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Symptom Control and Survival for People Severely ill With COVID: A Multicentre Cohort Study (CovPall-Symptom)

Authors :
Irene J. Higginson
Mevhibe B. Hocaoglu
Lorna K. Fraser
Matthew Maddocks
Katherine E. Sleeman
Adejoke O. Oluyase
Rachel L. Chambers
Nancy Preston
Lesley Dunleavy
Andy Bradshaw
Sabrina Bajwah
Fliss E.M. Murtagh
Catherine Walshe
Source :
Journal of Pain and Symptom Management. 64:377-390
Publication Year :
2022
Publisher :
Elsevier BV, 2022.

Abstract

Evidence of symptom control outcomes in severe COVID is scant.To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival.Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative care Outcome Scale - COVID version.We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were: breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival.Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.

Details

ISSN :
08853924
Volume :
64
Database :
OpenAIRE
Journal :
Journal of Pain and Symptom Management
Accession number :
edsair.doi.dedup.....3bec22e9e0411f31994d80841c4207ea
Full Text :
https://doi.org/10.1016/j.jpainsymman.2022.06.009