gms | German Medical Science

Background and status of (inter)national research: The current COVID-19 pandemic has severe societal, economic and political consequences worldwide. The global virus spread and the countermeasures impact noticeably on the health care sector, including specialist palliative care (SPC). While the principles of palliative care do not change in a pandemic, certain adaptations in structure and process characteristics are unavoidable.

Research question and objective: We aimed to explore the impact of the COVID-19 pandemic on structures and processes in SPC in Germany.

Method or hypothesis: In the methodological framework of constructivist grounded theory, we conducted 11 semi-structured expert interviews from May to July 2020 and, from February to June 2021, 23 episodic interviews with healthcare professionals (physicians, nurses, therapists, pastoral care, and social work) working in palliative care units, palliative care advisory teams or home-based palliative care teams across Germany. Tape recordings off all interviews were transcribed verbatim, analysed qualitatively and results were regularly discussed within the research group.

Results: The pandemic caused several problems in day-to-day routines including the constant discrepancy of differing perspectives and concerns, which required creative reactions. One key aspect was the difficulty of finding a definite formulation for some of the challenges, making it even harder to tackle them. Furthermore, notwithstanding the unpredictability of the situation, managers could often be hold accountable for the consequences of their decisions, which partly impeded the urgently needed trial and error culture. Overall, SPC teams had to strengthen coordination capacities at managerial level and rapid response at the level of everyday clinical work. Improvement of work routines, strong team spirit and anticipatory actions could be facilitated by shared visions, honest communication and especially by collaborative planning, decision-making and shared responsibility within the SPC team.

Discussion: Addressing the complex challenges caused by the COVID-19 pandemic requires a holistic approach as well as openness to learning and change. Finding strategies for problems without precedent and proven resolutions can facilitate teams to not only endure the pandemic and return to old routines but move forward with new ideas and innovations.

Practical implications: Despite the drastic impact of the pandemic, SPC teams could continue to ensure best possible care for patients and their families. Even though often described as overwhelming, services can stay powerful regarding the maintenance of the palliative core principles.

Appeal for practice (science and/or care) in one sentence: Challenging circumstances like the COVID-19 pandemic do not necessarily lead to stagnation within SPC for those who actively react.