New recommendations for healthcare workers: Prioritize opportunities for families to say final goodbyes

Phone calls between patients and their relatives should be prioritized during the pandemic to allow loved ones to say goodbye, a new study providing recommendations to healthcare professionals has suggested.

The study, by researchers at the Universities of Sheffield, Oxford and Liverpool is the first of its kind to give a voice to those bereaved during the pandemic. Published today in Palliative Medicine, it explores the impact of restricted visiting to hospitals and care homes due to COVID-19 on relatives' experience of their loved-one's final days, making important recommendations for health and social care professionals to boost the level of care provided.

Bereaved relatives described the ongoing pain of being absent at the end of a loved-one's life, with many not having seen their relatives for weeks or months due to the pandemic.

Relatives reported relying on connecting virtually with their family members in their final weeks of life, and it seemed these interactions could only happen when they were facilitated by health and social care professionals. There was also a need for more contact highlighted, including holistic as well as clinical communication with healthcare professionals about their loved one's wellbeing and psychological support.

The study makes important recommendations for health and social care professionals providing end-of-life care during a pandemic, finding opportunities must be prioritized for essential connections between families at end-of-life care:

• Prioritise connectedness between patients and relatives using video and telephone calls.
• Provide relatives with regular telephone updates about personal aspects of care (such as what they had eaten and if they had been able to communicate).
• Offer advice and guidance about how to prepare children for the death of a loved one.
• Facilitate opportunities for relatives to 'say goodbye' in person before death wherever possible.

The research team says that adopting these recommendations is important as previous research shows when the needs of relatives are addressed at the time a family member is dying, they cope and adjust better in bereavement with improved psychological outcomes and satisfaction with end-of-life care.

During the pandemic, relatives report that they are aware of the multiple demands on health and social care professionals and felt they are 'doing their best given the situation' but identify practical changes that could have made a difference to their experience of bereavement and loss.

Joint Senior Author, Dr. Catriona Mayland from the Department of Oncology and Metabolism at the University of Sheffield, said: "Health and social care professionals had very little time to prepare or train for the impact of the pandemic. They faced an increased workload with competing demands and heightened complexity.

"This includes facilitating connectedness between patients and their relatives during the pandemic and they are perceived to be instrumental in this. The study shows the clear need for the opportunity to say goodbye in a meaningful way for families and proactive measures such as protecting time to facilitate connections between patients and relatives will be a valuable way to help families be able to navigate end-of-life care for their loved one and the impact of their grief."

Lead author, Dr. Jeff Hanna from the Department of Psychiatry at the University of Oxford, said: "This timely research reports important recommendations for health and social care professionals as they provide end-of-life care during the pandemic. They have a pivotal role in facilitating vital interactions between relatives and their loved ones. The vast number of deaths in the UK means this work provides salient lessons for supporting families at end-of-life."

Dr. Stephen Mason, Research and Development Lead for the Palliative Care Unit at the University of Liverpool said: "Our analysis of the experiences of bereaved relatives and health and social care professionals continues, with the hope of providing further insights in how we can maintain and potentially improve care within the limitations of necessary pandemic public health restrictions.