Health care professionals and end-of-life care during the COVID-19 pandemic

Ferreira, Esther Angélica Luiz; Valete, Cristina Ortiz Sobrinho; Santos, André Filipe Junqueira dos; Passarini, Juliana Nalin de Souza; Silva, Alexandre Ernesto; Miwa, Michelle Uchida

doi:10.1590/1806-9282.20210417

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Original Article • Rev. Assoc. Med. Bras. 67 (9) • Sept 2021 • https://doi.org/10.1590/1806-9282.20210417 copy

Health care professionals and end-of-life care during the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to estimate self-perception of anguish and low quality of life among health care professionals who cared for the dying patients during the COVID-19 pandemic and to determine the characteristics of health care professionals and patients and end-of-life care.

METHODS:

An online survey that included health care professionals who cared for the dying patient from July 1 to October 31, 2020 was conducted. Low quality of life, anguish, characteristics of patients and health care professionals, and end-of-life care were recorded. Poisson regression was performed to assess the predictors of anguish and low quality of life.

RESULTS:

A total of 102 health care professionals, including 14 males (13.7%), with a median age of 37 years, composed of 41 physicians (40.2%), 36 physiotherapists (35.3%), and 25 nurses (24.5%) were included in this study. Self-perception of anguish occurred in 69.6% and was associated with physicians and disagreement with end-of-life care offered. Low quality of life was reported in 64.7% and was associated with not having time to talk to patients’ relatives. The agreement that medical care was enough reduced self-perception of low quality of life.

CONCLUSION:

Self-reported anguish was more frequent in physicians and when the disagreement about end-of-life care occurred. Low quality of life was more frequent when health care professionals did not have time to talk to patients’ relatives and was less frequent when health care professionals agreed that medical care was enough. Strategies should be done by health services to reduce the impact of the pandemic on health care professionals.

KEYWORDS:
COVID-19; COVID-19 pandemic; Palliative care; End-of-life care; Assisted death; Grief

		Anguish (%)	CPR	p-value^* * p-value associated with Poisson regression.	APR	95%CI	p-value^* * p-value associated with Poisson regression.
Health care professionals
Age (years)
	>37	70.0	1.01	0,93	Not included
	≤37	69.2	1	0,93	Not included
Sex
	Male	50.0	0.68	0.17	Not included
	Female	72.7	1	0.17	Not included
Professional category
	Physician	78.0	1.24	0.09	1.37	1.05–1.79	0.02
	Others	63.9	1	0.09	1.37	1.05–1.79	0.02
Patients
Age (years)
	>60	72.0	1.06	0.60	Not included
	≤60	67.3	1	0.60	Not included
Sex
	Male	70.0	1.01	0.89	Not included
	Female	69.4	1	0.89	Not included
SARS-CoV-2 infection
	Confirmed or probable	67.5	0.95	0.76	Not included
	No	70.8	1	0.76	Not included
Felt pain all the time or sometimes
	Yes	64.4	0.87	0.32	Not included
	No	73.6	1	0.32	Not included
End-of-life care
Agreement with end-of-life care offered
	No	85.0	1.32	0.02	1.42	1.10–1.83	0.006
	Others	64.1	1	0.02	1.42	1.10–1.83	0.006
Shared decision regarding limited life care support
	Yes	71.0	1.05	0.68	Not included
	Others	67.0	1	0.68	Not included
Have time to talk to patients’ relatives
	No	80.0	1.09	0.45	Not included
	Others	73.0	1	0.45	Not included
Agree that medical care was enough
	Yes	67.0	0.73	0.01	Not included
	Others	90.0	1	0.01	Not included
Visits were allowed in the last 2 days
	Yes	63.1	1	0.10	Not included
	No	77.7	1.23	0.10	Not included
Emotional and spiritual support offered to patients’ relatives
	No/probably no	73.0	1	0.56	Not included
	Yes	68.0	0.92	0.56	Not included
Place where care was offered
	Hospital	69.1	0.92	0.70	Not included
	Others	75.0	1	0.70	Not included
Death occurred in a COVID-19 division
	Yes	69.4	0.93	0.55	Not included
	No	73.9	1	0.55	Not included

		Quality of life≤4(%)	CPR	p-value^* * p-value associated with Poisson regression.	APR	95%CI	p-value^* * p-value associated with Poisson regression.
Health care professionals
Age (years)
	>37	54.0	0.72	0.03	Adjusting variable
	≤37	75.0	1	0.03	Adjusting variable
Sex
	Male	50.0	0.74	0.29	Not included
	Female	67.0	1	0.29	Not included
Professional category
	Physician	68.2	1.09	0.53	Not included
	Others	62.3	1	0.53	Not included
Patients
Age (years)
	>60	60.0	0.86	0.33	Not included
	≤60	69.2	1	0.33	Not included
Sex
	Male	64.6	1.01	0.94	Not included
	Female	63.8	1	0.94	Not included
SARS-CoV-2 infection
	Confirmed or probable	67.5	1.35	0.17	Not included
	No	50.0	1	0.17	Not included
Felt pain all the time or sometimes
	Yes	66.6	1.05	0.71	Not included
	No	63.1	1	0.71	Not included
End-of-life care
Agreement with end-of-life care offered
	No	70.0	1.13	0.45	Not included
	Others	61.5	1	0.45	Not included
Shared decision regarding limited life care support
	Yes	64.4	0.98	0.94	Not included
	Others	65.1	1	0.94	Not included
Have time to talk to patients’ relatives
	No	80.0	1.54	0.007	1.43	1.04–1.98	0.02
	Others	51.9	1.54	0.007	1.43	1.04–1.98	0.02
Agree that medical care was enough
	Yes	61.5	0.67	0.002	0.70	0.52–0.94	0.01
	Others	90.9	1	0.002	0.70	0.52–0.94	0.01
Visits were allowed in the last 2 days
	Yes	66.6	1	0.64	Not included
	No	62.2	0.93	0.64	Not included
Emotional and spiritual support offered to patients’ relatives
	No/probably no	68.6	1.16	0.31	Not included
	Yes	58.6	1	0.31	Not included
Place where care was offered
	Hospital	68.0	2.72	0.10	Not included
	Others	25.0	1	0.10	Not included
Death occurred in a COVID-19 division
	Yes	69.4	1.06	0.71	Not included
	No	65.2	1	0.71	Not included

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[1] *Corresponding author: estherferreira@ufscar.br