The Coronavirus pandemic has led to great challenges in delivering high quality end of life care to patients with and without COVID-19. If anyone would like to post a document or link that may be useful to health care professionals here, please contact the Division Head: Pippa Hawley (firstname.lastname@example.org).
Please also note that the BC Centre for Palliative Care also has many relevant items on its website and maintains a calendar of COVID-19-related webinars and resources at https://bc-cpc.ca/cpc/all-resources/covid-19-resources/#1586313525063-2d4eb83e-58c3.
MESSAGE BOARD: Sadly the 4th wave of Covid-19 is with us, primarily among the unvaccinated. The pandemic has exposed many deficiencies in health care capacity, resourcing and processes, which will hopefully lead to long-term improvements to our health care system. For more information please see the 2021 Canadian report on home and community care: https://cdnhomecare.ca/wp-content/uploads/2021/06/Home-and-Community-based-Palliative-Care-Shaping-the-Future-from-Lessons-Learned-during-the-COVID-19-Pandemic_JUN25.pdf .
The tools developed at the beginning of the pandemic are all still entirely applicable. Vaccination is still the top priority and none of the variants so far appear to be able bypass the effectiveness of the vaccines.
Please take a look at “Serious Illness Conversation Guide – PEDS”
Check out Amy Mabie’ lovely book for children ~4-8 yrs old to understand Coronavirus https://www.youtube.com/watch?v=nOAHvTdwza8&feature=youtu.be and a news article about it https://bit.ly/3enuKXk, and a similar book from the WHO for older children https://www.who.int/news-room/detail/09-04-2020-children-s-story-book-released-to-help-children-and-young-people-cope-with-covid-19.
See excellent CFPC guide to virtual teaching: applies to all levels of learner; https://portal.cfpc.ca/resourcesdocs/en/Supervision-of-FM-Learners-for-Virtual-Visits-final.pdf. The ability to access education virtually will be with us for the foreseeable future and is a useful resource.
VIRTUAL CARE TOOLS
See BC-specific Virtual Care Toolkit from Drs of BC https://www.doctorsofbc.ca/sites/default/files/dto_virtual_care_toolkit.pdf
Accreditation Canada also has a free downloadable guide available from https://store.accreditation.ca/products/virtual-care-toolkit
1. This one-page symptom management guideline has been tested in multiple settings and providing the relevant drugs are available it has not required modification since its original posting. Multiple other jurisdictions ave suggested the same or very similar interventions. Symptom management for adult patients with COVID-19 receiving end-of-life supportive care outside of the ICU
2. FraserHealth’s “Actively Dying Protocol”, with new Appendix for COVID-19 patients. Actively Dying Protocol Part 1, Actively Dying Protocol Part 2, FH Actively Dying Protocol COVID-19 Addendum 3-4-20. See also discharge planning tool and medication kit for expected EOL at home from COVID-19 FHDischargeChecklistforExpectedEOLinC19 patients and FH-C19EOLkit
3. VIHA’s Order Set for COVID-19 Palliative Management VIHACOVID-19PalliativeCareandSymptomManagementwithSOB0Mini-Sets VIHACOVID-19PalliativeSedationandEndofLifeM1.M2Module
4. VGH’s inpatient Order Set for COVID-19 Palliative Management VGHPalliativeCareComfortCareOrdersForCOVID-19WATERMARK
5. Link to Pallium webinars featuring our clinical faculty: Doris Barwich and Shalini Nayar on dyspnea https://youtu.be/Z_Pu2peHeHI, also Pippa Hawley and Dave Williscroft on a palliative approach to care for COVID-19 (everything but dyspnea) https://www.youtube.com/watch?v=mlf83Ddat_g&feature=youtu.be
“NORMAL” (i.e. non-pandemic) PALLIATIVE CARE GUIDELINES
1. The BC Guidelines and Protocols Advisory Committee 3-part Palliative Care Guideline
- Palliative Care for the Patient with Incurable Cancer or Advanced Disease – Part 1: Approach to Care (2017)
- Palliative Care for the Patient with Incurable Cancer or Advanced Disease – Part 2: Pain and Symptom Management (2017)
- Palliative Care for the Patient with Incurable Cancer or Advanced Disease – Part 3: Grief and Bereavement (2017)
2. BC Inter-professsional Palliative Symptom Management Guidelines – BC Centre for Palliative Care – see https://bc-cpc.ca/cpc/publications/symptom-management-guidelines/
ADVANCE CARE PLANNING
ACP TOOLS FOR HEALTH CARE PROVIDERS
