Lessons from the Literature

2020; Volume 21, No 6, June

Lessons from the Literature

Under My Microscope

Dr. Tania Pastrana. Used with permission.

IAHPC Research Advisor Dr. Tania Pastrana selects one article from recently published medical literature and describes why it is worthwhile.

A Comparison of Burnout Frequency among Oncology Physicians and Nurses Working on the Frontline and Usual Wards During the COVID-19 Epidemic in Wuhan, China

Y Wu, J Wang, C Luo, S Hu, X Lin, et al. (2020). J Pain Symptom Manage. April 10, 2020. DOI: 10.1016/j.jpainsymman.2020.04.008

Guidelines have been developed for the management of palliative care due to COVID-19, including those by NICE1 and WHO2, as well as international and national palliative care associations.3, 4 We have learned much about COVID-19,5 yet many aspects remain unknown.

Many health care professionals are in distress: we have had to face our own vulnerability, thousands have been infected, workload has increased, etc.

In the article I have chosen, the authors studied the burnout frequency of medical staff in different workplaces at the epicenter of the coronavirus disease 2019 pandemic. Using the Maslach Burnout Inventory, they compared the health care workers in frontline wards (FL) with usual wards (UW), and found that the frequency of burnout was significantly lower in the FL group than in the UW group (13% vs. 39%; p < 0.0001). When compared with the UW group, more FL workers (76%) felt less burnout than before the crisis. UWs were more worried about themselves or a family member becoming infected.

The authors conclude that, “Compared with medical staff working in their UW for uninfected patients, medical staff working on the FL had a lower frequency of burnout. It will be important to consider both health care workers on the FL and those in their usual work setting in the COVID-19 crisis.”

For burnout and self care, see: David J. Horn and Catherine B. Johnston. Burnout and Self Care for Palliative Care Practitioners. Medical Clinics of North America 2020; 104(3): 561-572. DOI: 10.1016/j.mcna.2019.12.007

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Context: The epidemic of coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China and has now spread worldwide. In the affected countries, physicians and nurses are under heavy workload conditions and are at high risk of infection.

Objectives: The aim of this study was to compare the frequency of burnout between physicians and nurses on the frontline (FL) wards and those working in usual wards (UWs).

Methods: A survey with a total of 49 questions was administered to 220 medical staff members from the COVID-19 FL and UWs, with a ratio of 1:1. General information, such as age, gender, marriage status, and the Maslach Burnout Inventory — medical personnel, were gathered and compared.

Results: The group working on the FLs had a lower frequency of burnout (13% vs. 39%; p < 0.0001) and were less worried about being infected compared with the UW group.

Conclusion: Compared with medical staff working on their UWs for uninfected patients, medical staff working on the COVID-19 FL ward had a lower frequency of burnout. These results suggest that in the face of the COVID-19 crisis, both FL ward and UW staff should be considered when policies and procedures to support the well-being of health care workers are devised.


1. National Institute for Health and Care Excellence (NICE). Managing COVID-19 Symptoms (Including at the End of Life) in the Community: Summary of NICE guidelines. BMJ 2020; 369: m1461. DOI: 10.1136/bmj.m1461
2. World Health Organization. Clinical management of COVID-19. Interim guidance. May 27, 2020. Accessed online May 28, 2020.
3. IAHPC, WHPCA, ICPCN, PalChase. Palliative Care Briefing Note. Symptom Control at the End of Life in Children with COVID-19 Infection. 2020. Accessed online May 28, 2020.
4. IAHPC, WHPCA, ICPCN, PalChase. Palliative Care Briefing Note. Recommendations for Symptom Control of Patients with COVID-19. 2020. Accessed online May 28, 2020.
5. MA Lake. What We Know So Far: COVID-19 current clinical knowledge and research. Clin Med 2020: 20(2).

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Contact Tania Pastrana

Media Watch

Media Watch is a weekly report published by Barry R. Ashpole, a Canadian communications consultant and educator, who monitors the literature and the lay press on issues specific to the quality of end-of-life care.

