Palliative and end-of-life care in pandemic times: Clinicians' perspectives on the dying process

Quintero Silva, Laura Marcela

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https://hdl.handle.net/2142/124336 Copy

Description

Title

Palliative and end-of-life care in pandemic times: Clinicians' perspectives on the dying process

Author(s)

Quintero Silva, Laura Marcela

Issue Date

2024-04-20

Director of Research (if dissertation) or Advisor (if thesis)

Schwingel, Andiara

Doctoral Committee Chair(s)

Schwingel, Andiara

Committee Member(s)

• Raj, Minakshi
• Thompson, Charee M
• Bobitt, Julie

Department of Study

Kinesiology & Community Health

Discipline

Community Health

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Palliative care
• end-of-life care
• COVID-19
• clinicians
• patient-centered care
• telehealth
• public-health emergencies
• patient-provider relationship
• interpersonal health communication
• cultural diversity.

Abstract

Over a three-year period, the COVID-19 pandemic transformed the landscape of palliative care delivery in the United States. Implementing strong mitigation measures to minimize the spread of the virus during the pandemic has impacted the nature of palliative care clinicians' work, challenging the implementation of comprehensive, patient-centered care models. Visitor restrictions and social distancing policies limited implementation of key aspects of palliative care, such as effective communication, shared decision-making, and conversations about goals of care. This scenario generated creative solutions, such as integrating telehealth modalities to maintain communication between patients, families, and clinicians during the pandemic. Although some scholarly articles have explored the broad impact of the COVID-19 pandemic on palliative care, the insights are diverse, and the evidence on this topic is limited, leaving gaps in understanding the profound impact of the pandemic restrictions on palliative care delivery practices. In this dissertation, I examine U.S. clinicians’ perspectives on how the COVID-19 pandemic has transformed the landscape of palliative care delivery in the U.S. and shaped its trajectory for the future. First, I conduct a scoping review to map and comprehensively explore the available literature about the impact of pandemic restrictions on structures and processes of palliative care for patients with COVID-19, as qualitatively and narratively reported by U.S. clinicians. The analysis of the 26 articles reveals that the pandemic impacted care settings, goals-of-care conversations, and palliative care clinicians' emotional health and well-being. It also described the opportunities and challenges of providing palliative care through telehealth modalities. In the second study, I interview 29 palliative medicine and geriatrics specialists to explore their perspectives on palliative care delivery during the pandemic and identify evolving challenges and opportunities over the course of the pandemic. Reflexive thematic analysis reveals that the pandemic increased awareness of the value of palliative care and its scope across the healthcare system, promoted deeper reflections about death and the understanding of the dying process, and changed clinicians’ approach to implementing palliative care. It also shows how delivering care under pandemic restrictions significantly impacted clinicians’ emotional health and well-being. In the third study, I examine U.S. clinicians’ perspectives on providing palliative care for culturally diverse communities. Themes generated through reflexive thematic analysis describe the perceived sociocultural factors that challenged the delivery of patient-centered care models during the pandemic. Healthcare inequities, added to historical and past experiences of discrimination, were reported as barriers to the generation of trust between patients and clinicians. This dissertation provides valuable insights into the impacts of the COVID-19 pandemic on palliative care delivery. Given the essential role of this model of care in supporting patients with complex health conditions and their families, it is imperative to a) raise awareness of the value of palliative care to ensure goal-concordant, patient-centered care in critical circumstances and b) strengthen current palliative care models to better prepare for future public health emergencies.

Graduation Semester

2024-05

Type of Resource

Thesis

Copyright and License Information

Copyright 2024 Laura Quintero Silva

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