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Symptom control and survival for people severely ill with COVID: a multicentre cohort study (CovPall-Symptom)

Research output: Contribution to Journal/MagazineJournal articlepeer-review

E-pub ahead of print
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<mark>Journal publication date</mark>23/06/2022
<mark>Journal</mark>Journal of Pain and Symptom Management
Publication StatusE-pub ahead of print
Early online date23/06/22
<mark>Original language</mark>English

Abstract

Context
Evidence of symptom control outcomes in severe COVID is scant.

Objective
To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival.

Methods
Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative Outcome Scale – COVID version (IPOS-COV).

Results
We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were: breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival.

Conclusion
Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.