1. Ariadne Labs have provided COVID-19-specific adapted materials for the Serious Illness Conversation Guide https://www.ariadnelabs.org/coronavirus/clinical-resources/covid-conversations/
2. Providence Health Communication Guide (including video) for Serious Illness Conversation, adapted for use by health care professional with a patient or patient’s SDM concerned about COVID-19, and links to other appropriate communications resources. http://covid19.providencehealthcare.org/resources/tools-covid-conversations-patientsdms
3. Fraser Health has various existing and new Advance Care Planning & Serious Illness Conversation resources. Health care Provider Serious Illness Resources (Adapted Guide and Mini Clinician Reference Guide). FH Medical Staff site http://medicalstaff.fraserhealth.ca/Clinical-Resources/#ACP), Patient and Family Advance Care Planning and Serious Illness Resources. Should you require more support around these conversations in Fraser Health, please call 1-877-TALK-034 (1-877-825-5034) or for consultative support email FHAdvanceCarePlanning@fraserhealth.ca
ACP RESOURCES DESIGNED FOR DIRECT PATIENT USE
1. BC-specific (but editable) 1-page patient handout for self-guided Advance Care Planning in current COVID-19 pandemic context, suitable for any person with chronic illness or frailty. Please edit as appropriate for local circumstances (i.e. resource links) and pdf before distribution to patients. Thanks to FH ACP team and Mino Mitri for assistance with development. LetsTalkforACPinCOVID-19PandemicwithChronic Illness23-3-20
2. Similar 2-page and 4- page documents can be found on Amy Tan’s blog (Alberta) at http://www.amytanmd.ucalgaryblogs.ca
3. A serious illness discussion video made in BC is now posted on Pallium’s YouTube channel. It is modelled as a serious illness discussion that a physician (in this case Morgan Lam) might have with a patient face-to-face, with a pandemic spin to make it more specific to the COVID situation. It is intended help open a conversation with a patient that can be done remotely, whether geographically or or from outside a patient’s room. https://youtu.be/Oh1SVOQUn08
4. A free, easy to use, evidence-based app designed for the creation of legacy video recordings from Recordmenow.org. An iphone, Windows or Mac computer/laptop required. Legacy support RecordMeNow.org (604) 418-8906.
OTHER PATIENT AND FAMILY-DIRECTED RESOURCES
Using other available videos
- Donning and doffing PPE (video): https://www.youtube.com/watch?v=_D0HtUCkUS4
- Marie Curie Society (UK): what to expect at end of life (video): https://www.youtube.com/watch?time_continue=243&v=slNShkHNNpw&feature=emb_title
BC OPERATIONAL ISSUES
1. Process for accessing PPE https://news.gov.bc.ca/releases/2020PSSG0023-000609
2. Prescribing suggestions to mitigate potential drug shortages Access to Drugs for Palliative Care in COVID-19 Pandemic 5-4-20
4. Coroner’s advice on completion of death certificates, and funeral regulations DeathCertsand FuneralsCovid19
2. COVID-19-specific BC Palliative Benefits and Expected Death in the Home forms (thanks to Nicola Macpherson) BC Pall Care Benefits (COVID-19) NM 30-3-20 Notification of Expected Death in the Home (COVID-19) NM 30-3-20
3. Personal Protective Equipment procedure advice Home Visit PPE Full Procedure v.7. Removal of PPE procedure (NB Lots of hand washing!) COVID19_MOH_BCCDC_Doffing. Video demonstrating PPE procedure for a home visit https://www.youtube.com/watch?v=vpoiGcJ1_0U
4. Review of COVID-19 for physicians caring for patients in a non-ICU approach, by Lawrence Chow; BC internist/palliative care physician. COVID-19 Non-ICU Approach to Care LChow 1April 2020
5. Pallium are offering LEAP-Mini courses online for free during the pandemic. https://www.pallium.ca/course/covid-19-response-free-online-modules/ Leap Core is now available for group bookings in combined self-directed module completion and webinar format.
There are currently no scheduled LEAP facilitator training courses being run, but please contact Pallium to discuss if you have a group of future facilitators who would like a course.
7. CMAJ article March 31, 2020 on Palliative Care in a Pandemic. PandemicPalliativeCareCMAJ
8. UK palliative care resource list (including some international resources) https://www.palliativedrugs.com/download/Palliative_care_collated_COVID_resources_V02_200327.pdf
9. US Center to Advance Palliative Care COVID resources https://www.capc.org/toolkits/covid-19-response-resources/