Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada
Objective To compare end-of-life in-person family presence, patient–family communication and healthcare team–family communication encounters in hospitalised decedents before and during the COVID-19 pandemic.Design In a regional multicentre retrospective cohort study, electronic health record data we...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e062937.full |
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| author | Shirley H Bush Monisha Kabir Peter Lawlor James Downar Brandi Vanderspank-Wright Sarina Isenberg Peter Tanuseputro Akshai Iyengar Claire Dyason Julie Lapenskie Colleen Webber Henrique Parsons Samantha Rose Adeli Ella Besserer Leila Cohen Valérie Gratton Rebekah Murphy Grace Warmels Adrianna Bruni Chelsea Noel Brandon Heidinger Koby Anderson Kyle Arsenault-Mehta Krista Wooller Daniel Bedard Paula Enright Isabelle Desjardins Khadija Bhimji |
| author_facet | Shirley H Bush Monisha Kabir Peter Lawlor James Downar Brandi Vanderspank-Wright Sarina Isenberg Peter Tanuseputro Akshai Iyengar Claire Dyason Julie Lapenskie Colleen Webber Henrique Parsons Samantha Rose Adeli Ella Besserer Leila Cohen Valérie Gratton Rebekah Murphy Grace Warmels Adrianna Bruni Chelsea Noel Brandon Heidinger Koby Anderson Kyle Arsenault-Mehta Krista Wooller Daniel Bedard Paula Enright Isabelle Desjardins Khadija Bhimji |
| author_sort | Shirley H Bush |
| collection | DOAJ |
| description | Objective To compare end-of-life in-person family presence, patient–family communication and healthcare team–family communication encounters in hospitalised decedents before and during the COVID-19 pandemic.Design In a regional multicentre retrospective cohort study, electronic health record data were abstracted for a prepandemic group (pre-COVID) and two intrapandemic (March–August 2020, wave 1) groups, one COVID-19 free (COVID-ve) and one with COVID-19 infection (COVID+ve). Pre-COVID and COVID-ve groups were matched 2:1 (age, sex and care service) with the COVID+ve group.Setting One quaternary and two tertiary adult, acute care hospitals in Ottawa, Canada.Participants Decedents (n=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170).Main outcome measures End-of-life (last 48 hours) in-person family presence and virtual (video) patient–family communication, and end-of-life (last 5 days) virtual team–family communication encounter occurrences were examined using logistic regression with ORs and 95% CIs. End-of-life (last 5 days) rates of in-person and telephone team–family communication encounters were examined using mixed-effects negative binomial models with incidence rate ratios (IRRs) and 95% CIs.Results End-of-life in-person family presence decreased progressively across pre-COVID (90.6%), COVID-ve (79.4%) and COVID+ve (47.1%) groups: adjusted ORs=0.38 (0.2–0.73) and 0.09 (0.04–0.17) for COVID-ve and COVID+ve groups, respectively. COVID-ve and COVID+ve groups had reduced in-person but increased telephone team–family communication encounters: IRRs=0.76 (0.64–0.9) and 0.61 (0.47–0.79) for in-person, and IRRs=2.6 (2.1–3.3) and 4.8 (3.7–6.1) for telephone communications, respectively. Virtual team–family communication encounters occurred in 17/85 (20%) and 10/170 (5.9%) of the COVID+ve and COVID-ve groups, respectively: adjusted OR=3.68 (1.51–8.95).Conclusions In hospitalised COVID-19 pandemic wave 1 decedents, in-person family presence and in-person team–family communication encounters decreased at end of life, particularly in the COVID+ve group; virtual modalities were adopted for communication, and telephone use increased in team–family communication encounters. The implications of these communication changes for the patient, family and healthcare team warrant further study. |
| format | Article |
