Back to Top Skip to main content Skip to sub-navigation

Palliative care provides comfort to COVID-19 patients, families

Military health personnel taking care of a patient Air Force 2nd Lt. Aundrea Temple, assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, Calif., cares for a patient at Dameron Hospital, California (Photo by: Army National Guard photo illustration by Staff Sgt. Eddie Siguenza).

Recommended Content:

COVID-19 Vaccine Toolkit | Coronavirus

When COVID-19 was spreading across Italy in February 2020, all eyes at David Grant U.S. Air Force Medical Center at Travis Air Force Base, California were fixated on the unfolding pandemic, realizing their hospital may potentially be one of the first to be impacted.

Air Force Lt. Col. Laurie Migliore, acting director, Clinical Investigation Facility and director of Biobehavioral Research, along with essential medical personnel were charged with reviewing Grant's Crisis Standards of Care, particularly the availability of palliative care for potential COVID-19 patients.

Migliore said it became evident from seeing the death rates in Italy that DGMC may be impacted with unprecedented numbers of critically ill and potentially dying patients. They had to be ready to provide both medical and palliative care.

"Our goal was to develop a point of care tool that was targeted, practical and easy to use by frontline medical providers," said Migliore, who is also a registered nurse. "As the pandemic began to spread throughout the country, the volume of information evolved from scarce to the point of overwhelming."

Migliore developed a toolkit to provide guidance and information to medical personnel in four areas:

  • Basic understanding of palliative care and palliative care principles
  • Communication strategies and resources (getting on the same page, scripts)
  • Symptom management (alleviating pain, breathlessness, anxiety, etc.)
  • Support for caregivers (dealing with blame, guilt, anger, grief, death/dying)

Palliative care is specialty medical care for individuals with serious illnesses and is often provided by specially-trained teams of doctors, nurses, social workers, chaplains, and therapists.

Air Force Reserve Col. Stephen Hernandez, who was activated and deployed to New York City in April 2020, supported FEMA-led operations in New York. During his deployment, he served as the deputy team lead at Lincoln Medical Center in the Bronx, New York. He became a wealth of knowledge for Migliore with direct exposure to COVID-19 patients and their palliative needs.

During Hernandez's six weeks at the medical center, palliative care for COVID-19 patients was almost non-existent. He stated if the frontline medical staff had access to something similar to the toolkit the Grant team is developing, they could have focused more on providing palliative care rather than only life-prolonging care.

"Palliative care is important during a pandemic to optimize patient and family quality of life and to mitigate suffering among people with a serious illness," said Hernandez, who served as the chief nurse for more than 60 other reservists providing care at Lincoln. "It also has the potential to maximize and conserve limited resources to focus on seriously ill patients who have a higher likelihood of recovery."

Based on the evolving pandemic and feedback from Hernandez, Migliore and the staff supporting the project began a PICO (Population, Intervention, Comparison, Outcome and Time) analysis, literature review and toolkit development.

Military health personnel providing curbside COVID-19 testing
Air Force Maj. Alisha Florence and Senior Airman Rachael Tuczynski, nurses assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, California, gather information and perform preliminary patient checks outside of Adventist Health Lodi Memorial hospital in Lodi, California, July 29, 2020. The medical team, in support of Task Force 46, Joint Force Land Component Command, U.S. Army North, helped initiate curbside checks as a way to expedite care for growing COVID-19 cases in this San Joaquin County facility (Photo by: Army National Guard Staff Sgt. Eddie Siguenza).

They also submitted a grant proposal to purchase tablets and other technology required to provide communication between patients and their families.

Migliore said that the PICO analysis and literature review identified three primary needs by staff and patients during the pandemic.

  • Critical need for frontline/primary care staff to receive rapid palliative care training
  • Access to existing palliative care specialists as consultants and subject matter experts
  • Need for regular palliative education and training

About a year after the project began, the toolkit is now available, empowering frontline medical staff and bridging the gap in palliative care.

"The toolkit focuses on palliative care, communication, symptom management, and support of caregivers," said Migliore, who was personally affected during the pandemic and benefited from information the toolkit provided to the staff, taking care of her husband and using the means of communication the tablets provided. Her husband was admitted to Grant's ICU with cardiac issues during the pandemic.

"When I brought him to the emergency room I wasn't prepared for him to be admitted, I thought that he would get some medications, stabilize, and return home," she said.

Instead, he was admitted from the emergency room to the intensive care unit and the only means for them to communicate was through the tablets provided by the pilot program.

"The nurse taking care of my husband learned that I was one of the team leads for the project," Migliore added. "She told me how grateful the staff was for the tablets and how helpful they were for patients and staff during the visitor restrictions."

The toolkit is now available to all DHA medical professionals on the organization's internal website.

According to Migliore, the pilot is concluding soon and the results and lessons learned will be published and made available to military hospitals and clinics, incorporating the COVID-19 Palliative Care Toolkit into inpatient practices.

"We worked out some significant challenges despite constantly deploying staff and issues with inpatient internet capability," she said. "We incorporated feedback from the field to refine the contents for a simple yet relevant and practical resource."

The short-term goal of the pilot was to provide immediate palliative care resources to medical staff based on evidence and vetted by palliative care subject-matter experts for immediate use during the pandemic. The long-range objective is to develop centralized, standardized resources for palliative care use throughout the Military Health System.

"The enterprise would benefit from standard order sets, protocols, and simulation training for staff/patient communication for goals of care during high-stress crisis situations," Migliore said. "Ultimately, the impact (of palliative care) is improved quality of life, decreased suffering, and satisfied patients and families."

You also may be interested in...

