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

Palliative care provides comfort to COVID-19 patients, families

Image of Military health personnel taking care of a patient. Click to open a larger version of the image. 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

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 Testing and Treatment Graphic 2

Infographic
4/21/2022
COVID-19 Testing and Treatment Graphic 2

If your military hospital or clinic offers these antiviral treatments as part of the COVID-19 Test to Treat Initiative, use these graphics to promote your services to your beneficiaries.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Treatment

COVID-19 Testing and Treatment Main Graphic

Infographic
4/21/2022
COVID-19 Testing and Treatment Main Graphic

If your military hospital or clinic offers these antiviral treatments as part of the COVID-19 Test to Treat Initiative, use these graphics to promote your services to your beneficiaries.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Treatment

Preteens Teens Can Get Boosted Too

Infographic
2/3/2022
Preteens Teens Can Get Boosted Too

Preteens and Teens can get boosted, too! The CDC recommends a booster shot of Pfizer-BioNTech vaccine for preteens/teens ages 12 and older, 5 months after their second shot.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Vaccines for Children

VaxFacts: Should I get a booster?

Infographic
2/3/2022
VaxFacts: Should I get a booster?

Should I get a COVID-19 Booster Shot?

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Vax Facts

Additional Dose of mRNA

Infographic
2/3/2022
Additional Dose of mRNA

Should I get an additional dose of the mRNA Vccine?

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Get to Know the COVID-19 Vaccines

Compromised Immune System

Infographic
2/3/2022
Compromised Immune System

Do you have a compromised immune system? The CDC recommends you get an additional primary dose of the mRNA COVID-19 vaccine.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Get to Know the COVID-19 Vaccines

VAXFacts TRICARE coverage Vaccine

Infographic
2/3/2022
VAXFacts TRICARE coverage Vaccine

Will TRICARE cover the COVID-19 Vaccine? Yes. TRICARE offers the vaccine itself at no cost, but there may be a cost based on your plan for an office visit or if you require follow-on care.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Vax Facts

Make Guidance for DOD Facilities

Infographic
2/3/2022
Make Guidance for DOD Facilities

Mask Guidance for Department of Defense Facilities.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

Another Reason to get Vaccinated

Infographic
2/3/2022
Another Reason to get Vaccinated

The new Omicron variant is the most common variant in the United States. The Omicron variant is another reason to get vaccinated!

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Get to Know the COVID-19 Vaccines

Formulary Search Tool Buckslip (Page 2)

Infographic
1/27/2022
Formulary Search Tool Buckslip (Page 2)

The back side of a buck slip. Educates beneficiaries what the search tool is and what information can be found. QR code is on the right and links to the search tool. The TRICARE and Express Scripts logo are on the bottom left.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Pharmacy Operations Toolkit

Formulary Search Tool Buckslip (Page 1)

Infographic
1/27/2022
Formulary Search Tool Buckslip (Page 1)

The front side of a buck slip. Educates beneficiaries what the search tool is and what information can be found. Links to esrx.com/tform. Has three graphics grouped together on the right hand side.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Pharmacy Operations Toolkit

We Can Do It (1081 x 1081)

Infographic
1/10/2022
We Can Do It  (1081 x 1081)

We can do it: Simple measures can protect you and your community. Wear a mask, get vaccinated, and check out where and when you can get your booster! https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

We Can Do It (1201 x 901)

Infographic
1/10/2022
We Can Do It  (1201 x 901)

We can do it: Simple measures can protect you and your community. Wear a mask, get vaccinated, and check out where and when you can get your booster! https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

Quarantine vs Isolation

Infographic
1/10/2022
Quarantine vs Isolation

Been exposed or feeling symptoms of COVID-19? Make sure you understand the difference between quarantine and isolation to keep your community safe. https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

We Have the Tools

Infographic
1/10/2022
We Have the Tools

We have the tools to fight: Protect yourself and your community from the spread of COVID-19 with the right tools. Make sure you wear your mask, get vaccinated, and find your nearest testing site. Learn more https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 6

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.