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Cancer and COVID-19 in Victoria: unpacking the complexities of providing palliative care services

World Hospice and Palliative Care Day was held on Saturday 10 October this year. The VCCC alliance held a webinar, ‘Unpacking the Complexities of Providing Palliative Care Services During a Pandemic’, as part of its Cancer and COVID-19 in Victoria online series.

Palliative care is particularly affected by the pandemic due to the pandemic's impact on the nature of palliative care as a discipline, which centres on physical presence, touch, and face-to-face relationships.

Victoria is seeing firsthand some of these issues. Translating the Chief Health Officer’s directives, which drive policy change at a broader legalistic level, and reconciling the impact these directives have on individuals and their families is challenging and emotional. Three significant directives need alignment in this particular arena; being hospital-, care facility visitors-, and stay-at-home directions.

Tension arises from the convergence of these directions. In addition, the number of times directions have changed reflects the issue of living and working in what is an evolving space during a pandemic. It also indicates the time it is taking for alignment of directions to occur.

On top of this, there is the added trauma of death and dying during COVID-19 for palliative patients, their families and carers, which doesn’t exist in non-pandemic times. There are immediate and longer-term effects on surviving relatives that will continue for years and will likely need funding and support. Health professionals now carry the added burden of wondering if they have contributed to some of the trauma of this pandemic through decisions made and the way that care has been provided. There is still a question of what would be done differently if there is a third wave.

There is also the impact on health care workers, who normally would not face an infectious risk of this magnitude in their occupation, or a risk of infecting their families. There is currently an ethics consideration that is not normally present in palliative care, where what is good for the individual patient, such as leniency regarding increased visiting time, can now potentially be catastrophic for tens or hundreds of other patients and staff.

Cancer Council has been collaborating with peak bodies to share challenges. A lot of queries are from the community, who are confused as to how to interpret some of the guidelines around visitors. Strongest feedback is that there is inconsistency in the interpretation of guidelines. While it’s a positive that the most recent hospital guidelines are addressing some of the challenges of palliative care, people are currently having different and negative experiences, particularly those with the least health literacy.

Cancer Council is receiving approximately 180 calls a day in relation to COVID-19. One example was an end-of-life patient in a 'COVID-free' region, who could not be with their child at the time of death because their infant grandchild was not allowed in the room. One quote from a member of the public was, ‘Mum was a victim...She won't be counted in the statistics because she didn't have the virus, but she was the victim of what this virus does to people who have terminal illness.’

So, how do health care workers operate sustainability during this time? One suggestion is remembering that the goals are the same during difficult times as in good times; in fact, it is during difficult times that these goals take on greater meaning. Another observation is that colleagues are now taking the time to look out for one another, when traditionally healthcare hasn't always excelled at this. A learning during this time is we only provide services as good as the support that we provide for one another as well.

This article is based on the VCCC alliance webinar 'Cancer and COVID-19 in Victoria: unpacking the complexities of providing palliative care services during a pandemic'. It is a summary and interpretation of the content and does not represent the views of the presenters or hosting body.

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