key: cord-0990737-sj7uipha
authors: Bullich-Marín, Ingrid; Costas-Muñoz, Emma; López-Matons, Nuria
title: End-of-life palliative care in times of pandemic: The PADES-COVID experience()
date: 2021-10-06
journal: Med Clin (Engl Ed)
DOI: 10.1016/j.medcle.2021.02.012
sha: 0f5a0b93bb5ccb95caf40b45348967976f225fa9
doc_id: 990737
cord_uid: sj7uipha

nan

The recent article by Julià-Torras et al. on pressing reflections from palliative care in the face of the next epidemic of COVID-19 1 mentions the great difficulties encountered in the home and nursing home settings at the beginning of the first wave of the pandemic in Spain.

In the city of Barcelona, 5418 people died between the start of the pandemic and 30 December 2020. 2 During the weeks between 28/03 and 12/04 an average of 130-140 patients died in the city of Barcelona per day, with around a third of them dying at home or in a nursing home. 3 Aware of the difficulty of accessibility to hospitals for palliative patients and the need for people at home to have access to specific palliative care, a specific home palliative care support team (PADES-COVID) was set up in the city of Barcelona on 1 April 2020. In line with the proposals for adapting palliative care services to the pandemic, 4 this action is seen as an example of flexibility and transformation from a conventional PADES service.

The purpose of this letter to the editor is to describe the experience, operation and main results of the PADES-COVID activity during the first wave of the pandemic.

PADES-COVID is a rapid response resource for the care of COVID+ patients or patients with compatible symptoms from any health service of the Catalan Public Health System (SISCAT). It provides care from Monday to Sunday (from 8 am to 8 pm) for patients with palliative needs resulting from SARS-COV-2 infection who were not previously cared for by a PADES. These patients are cared for by professionals in medicine, nursing, social work and psychology, with advanced skills in palliative care. The visits are joint, which allows multidimensional care to be planned and organised on the basis of an assessment of the physical, psychosocial and spiritual needs of the person and their families, incorporating bioethical aspects in decision-making. During the first two months of PADES-COVID, 180 patients (55.6% women) were treated, with a mean age of 78.8 years. 41.6% were complex chronic patients (CCP) or advanced chronic disease patients (ACDP). Each patient received a mean of 3 (SD 2.65) interventions. 17% of the patients died at the time of the first visit, during the team's intervention. The follow-up of 76.7% of the patients was carried out by the reference PADES team.

In the first wave of the pandemic, PADES-COVID provided care to a small number of people with palliative needs at home and in nursing homes, compared to those initially planned and to all those who died in the city of Barcelona. Even so, the rating of the resource by the rest of the SISCAT services in the territory was very satisfactory, as well as for the patients and their families and the professionals on the team.

The PADES-COVID, based on the care model and work methodology carried out by the PADES teams over 30 years of experience, 5 has proved to be a good proposal for responding to the emerging palliative needs of COVID-19. It is considered a realistic and feasible proposal and corresponds to the specific proposals for new COVID-19 outbreaks put forward by Julià-Torras et al. 1 which include: teams with specific competencies in palliative care; symptom control; psycho-emotional support; support in rapid decision making; and hospital-to-home transfer of patients, among others. For this reason, the need to reactivate it in the face of a possible third wave of the pandemic was considered.

COVID-19: reflexiones de urgencia desde los cuidados paliativos ante la próxima epidemia

S/Coronavirus SARS-CoV-2. Situació Actual Catalunya. Barcelona: Departament de Salut

Información estadística para el análisis del impacto de la crisis COVID-19. Madrid: INE [Accessed 30

Organización paliativa durante la pandemia de la COVID-19 y propuestas para la adaptación de los servicios y programas de cuidados paliativos y de atención psicosocial ante la posibilidad de reactivación de la pandemia y época pos-COVID-19

Equipos de soporte domiciliario de cuidados paliativos en España

Medicina Clínica xxx (xxxx) xxx-xxx a Adjuntía Dirección Programa de Atención Domiciliaria-Equipos de Soporte y Equipos de Atención Residencial