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During the initial wave of the COVID-19 pandemic, many public health directives and policies, such as isolation measures were implemented by the government. This resulted in changes to the way healthcare was delivered, including palliative care.
A recent study by Cherba (2023) and colleagues explored the impact of COVID-19 policies on palliative care in Canada, including dying at home.
Interviews were conducted with 29 participants with expertise in the policy and practice context of dying at home or who care for the patients in this setting. The results showed that the these pandemic policy responses had a large impact, specifically to visitor restrictions, limitations on home care services, and the choice of dying at home. The three themes highlighted from the analysis were a preference and demand for dying at home, a bigger dependence on family and friends in their role as caregivers and challenges in implementing policy changes during a pandemic demonstrating equity-related issues.
The first theme demonstrates a scenario where the demand for dying at home was increased, however the healthcare system could not meet the demands in providing adequate support for these preferences. The demand for end-of-life care at home was driven by factors like restrictive hospital visitation policies. While these pandemic restrictions posed challenges, unexpectedly, positive changes were found from these including a better collaboration among healthcare providers and encouraging new approaches to provide care. The pandemic however did help uncover the lack of at home medical support while dying at home and emphasized the need for public education on these treatments.
The second theme underscores the dependence on family and friends as caregivers for end-of-life care, which also limits the ability to support dying at home. Families were now responsible for caregiving and highlighted the need for support from the community. Financial pressure on non-profit organizations strained the home-based support and help to make the existing inequities in the healthcare system and end-of-life care even more evident. A comprehensive care framework could be beneficial for these families.
The third theme highlights the difficulties of developing and implementing new policy changes during a pandemic. Participants shared the difficulties they experienced in applying the new province-wide directives and restrictions. Remote regions were found to have less palliative care resources which highlighted the inequities. The role of caregiving was often transferred to family and friends emphasizing their importance in end-of-life care. Future policies are encouraged to integrate palliative care principles and address some needs of healthcare access.
In conclusion, this study brings highlights the different impacts of COVID-19 policies in the Canadian healthcare system. It helps to recognize the pivotal role played by family and friends in a caregiver role in community organized end-of-life care. Additionally, attention is brought to the health inequities found in these palliative treatments to highlight the benefits a more inclusive approach to policy development could bring to the system. The research also suggests potential benefits of a change in future end-of-life preferences and public attitudes regarding dying at home, which can create additional responsibility for end-of-life-care. Overall, the findings encourage a nuanced and responsive healthcare approach the considers the patients multiple different desires and encourage and inclusive system, particularly in the delicate context of end-of-life care during a pandemic.
Source: Cherba, M., Funk, L., Scott, E., Salman, B., Rounce, A., Mackenzie, C., … & Cohen, S. R. (2023). How initial policy responses to COVID-19 contributed to shaping dying at home preferences and care provision: key informant perspectives from Canada. BMC Health Services Research, 23(1), 1330.
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