COVID-19 Episode 5: End of Life Care

A current concern for primary care clinicians is how to manage end of life care in the context of the COVID-19 pandemic. Lisa and Sara are joined by Dr Liam Hosie, Dr Adam Firth and Dr Viren Mehta who have sifted through the key information and guidelines that are available on this topic.

We talk about:

• Advanced care planning
• Common symptoms for patients with COVID-19 at the end of life
• Discuss 5 guidelines (including NICE, RCGP, Hospice UK) relevant to this topic and some take home messages
• Anticipatory medication and stock issues
• Post death support for families and for clinicians

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Useful resources: 

• Dr Adam Firth Stockport Grand Round: Making sense of symptom control guidance in suspected COVID - a GPs perspective: https://app.box.com/s/in48s14ee7r1c0pzk2i63m914gr1p0um

• NG31 NICE Guidelines: Care of dying adults in the last days of life (Dec 2015): https://www.nice.org.uk/guidance/ng31

• GMMMG Guidelines: Palliative care pain and symptom control: http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf#search=%22end%20of%20life%22

• RCGP: Community palliative, end of life and bereavement care in the COVID-19 pandemic (March 2020): https://elearning.rcgp.org.uk/pluginfile.php/149342/mod_resource/content/1/COVID%20Community%20symptom%20control%20and%20end%20of%20life%20care%20for%20General%20Practice%20FINAL.PDF

• NICE COVID-19 rapid guideline: Managing symptoms (including at the end of life) in the community (Apr 2020): https://www.nice.org.uk/guidance/ng163

• Hospice UK guidance including advice for carers and health care professionals: https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/coronavirus-guidance

• Harvard Business Review: That Discomfort You’re Feeling Is Grief: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

• Funerals and Dying in Absentia: Inspiration and tips during COVID-19: http://www.orderofthegooddeath.com/funerals-dying-in-absentia-inspiration-tips-during-covid-19

• RCGP: End of Life Care Quality Improvement Resources: https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/daffodil-standards/end-of-life-care-quality-improvement-resources.aspx

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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C

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This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 

The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.

Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.

The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.