TABLE 3

Experts’ reported barriers or concerns towards implementation of recommendations

RecommendationBarriers / concerns
1ACP should be routinely done or reviewed by clinicians with patients and their loved ones at diagnosis of serious COVID-19.

  • The rapidly evolving disease resulting in lack of clarity on the patient's condition to allow for a long-term plan

  • The often rapid trajectory towards death

  • Patients being too ill to participate in ACP

  • Patients experiencing too much anxiety to participate in ACP conversations

  • Family not being physically present

6Staff taking care of patients with serious COVID-19 should receive training in optimizing clinician–patient communication whilst wearing PPE

  • Practical concerns to implement a training during pandemic

7Staff taking care of patients with serious COVID-19 should receive training in online clinician–family communication (while using telephone or video conferencing).

  • Practical concerns to implement a training during pandemic

8Healthcare professionals trained in providing palliative care should be involved in hospitalised patients with serious COVID-19 with persistent symptoms and concerns despite optimal disease treatment.

  • Practical concerns

  • Resource limitations, including limited availability of palliative care specialists

9Healthcare professionals trained in providing palliative care should be involved in patients with serious COVID-19 with persistent symptoms and concerns despite optimal disease treatment treated at home.

  • Limited availability of PPE

  • Limited resources available for patients at home or in care homes, including limited availability of palliative care specialists

  • Risk of transmission of COVID-19

10Healthcare professionals providing spiritual care (such as chaplains) should be part of the treatment team of patients with serious COVID-19 with persistent symptoms and concerns despite optimal disease treatment (irrespective of setting, so in the hospital, community or long-term care facilities).

  • Limited availability of PPE

  • Limited availability of spiritual / existential care providers

  • Patients being too breathless to talk.

11Healthcare professionals providing psychosocial care (such as psychologists and social workers) should be part of the treatment team of patients with serious COVID-19 with persistent symptoms and concerns despite optimal disease treatment (irrespective of setting, so in the hospital, community or long-term care facilities).

  • Limited availability of PPE

  • Limited availability of psychosocial healthcare professionals

  • Risk of transmission of COVID-19 to psychosocial healthcare professionals

12Family members/loved ones should be invited and supported (for example being provided with PPE if indicated) to visit in person the dying patient with COVID-19.

  • Limited availability of PPE;

  • Visits being a source of distress for families and staff

  • Risk of transmission of COVID-19 to visitors

  • Lack of time between diagnosing dying and actual death

13Family members/loved ones of deceased patients with COVID-19 should be offered bereavement support by healthcare professionals trained in palliative care or bereavement support

  • Limited availability of bereavement support

Abbreviations: ACP: Advance Care planning; PPE: personal protection equipment.