Pandemic had 'immeasurable impact' on dying cancer patients

Cancer patients dying in hospital had 'possible deficits' in holistic care. Picture: Gorodenkoff Productions

Cancer patients dying in hospital during the pandemic experienced “possible deficits” in holistic care linked to restrictions, including inadequate communication and poor pastoral care access, the first review of care of the dying in an Irish hospital has found.

The review, which focused on oncology patients at Cork University Hospital, found challenges for patients, their families, and staff, linked to visiting restrictions necessitated by covid risks and pandemic-related staff shortages.

The authors of a study involving CUH, Marymount University Hospice, and University College Cork also suggested “these disruptive changes will have had a significant impact on bereaved family members” .

“We were concerned about the impact of covid-19 on the quality of care provided at end-of-life in 2021 in a national cancer centre,” they said.

They found: “Sixty-six patient deaths occurred in our cancer centre in 2021. The ‘risk of dying’ was documented in 65.2% of records. Palliative care services were involved in 77%, and pastoral care in 10.6%.

“What was important to the patient was documented in 24.2%. The ‘quality-of-death’ score was satisfactory for most but poor in 21.2%”.

That year across the hospital, 1,037 patients died, including 151 from covid-19. 

The study found an “immeasurable impact” on patients caused by the pandemic. 

A pervasive fear of the unknown, compounded by isolation due to stringent visiting restrictions and sensitive communication being hampered by layers of personal protective equipment [PPE], has led to significant concerns about the magnitude of the impact on the EOLC [end-of-life care] experience for patients and their families during this time.

The team suggested reasons for disruptions to normal care, including the significant impacts for staff themselves, particularly international staff, and high levels of staff shortages.

Referral to spiritual care

They said these may have led to “a de-prioritisation of some of the less interventional approaches to end-of-life care, such as time to have conversations about what is important to patients, and the provision of, or referral to, spiritual care".

The researchers, including Dr Mary-Jane O’Leary, consultant in palliative medicine, and oncologist Professor Seamus O’Reilly, indicated there could be wider issues. 

“It is possible that the gaps in service provision evident in our study predated the pandemic and were subsequently magnified by the disturbances to clinical practice and patient care caused by the covid-19 outbreak,” the study states.

The authors said covid-19 put the spotlight on how well end-of-life care is delivered in Irish hospitals.

“Covid-19 has brought with it many clinical challenges. But it has also forced us to examine all aspects of current practice,” they said.

The findings have already led to changes in end-of-life care in the oncology department, the paper states. 

CUH was already part of the Hospice Friendly Hospital programme run by the Irish Hospice Foundation.

The study, 'Room to Improve: An Audit of In-Hospital End-of-Life Care for Oncology Patients in a Tertiary Cancer Centre in Ireland During the Covid-19 Pandemic', can be read in the Journal of Death and Dying.