Advance care planning and COVID-19

1st July 2021

Specialist palliative care services play an important role in conducting advance care planning during COVID-19. Little is known about the challenges to advance care planning in this context, or the changes services made to adapt.

The CovPall study team based at the Cicely Saunders Institute, Hull-York Medical School and Lancaster University have published an analysis of data collected by an online survey of  277 palliative care services in the UK during the COVID-19 pandemic. The analysis describes the challenges that UK specialist palliative care services experienced regarding advance care planning during COVID-19 and changes that were made to support timely conversations.

High quality advance care planning is viewed as a process that adopts a holistic, collaborative, and individualised approach. Prior to COVID-19, challenges to advance care planning included time constraints, lack of training, fears of taking away hope, limited resources, and insufficient knowledge.

The COVID-19 pandemic exacerbated already-existing challenges to conducting high-quality, individualised advance care planning, including the ability to maintain a personalised approach, and sharing information between services. There are COVID-19-specific challenges to advance care planning – including the complexities of decision-making for a novel infectious disease, communication issues, and workload pressures.

In responding to these challenges, services adapted local processes (prioritising specific components, normalisation and integration into everyday practice) and structures (using technology, shifting resources, and collaboration) of care.

COVID-19 has provided an opportunity to re-think advance care planning in which the starting point to any discussion is always the values and priorities of patients themselves. Providers and policymakers need to urgently consider how high-quality advance care planning can be resourced and normalised as a part of standard care across the health sector, ahead of future or recurrent pandemic waves and in routine care more generally.

Bradshaw A, Dunleavy L, Walshe C, Preston N, Cripps RL, Hocaoglu M, Bajwah S, Maddocks M, Oluyase AO, Sleeman K, Higginson IJ, Fraser L, Murtagh F; CovPall study team.    Understanding and addressing challenges for advance care planning in the COVID-19 pandemic: An analysis of the UK CovPall survey data from specialist palliative care services. Palliat Med. 2021 May 26:2692163211017387. doi: 10.1177/02692163211017387. Epub ahead of print. PMID: 34034585.