AUTHOR=Andrade Camila Rabelo Monteiro de , Luz Fernanda Silva Trindade , Oliveira Neimy Ramos de , Kopittke Luciane , Santa Rosa Luiza Marinho Motta , Gomes Angelica Gomides dos Reis , Bartolazzi Frederico , Francisco Saionara Cristina , Costa Felicio Roberto da , Jorge Alzira de Oliveira , Cimini Christiane Corrêa Rodrigues , Carneiro Marcelo , Ruschel Karen Brasil , Schwarzbold Alexandre Vargas , Ponce Daniela , Ferreira Maria Angélica Pires , Guimarães Júnior Milton Henriques , Silveira Daniel Vitório , Aranha Fernando Graça , Carvalho Rafael Lima Rodrigues de , Godoy Mariana Frizzo de , Viana Lucas Macedo Pereira , Hirakata Vânia Naomi , Bicalho Maria Aparecida Camargos , Marcolino Milena Soriano TITLE=Palliative care and COVID-19: acknowledging past mistakes to forge a better future JOURNAL=Frontiers in Medicine VOLUME=11 YEAR=2024 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1390057 DOI=10.3389/fmed.2024.1390057 ISSN=2296-858X ABSTRACT=Context

COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly.

Objectives

To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.

Methods

This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG).

Results

Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves.

Conclusion

A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.