COVID-19 end-of-life care: symptoms and supportive therapy use in an Australian hospital.

Content Provider	Europe PMC
Author	Wong, Aaron K. Demediuk, Lucy Tay, Jia Y. Wawryk, Olivia Collins, Anna Everitt, Rachel Philip, Jennifer Buising, Kirsty Le, Brian
Abstract	AbstractBackgroundDescriptions of symptoms and medication use at end of life in COVID‐19 are limited to small cross‐sectional studies, with no Australian longitudinal data.AimsTo describe end‐of‐life symptoms and care needs of people dying of COVID‐19.MethodsThis retrospective cohort study included consecutive admitted patients who died at a Victorian tertiary referral hospital from 1 January to 30 September directly due to COVID‐19. Clinical characteristics, symptoms and use of supportive therapies, including medications and non‐pharmacological interventions in the last 3 days of life were extracted.ResultsThe cohort comprised 58 patients (median age 87 years, interquartile range (IQR) 81–90) predominantly admitted from home (n = 30), who died after a median of 11 days (IQR 6–28) in the acute medical (n = 31) or aged care (n = 27) wards of the hospital. The median Charlson Comorbidity Score was 7 (IQR 5–8). Breathlessness (n = 42), agitation (n = 36) and pain (n = 33) were the most frequent clinician‐reported symptoms in the final 3 days of life, with most requiring opioids (n = 52), midazolam (n = 40), with dose escalation commonly being required. While oxygen therapy was commonly used (n = 47), few (n = 13) required an anti‐secretory agent.ConclusionsThis study presents one of the first and largest Australian report of the end of life and symptom experience of people dying of COVID‐19. This information should help clinicians to anticipate palliative care needs of these patients, for example, recognising that higher starting doses of opioids and sedatives may help reduce prevalence and severity of breathlessness and agitation near death.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8250873&blobtype=pdf
Page Count	6
ISSN	14440903
Journal	Internal Medicine Journal [Intern Med J]
Volume Number	51
DOI	10.1111/imj.15300
PubMed Central reference number	PMC8250873
Issue Number	9
PubMed reference number	33755283
e-ISSN	14455994
Language	English
Publisher	John Wiley & Sons Australia, Ltd
Publisher Date	2021-09-01
Publisher Place	Melbourne
Access Restriction	Open
Rights License	This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency. © 2021 Royal Australasian College of Physicians
Subject Keyword	COVID‐19 palliative care death signs and symptoms infectious disease
Content Type	Text
Resource Type	Article
Subject	Internal Medicine