A Virtual Children's Hospice in Response to COVID-19: The Scottish experience

Journal of Pain & Symptom Management | Online – 13 May 2020 – This case report describes Children’s Hospices Across Scotland, the only provider of pediatric hospice provider in Scotland, and its experience implementing a telehospice program in response to COVID-19... CHAS had strategically planned to implement telehospice, but COVID-19 accelerated the process. The organization evaluated its pediatric clinical and wrap-around hospice services and rapidly migrated them to a virtual environment. They creatively added new services to meet the unique needs of the entire family, who were caring for a child at end of life during COVID-19. DOI: 10.1016/j.jpainsymman.2020.05.011

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Mapping paediatric palliative care development in the WHO-European region: Children living in low-middle income countries are less likely to access it

Journal of Pain & Symptom Management | Online – 10 May 2020 – Regardless of income group, paediatric PC programmes are flourishing across the region. However, results show that development has been uneven with more services, professionals and professional activity detected in high-income countries. In the past, several countries have undertaken national needs assessments. Data from this study provides the first European overview of the responses implemented by countries to tackle the identified needs. Data from this study also indicates that standards and norms regulating the provision of paediatric PC are more likely to exist in high-income countries. DOI: 10.1016/j.jpainsymman.2020.04.028

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Resource: European Association for Palliative Care Atlas of Palliative Care in Europe 2019 (see Chapter 2, ‘Integration of Palliative Care & Paediatrics,’ pp.54-55).

Bereavement Support on the Frontline of COVID-19: Recommendations for hospital clinicians

Journal of Pain & Symptom Management | Online – 3 May 2020 – The authors review research evidence and provide evidence-based recommendations and resources to mitigate poor bereavement outcomes and support staff. For relatives, bereavement risk factors include dying in an ICU, severe breathlessness, patient isolation or restricted access, significant patient and family emotional distress, and disruption to relatives’ social support networks. Recommendations include advance care planning; sensitive and regular communication with family members alongside accurate information provision; enabling family members to say goodbye in person where possible; supporting virtual communication; and, providing symptom management, emotional and spiritual support. DOI: 10.1016/j.jpainsymman.2020.04.024

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Caring for bereaved family members during the COVID-19 pandemic: Before and after the death of a patient

Journal of Pain & Symptom Management | Online – 7 May 2020 – Bereavement care is an integral component of quality end-of-life care. However, few hospitals and other health care institutions offer universal bereavement care to all families of deceased patients. Given the current COVID-19 pandemic, there is an urgency from a public health perspective to expand bereavement services in an attempt to mitigate poor bereavement outcomes, including prolonged grief disorder and other psychiatric disorders. The authors recommend that all hospitals implement basic bereavement outreach, utilizing palliative care tools and psychological strategies to prepare families for the death of their loved ones and to support them afterwards in the initial months of their bereavement. DOI: 10.1016/j.jpainsymman.2020.05.002

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Resource: A National Response to Pandemic-related Grief. Canadian Virtual Hospice, May 2020.

Best case/Worst case: ICU (COVID-19) – A tool to communicate with families of critically ill patients with COVID-19

Palliative Medicine Reports | Online – 30 April 2020 – During the COVID-19 pandemic, critically ill patients have been hospitalized and strictly isolated. Palliative care clinicians at the University of Wisconsin were asked to bridge a gap in communication between patients' families and critical care teams, as bedside demands overwhelmed the critical care team's capacity to provide consistent communication with family. In response, they adapted an established intervention to support daily conversations between hospital-based clinicians and out-of-hospital family. The original ‘Best Case/Worst Case’ intervention was designed specifically for face-to-face clinical interactions to support shared decision making in the context of life-limiting surgical illness. DOI: 10.1089/pmr.2020.0038

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Media Watch monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. View current and back issues here.

Editor’s note: Readers of this newsletter may be interested in “COVID-19 and older People in Asia: AWGS Calls to Actions,” an article publicized in the May 29 issue of The Asia Pacific Hospice Palliative Care Network’s monthly newsletter. “The Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to COVID?19 pandemic, and proposed recommendations for older people which are germane to the Asian context,” states the abstract. The article, published by Geriatrics Gerontology International, is open access here. DOI: 10.1111/ggi.13939

For more reliable information on COVID-19, see the new IAHPC web page:

Resources Relevant to Palliative Care and COVID-19

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