COVID-19 can lead to long-term health concerns

Article Around MHS
9/23/2021
Debra Lamb, a 30-year civil service veteran at Ft. Carson, contracted the COVID-19 virus late in 2020 and experienced a harrowing ordeal before partially recovering months later.

Debra Lamb, a 30-year civil service veteran at Ft. Carson, contracted the COVID-19 virus late in 2020 and experienced a harrowing ordeal before partially recovering months later.

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts

DODEA Schools Keeps On With In-Person Classes, and Fall Sports, Too

Article
9/23/2021
Kids playing football

DODEA schools are striving to continue in-person learning in the 2021-22 school year.

Recommended Content:

Children's Health | Coronavirus

6th Medical Group Delivers Mandatory Vaccines

Article Around MHS
9/21/2021
An Airman from the 6th Medical Group prepares a COVID-19 vaccine for distribution at MacDill Air Force Base, Florida.

Airmen from the 6th Medical Group began redistributing doses of the COVID-19 vaccine at MacDill Air Force Base, Florida, on Sept. 9, 2021. This comes after the Secretary of Defense issued a memorandum on Aug. 23, 2021, mandating all active duty personnel to be fully vaccinated against COVID-19.

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts

Vaccines for Teens

Infographic
9/17/2021
Adolescents can get COVID-19. The Pfizer vaccine has been tested for those ages 12-15. Visit www.TRICARE.mil/VaccineAppointments to make an appointment.

A graphic showing the types of vaccines, how they work, and safety monitoring of the vaccines. Includes the MHS and TRICARE logos on the bottom right, and includes graphics of scientists, doctors, and patients.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | Vaccine Eligibility

Get to Know the Vaccines

Infographic
9/17/2021
Get to know the vaccines – types of vaccines, how they work and safety monitoring.

A graphic showing the types of vaccines, how they work, and safety monitoring of the vaccines. Includes the MHS and TRICARE logos on the bottom right, and includes graphics of scientists, doctors, and patients.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines

Get to know the COVID19 Vaccines

Infographic
9/17/2021
Get to know the vaccines – they do not contain the live virus, they do not interact with our DNA, and have been tested rigorously.

Get to know the vaccines - they do not contain the live virus, they do not interact with our DNA, and have been tested rigorously

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines

Get to Know the Vaccines

Publication
9/17/2021

A graphic showing the types of vaccines, how they work, and safety monitoring of the vaccines. Includes the MHS and TRICARE logos on the bottom right, and includes graphics of scientists, doctors, and patients.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines

Get to know the COVID19 Vaccines

Publication
9/17/2021

Get to know the vaccines – they do not contain the live virus, they do not interact with our DNA, and have been tested rigorously.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines

Got Your 6

Video
9/16/2021
Got Your 6 Infographic

‘Got Your 6’ is TRICARE’s COVID vaccine video series that delivers important information and updates, on days that end in ‘6.’ It includes the latest information about DOD vaccine distribution, the TRICARE health benefit, and vaccine availability. Got a question about ‘Got Your 6’? Send an email to dha.ncr.comm.mbx.dha-internal-communications@mail.mil

Recommended Content:

COVID-19 Vaccine Toolkit | Coronavirus | COVID-19 Vaccine Efforts

After the ventilator COVID survivor advocates for vaccine

Article Around MHS
9/15/2021
Tim Harris is sedated while on a ventilator

Tim Harris, a mobilization and planning specialist, U.S. Army Medical Center of Excellence, is sedated while on a ventilator at Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, June 27, 2020.

Recommended Content:

Coronavirus

Army Medicine Europe Provides Additional COVID Vaccinations for Immune Compromised

Article Around MHS
9/13/2021
Franz Dietrich, a German local national assigned to Training Support Activity Europe, receives a COVID-19 vaccination at the 7th Army Training Command's (7ATC) Rose Barracks, Vilseck, Germany, May 4, 2021. The U.S. Army Health Clinics at Grafenwoehr and Vilseck conducted a "One Community" COVID-19 vaccine drive May 3-7 to provide thousands of appointments to the 7ATC community of Soldiers, spouses, Department of the Army civilians, veterans and local nationals employed by the U.S. Army. (U.S. Army photo by Markus Rauchenberger)

Army medical treatment facilities in Europe are now offering an additional dose of COVID vaccine for immune compromised beneficiaries.

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts

The COVID-19 Pandemic: How Health Care Workers are Coping

Article
9/13/2021
a nurse helping a COVID-19 patient

For health care providers, experiencing the pandemic inside a hospital has brought

Recommended Content:

Coronavirus | Military Health Podcasts

Increased COVID Restrictions on the Pentagon Reservation

Article
9/8/2021
Military personnel wearing a face mask

Due to the increase in COVID-19 cases and positive test cases in the National Capital Region, the Pentagon Reservation will move to Health Protection Condition Bravo Plus (Bravo+)

Recommended Content:

COVID-19 Vaccine Toolkit | Coronavirus

Digital health innovation emerges during COVID-19 pandemic

Article
8/31/2021
The Defense Health Agency’s Connected Health Branch was there to support, advise and deliver new health innovations throughout the pandemic. (Graphic courtesy of DHA Connected Health)

The DHA's Connected Health Branch was there to support, advise, and deliver new health innovations throughout the pandemic.

Recommended Content:

Connected Health | Coronavirus

As Fitness Tests Resume, Troops Seek Post-COVID Exercise Routines

Article
8/31/2021
Military personnel physically training

Keeping fit during pandemic proves hard for some.

Recommended Content:

Total Body Preventive Health and Total Force Fitness | Total Force Fitness | Physical Fitness | Coronavirus
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 42

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.