gms | German Medical Science

Background and current state of (inter)national research:The COVID-19 pandemic impacted palliative care structures mainly in two ways: palliative care needs increased due to terminally ill COVID-19 patients and hygiene measures impaired the maintenance of palliative care provision. Pandemic response teams (PRT) are instruments of the subsidiarity organized pandemic management and operate at health facility, legislative and administrative levels.

Research questions and objectives: To examine PRT management of end-of-life care problems, challenges and solutions in Germany.

Methods: Semi-structured qualitative expert video/telephone-interviews (10/2020–2/2021) with PRT members on health facility and on public administration level followed by structured content analyses.

Results: 42 interviews on 43 PRT were analysed. PRT (health facility n=23; public administration n=20) were included from 14 federal states. Interviewees were heads (41.5%), members (48.8%) or consultants (9.7%) of PRT. Professional backgrounds were medicine (35.7%), nursing (14.3%), engineering (11.9%), civil security (9.6%), law (4.8%) and others (23.7%).

PRT prioritized tasks were on organisational (e.g. protective equipment procurement, personal capacities), structural (e.g. preparing for increasing patient numbers, outbreaks in long-term care facilities), informational (e.g. structure and share information) and, foremost on health facility level, patient care level (e.g. balance conflicting priorities on COVID-19 protection and patients’ quality of life and care). Active measures or at least considerations on frequent end-of-life care issues such as social contact restrictions as well as family carers’ and team members’ burdens were reported for 29 PRT, 14 did not consider them at all. Public administration PRT focus was on execution of legal requirements e.g. compliance with contact restrictions. Legal requirements did not consider regulations for (non-)COVID-19 patients at their end of life, their families and health facilities. Health facility PRT actions included supporting individual decision-making, enabling and inducing creative alternatives, e.g. digital conversation, saying goodbyes or meeting outdoor. Basic infrastructure for e.g. digital communication was not sufficiently available. Challenges were dysfunctional or non-existing networks and interactions between administrative and health facility levels due to missing persons responsible for palliative care.

Discussion: Findings indicate that PRT subordinated needs of patients in end-of-life care to other pandemic challenges or completely neglected those. Considering palliative care expertise in PRT might prevent this.

Practical implications: Providing state of the art end-of-life care for terminally ill patients with COVID-19 or other diseases in a pandemic situation depends on the sufficient consideration of palliative care needs in pandemic PRT, in particular on health facility and public administration level. Communication infrastructure, networks and implementation of palliative care expertise in creating pandemic plans and installing PRT should improve pandemic management and preparedness.

Funding: BMBF