The spread of COVID-19 across the globe is causing, and will continue to cause, understandable alarm. As the pandemic continues to ravage nations and the number of deaths continues to rise in the UK, the subject of death and dying is receiving much attention. Often seen as a taboo among some populations, death and dying and COVID-19 have now taken centre stage.
It is too early to make definitive conclusions about how many deaths are occurring due to novel coronavirus and impossible to say with certainty how many people the virus will kill. Caution must be taken in reading too much into figures across the world (mortality rates for countries differ). Issues regarding COVID-19 are evolving quickly, with experts disclosing figures daily (sometimes more often). The published hard data can create mistaken impressions about the underlying facts, even if both the data and the accounts are accurate. Snapshots can be misleading for many reasons and this can skew the data. Amassing data, however, is essential to aid current learning, contribute to research and for prospective learning.
Any death is devastating for the families involved, and COVID-19 has the potential to prompt nurses and patients to have conversations about what they would want were they to become seriously unwell. It is important to engage in dialogue about all possible outcomes, including those we may not be comfortable talking about. For some people the consequences of being infected with coronavirus and developing COVID-19 will be life threatening. Those most at risk are the elderly, frail and/or people with underlying chronic or serious illness (Public Health England, 2020), although this may change. These groups are often the core patient populations in palliative care. COVID-19 brings with it a severe acute care crisis of unknown duration, in which large numbers of people will become ill, some critically, and across the globe thousands will die.
In these situations, the familiar concerns of palliative care, namely quality of life, respect for patient goals, advance care planning, pain and symptom management, and support for caregivers, may not appear important. However, palliative care has never been more important. End-of-life care offers support to people in their final months or years of life, helping them to live as well as possible until they die—and to die with dignity. Asking people about their preferences allows members of the multidisciplinary team to take these into account as they plan care, putting the person at the centre. Support also has to be extended to the family, carers and other people important to the patient.
People have the right to express their wishes about where they would like to receive care and where they want to die. Nurses are key in making sure that individuals approaching the end of life are supported to die in the place of their choice, where practically possible, in the way that they desire and with those whom they love (Royal College of Nursing, 2019).
Some of the patients who have died as result of COVID-19 have not been cared for in intensive care, because this would not have impacted on their outcome. Instead, their care has respected their wishes, including where they wanted to die—be it at home, in care a home, a hospice or on a ward. COVID-19 must not change this and people should give serious thought to what may be seen as difficult conversations. The term ‘advance care planning’ is used to describe the conversations that occur between people, families and carers, and those looking after them, about their priorities for care, identifying what would matter if the person became so sick that they might die.
It is important to emphasise the unique skills and strengths that are found in palliative care. If/when triage is needed to prioritise care, when critical care beds are in short supply, there will be a need to communicate this sensitively to patients and their families, suggesting an alternative path—and palliative care nurses already do this. The provision of palliative care, managing pain symptoms, ensuring comfort in dying, spiritual care and offering support to healthcare teams must be part of our response to COVID-19. The care aspect of palliative care is just as important as mechanical ventilation and other interventions.