Skip to main content

Military Health System

Palliative care provides comfort to COVID-19 patients, families

Image of 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:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

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...

How COVID-19 fast-tracked innovation in the Military Health System

Article
7/20/2021
Military personnel receiving the COVID-19 test

As the COVID-19 pandemic disrupted every aspect of healthcare delivery, the Military Health System responded with new and innovative ways to fight the disease and deliver safe, quality care to patients.

Recommended Content:

| Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

COVID Vaccinations Rise -- But So Do Concerns of the Delta Variant

Article
7/1/2021
Military personnel wearing a face mask preparing a COVID-19 vaccine

MHS expected to reach 70% COVID-10 vaccination rate in July.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

New COVID-19 Delta Variant: What You Need to Know to Stay Safe

Article
6/28/2021
Military personnel receiving the COVID-19 vaccine

COVID-19 Delta variant spreading rapidly; it’s time to get vaccinated

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

Army’s 773rd administers mobile COVID-19 testing during DEF21

Article
6/4/2021
Three military personnel, wearing masks and lab coats, pose for a picture in an Albanian lab.

Approximately 800 Army Reserve soldiers from the U.S. and Europe participated in DEFENDER-Europe 21.

Recommended Content:

Health Readiness & Combat Support | Coronavirus & the MHS Response | Coronavirus and the COVID-19 Vaccine | Readiness Capabilities

Mental Health Panel Discusses Impact of COVID-19

Article
6/3/2021
Military personnel wearing face mask speaking on a panel

Walter Reed Bethesda hosts mental health panel to discuss the impacts of COVID-19.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | | Psychological Fitness

Based on data, MHS experts encourage vaccines for adolescents

Article
6/1/2021
Sister and brother smiling at each other

With the Pfizer vaccine approved for youth ages 12 to 15, MHS adolescents are lining up to get the COVID-19 vaccine.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Children's Health

“Shots in arms” – OPT planned & coordinated to meet COVID-19 mission

Article
5/28/2021
Military personnel sitting around a table talking

The Department of Defense’s COVID-19 Operational Planning Team has been the quiet force behind the DOD’s vaccination effort since November.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

Adolescents ages 12 and older eligible for COVID-19 vaccinations

Article
5/27/2021
Son of military personnel receiving his COVID-19 vaccine

Pfizer vaccine now authorized for children 12 and older.

Recommended Content:

Children's Health | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

COVID-19 Town Hall with RADM Anne M. Swap

Article
5/24/2021
MHS and Military OneSource NCR COVID-19 Town Hall with Rear Admiral Anne M. Swap, Director, National Capital Medical Directorate, Wednesday, May 26 at 11:50 a.m. ET

The purpose of this event is to inform National Capital Region (NCR) beneficiaries of DHA’s efforts with battling coronavirus (COVID-19) and encourage them to not delay care.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

Adirim, Place laud DHA response to COVID-19 in briefing

Article
5/21/2021
Defense Health Agency Director Lt. Gen. (Dr.) Ronald J. Place speaking at a press conference

Dr. Terry Adirim, acting assistant secretary of defense for health affairs, and Army Lt. Gen. (Dr.) Ronald J. Place, director of the Defense Health Agency, provided a COVID-19 update during a Pentagon press briefing.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

Sailors continue to receive COVID-19 vaccine

Article
5/20/2021
Military personnel wearing a face mask receiving the COVID-19 vaccine

Sailors continue to voluntarily receive one of the three available COVID-19 vaccines.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

MHS quickly adapted to improve patient experience during pandemic

Article
5/19/2021
Military health personnel waiting for the next phone call on the COVID-19 advice line

MHS adapted technology to boost patient experience during pandemic

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

DHA Director visits MCAGCC to hear from the ‘Boots on the Ground’

Article
5/19/2021
Military personnel wearing face masks walking

DHA Director visits Marine Corps Air Ground Combat Center Twentynine Palms.

Recommended Content:

MHS GENESIS: The Electronic Health Record | Military Health System Transformation | Coronavirus & the MHS Response | Coronavirus and the COVID-19 Vaccine

Military medicine heroes recognized for COVID-19 pandemic response

Article
5/17/2021
Photo of the virtual "Heroes of Military Medicine" award ceremony

COVID-19 pandemic will affect military medicine for years to come, DHA Director Place tells HJF awards ceremony.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

DHA leadership recognizes, advances 60th MDG mission

Article
5/14/2021
Army Lt. Gen. Ronald Place visits Travis Air Force Base

DHA leadership visit 60th Medical Group at Travis AFB.

Recommended Content:

Coronavirus & the MHS Response | Coronavirus and the COVID-19 Vaccine | MHS GENESIS: The Electronic Health Record
<< < 1 2 3 4 5  ... > >> 
Showing results 61 - 75 Page 5 of 14
Refine your search
Last Updated: January 17, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery