or a lot less31 (8.5%)5.9 to 11.415 (9.7%)5.2 to 14.6<0.0001
    Stayed the samec147 (40.5%)35.4 to 45.596 (61.9%)54.1 to 69.2
    Doing more or a lot morec185 (51.0%)45.7 to 56.044 (28.4%)21.8 to 35.9
    Total363155
    Death verification
    Doing less or a lot lessc11 (3.7%)1.7 to 6.059 (38.1%)30.5 to 46.1<0.0001
    Stayed the samec98 (32.7%)27.0 to 38.169 (44.5%)36.6 to 52.7
    Doing more or a lot morec191 (63.7%)58.1 to 69.627 (17.4%)11.7 to 23.5
    Total300155
    Death certification
    Doing less or a lot less8 (9.5%)3.8 to 16.715 (9.7%)5.3 to 14.40.52
    Stayed the same54 (64.3%)52.9 to 74.088 (57.1%)49.4 to 64.9
    Doing more or a lot more22 (26.2%)17.4 to 35.851 (33.1%)26.2 to 41.0
    Total84154
    Palliative care for patients who do not have COVID-19
    Doing less or a lot less9 (2.4%)1.0 to 4.16 (3.8%)1.2 to 7.2<0.0001
    Stayed the samec129 (34.3%)29.8 to 39.1113 (72.4%)64.6 to 79.6
    Doing more or a lot morec238 (63.3%)58.5 to 68.237 (23.7%)17.0 to 30.8
    Total376156
    Collaborative working with specialist palliative care teams
    Doing less or a lot less52 (14.1%)10.5 to 17.721 (13.5%)8.6 to 19.4<0.0001
    Stayed the samec148 (40.1%)35.3 to 45.392 (59.0%)51.0 to 66.5
    Doing more or a lot morec169 (45.8%)40.7 to 50.743 (27.6%)20.7 to 34.9
    Total369156
    • 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.

    • View popup
    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 pandemica
    Community nurses±95% CI for (%)GPs±95% CI for (%)P valueb
    Total
    Home visits387156
    Doing less or a lot lessc97 (44.5%)38.0 to 50.535 (28.9%)21.0 to 36.9<0.0001
    Stayed the samec36 (16.5%)11.5 to 21.566 (54.5%)45.1 to 63.2
    Doing more or a lot morec85 (39.0%)32.6 to 45.920 (16.5%)10.2 to 23.5
    Total218121
    Telephone reviews
    Doing less or a lot lessc93 (37.2%)31.1 to 42.972 (50.7%)42.1 to 59.0P = 0.08
    Stayed the samec7 (2.8%)0.8 to 5.20 (0.0%)–
    Doing more or a lot morec150 (60.0%)54.2 to 66.070 (49.3%)41.0 to 57.9
    Total250142
    Virtual consultations
    Doing less or a lot lessc34 (13.0%)9.0 to 17.642 (34.1%)25.8 to 43.0<0.0001
    Stayed the same9 (3.4%)1.5 to 5.62 (1.6%)0.0 to 4.3
    Doing more or a lot morec218 (83.5%)78.8 to 88.179 (64.2%)55.2 to 72.6
    Total261123
    Face-to-face visits
    Doing less or a lot lessc38 (13.9%)10.0 to 18.253 (39.8%)31.8 to 48.0<0.0001
    Stayed the samec25 (9.1%)5.8 to 12.879 (59.4%)50.8 to 67.6
    Doing more or a lot morec211 (77.0%)71.7 to 81.91 (0.8%)0.0 to 2.4
    Total274133
    • 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.

Supplementary Data

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    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.

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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
BJGP Open 2021; 5 (4): BJGPO.2021.0095. DOI: 10.3399/BJGPO.2021.0095

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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
BJGP Open 2021; 5 (4): BJGPO.2021.0095. DOI: 10.3399/BJGPO.2021.0095
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Keywords

  • primary health care
  • general practice
  • district nursing
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  • COVID-19

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