Lessons from the Literature

2021; Volume 22, No 4, April

Under My Microscope

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

Dr. Tania Pastrana. Used with permission.

By Dr. Tania Pastrana
IAHPC Research Advisor

The Impact of COVID-19 on Palliative Care Workers across the World: A qualitative analysis of responses to open-ended questions

One year ago I presented the first papers on COVID and palliative care in this space. Since then, almost 900 papers have been published highlighting different aspects of the pandemic related to palliative care. This selected paper was derived from an IAHPC members’ survey about the impact of the pandemic on palliative care health workers (who are members of the IAHPC) around the world.

The survey was conducted online. We analyzed the comments and identified impacts on palliative care development, the workforce, and the organization of work. We identified a change in the concept and praxis of palliative care. At the personal level, workers reported economic and financial impacts, feeling vulnerable to exposure, and emotional impacts. Participants shared how counseling and support networks provided important resilience-building buffers. Coping strategies, such as team and family support, were important factors in workers’ capacity to adapt and respond.

Other teams have studied the impact on health care workers: Rabow et al.1 explore COVID-related grief among health care workers in the USA in their paper, “Witnesses and Victims Both: Healthcare workers and grief in the time of COVID-19.” It was published with a special note by editor David Cassaret, who emphasized that the topic is too often overlooked or minimized. A paper by Mendahl et al.2 reflects the experiences of nursing staff in Denmark, which swung between pride and uncertainty. Dunleavy et al.3 explore the creative response of specialist palliative care service during the pandemic, and highlighted the flexible, highly adaptive and low-cost solutions adopted, also called “frugal innovations,” in response to COVID-19.

Thanks for the participation of all who answered the IAHPC questionnaire! I invite you to read the article and share your thoughts.

  1. Rabow MW, Huang C-HS, White-Hammond GE, Tucker RO. Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19. J Pain Symptom Manage 2021. DOI: 10.1016/j.jpainsymman.2021.01.139
  2. Marsaa K, Mendahl J, Heilman H, Johansson H, Husum M, et al. Pride and Uncertainty: A qualitative study of Danish nursing staff in temporary COVID-19 wards. J Hosp Palliat Nurs 2021; 23(2): 140-144. DOI: 10.1097/NJH.0000000000000722
  3. Dunleavy L, Preston N, Bajwah S, Bradshaw A, Cripps R, et al. ‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall). Palliat Med 2021. DOI: 10.1177/02692163211000660.

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Objective: With over two million deaths and almost 100 million confirmed cases, the COVID-19 pandemic has caused a “tsunami of suffering.” Health care workers, including palliative care workers, have been severely impacted. This study explores how the COVID-19 pandemic has impacted palliative care workers around the world and describes the coping strategies they have adopted to face their specific situation.

Method: We conducted a qualitative analysis of written, unstructured comments provided by respondents to a survey of IAHPC members between May and June 2020. Free text was exported to MAX QDA, and a thematic analysis was performed by reading the comments and developing a coding frame.

Results: Seventy-seven palliative care workers from 41 countries submitted at least one written comment, resulting in a data corpus of 10,694 words and a total of 374 coded comments. Eight main themes are emerged from the analysis: palliative care development, workforce impact, work reorganization, palliative care reconceptualization, economic and financial impacts, increased risk, emotional impact, and coping strategies.

Significance of results: The pandemic has had a huge impact on palliative care workers including their ability to work and their financial status. It has generated increased workloads and placed them in vulnerable positions that affect their emotional well-being, resulting in distress and burnout. Counseling and support networks provide important resilience-building buffers. Coping strategies such as team and family support are important factors in workers’ capacity to adapt and respond. The pandemic is changing the concept and praxis of palliative care. Government officials, academia, providers, and affected populations need to work together to develop, and implement steps to ensure palliative care integration into response preparedness plans so as not to leave anyone behind, including health workers.


Change is constant... or is it? A fresh iteration of Article of the Month, from the 2010s, resurfaced in 2019 as Dr. Tania Pastrana’s Under My Microscope.

Do you have any questions regarding Under My Microscope?

Contact Tania Pastrana

Media Watch

The articles below are selected from Barry R. Ashpole’s weekly report, Media Watch.

[Editorial] Incompatible: End-of-life care and health economics

BMJ Supportive & Palliative Care | Online – 8 March 2021 – Worldwide, the financial cost to an individual with severe illness is significant. In the U.S., the risk of bankruptcy increases by 250% with a cancer diagnosis. Even in the U.K. where healthcare is free at delivery, those with a cancer diagnosis were found, on a monthly average, to be £570 poorer. In the U.K., most people die in hospital, despite it being the least preferred location. Many may have unnecessary clinical interventions unlikely to impact quality and/or length of life. Hospital care is expensive but comprehensive palliative care at home may also be costly. Tailored end-of-life care integrated into public healthcare reduces emergency hospital and intensive care unit admissions and length of hospital stay. A more personalised approach therefore has great potential to avoid unnecessary resource use while simultaneously benefitting the patient. In the U.K., all these issues are being tackled by a new national strategy to redesign palliative care services. DOI: 10.1136/bmjspcare-2020-002388

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The Application of Social Innovation in Healthcare: A scoping review

Infectious Disease of Poverty | Online – 8 March 2021 – In this article, the authors sought to critically review the application of social innovation in healthcare and present the results of a scoping review of peer review research published from 2010 to 2020. Although research on social innovation in health has increased in recent years, there is still very little research originating from low- and middle-income countries (LMIC). There is consequently ample opportunity and a need to build stronger evidence on social innovation in health, to deepen the investigation, engage more social scientists, draw on theory from management, organisational and institutional studies, adopt a health systems perspective, and build capacity for this concept and its processes and outcomes in LMIC. The Kerala palliative care (PC) model demonstrated large scale institutional change as it reframed PC provision from a medical frame to a social justice frame, with a professional hospice or hospital model replaced by the bottom-up organisation of services delivered primarily by community volunteers. DOI: 10.1186/s40249-021-00794-8

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A Systematic Review of Classifications Systems to Determine Complexity of Patient Care Needs in Palliative Care

Palliative Medicine | Online – 12 March 2021 – Providing the right care for each individual patient is a key element of quality palliative care (PC). Complexity is a relatively new concept, defined as the nature of patients’ situations and the extent of resulting needs. Classifying patients according to the complexity of their care needs can guide integration of services, anticipatory discussions, health service planning, resource management and determination of needs for specialist or general PC. However, there is no consistent approach to interpreting and classifying complexity of patient needs. This systematic review describes six systems that classify patients in accordance with their care needs. Applying these systems, or the aspects of care they identify, to clinical care, may assist in anticipatory planning for healthcare professionals. In particular, as specialist PC services such as high care hospices are faced with resource challenges, it may identify those patients for whom general palliative services are appropriate. DOI: 10.1177/0269216321996983

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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.


Finding common ground Longtime contributor Barry Ashpole shares this thought for IAHPC’s 25th year: Monitoring the news media and the literature from week-to-week has served to underscore the fact that all countries share common ground in their respective efforts to effect change in the illness experience and to improve the quality of end-of-life care. This is in spite of the differences in health care systems, how these are funded, and culture from one country to the next.

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