| id | doaj-art-720cf5bef7994dcf8bed26721e09716b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-720cf5bef7994dcf8bed26721e09716b2025-01-24T21:10:08ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-062937Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, CanadaShirley H Bush0Monisha Kabir1Peter Lawlor2James Downar3Brandi Vanderspank-Wright4Sarina Isenberg5Peter Tanuseputro6Akshai Iyengar7Claire Dyason8Julie Lapenskie9Colleen Webber10Henrique Parsons11Samantha Rose Adeli12Ella Besserer13Leila Cohen14Valérie Gratton15Rebekah Murphy16Grace Warmels17Adrianna Bruni18Chelsea Noel19Brandon Heidinger20Koby Anderson21Kyle Arsenault-Mehta22Krista Wooller23Daniel Bedard24Paula Enright25Isabelle Desjardins26Khadija Bhimji27Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canadaprofessor of palliative careOttawa Hospital Research Institute, Ottawa, Ontario, Canada8 Bruyère Research Institute, Ottawa, Department of Medicine, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaDepartment of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaBruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaFaculty of Medicine, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Family and Community Medicine, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Psychiatry, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Ottawa Hospital, Ottawa, Ontario, CanadaInstitut du Savoir Montfort, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Medicine, Ottawa Hospital, Ottawa, Ontario, CanadaDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, CanadaObjective To compare end-of-life in-person family presence, patient–family communication and healthcare team–family communication encounters in hospitalised decedents before and during the COVID-19 pandemic.Design In a regional multicentre retrospective cohort study, electronic health record data were abstracted for a prepandemic group (pre-COVID) and two intrapandemic (March–August 2020, wave 1) groups, one COVID-19 free (COVID-ve) and one with COVID-19 infection (COVID+ve). Pre-COVID and COVID-ve groups were matched 2:1 (age, sex and care service) with the COVID+ve group.Setting One quaternary and two tertiary adult, acute care hospitals in Ottawa, Canada.Participants Decedents (n=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170).Main outcome measures End-of-life (last 48 hours) in-person family presence and virtual (video) patient–family communication, and end-of-life (last 5 days) virtual team–family communication encounter occurrences were examined using logistic regression with ORs and 95% CIs. End-of-life (last 5 days) rates of in-person and telephone team–family communication encounters were examined using mixed-effects negative binomial models with incidence rate ratios (IRRs) and 95% CIs.Results End-of-life in-person family presence decreased progressively across pre-COVID (90.6%), COVID-ve (79.4%) and COVID+ve (47.1%) groups: adjusted ORs=0.38 (0.2–0.73) and 0.09 (0.04–0.17) for COVID-ve and COVID+ve groups, respectively. COVID-ve and COVID+ve groups had reduced in-person but increased telephone team–family communication encounters: IRRs=0.76 (0.64–0.9) and 0.61 (0.47–0.79) for in-person, and IRRs=2.6 (2.1–3.3) and 4.8 (3.7–6.1) for telephone communications, respectively. Virtual team–family communication encounters occurred in 17/85 (20%) and 10/170 (5.9%) of the COVID+ve and COVID-ve groups, respectively: adjusted OR=3.68 (1.51–8.95).Conclusions In hospitalised COVID-19 pandemic wave 1 decedents, in-person family presence and in-person team–family communication encounters decreased at end of life, particularly in the COVID+ve group; virtual modalities were adopted for communication, and telephone use increased in team–family communication encounters. The implications of these communication changes for the patient, family and healthcare team warrant further study.https://bmjopen.bmj.com/content/12/6/e062937.full |
| spellingShingle | Shirley H Bush Monisha Kabir Peter Lawlor James Downar Brandi Vanderspank-Wright Sarina Isenberg Peter Tanuseputro Akshai Iyengar Claire Dyason Julie Lapenskie Colleen Webber Henrique Parsons Samantha Rose Adeli Ella Besserer Leila Cohen Valérie Gratton Rebekah Murphy Grace Warmels Adrianna Bruni Chelsea Noel Brandon Heidinger Koby Anderson Kyle Arsenault-Mehta Krista Wooller Daniel Bedard Paula Enright Isabelle Desjardins Khadija Bhimji Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada BMJ Open |
| title | Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada |
| title_full | Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada |
| title_fullStr | Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada |
| title_full_unstemmed | Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada |
| title_short | Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada |
| title_sort | comparative end of life communication and support in hospitalised decedents before and during the covid 19 pandemic a retrospective regional cohort study in ottawa canada |
| url | https://bmjopen.bmj.com/content/12/6/e062937.full |
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