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. 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 Vaccine PSA #3

Video
1/29/2021
COVID-19 Vaccine PSA #3

A Department of Defense Public Service Announcement communicating the Department’s confidence in the safety of the vaccine, confidence in the efficacy of vaccines and transparency in the latest vaccine information. Widespread vaccination against COVID-19 aligns with the Department of Defense’s priorities of protecting service members, DoD civilians, and families; safeguarding national security capabilities; and supporting the whole-of-nation response to the COVID-19 pandemic. (Video by Air Force Staff Sgt. Christopher Duckworth)

Recommended Content:

MHS Toolkits and Branding Guidance | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

LTG Place Vaccine Roll-Out Video

Video
1/18/2021
LTG Place Vaccine Roll-Out Video

DHA Director LTG Ron Place talks about coronavirus vaccines, their safety and efficacy, and encourages everyone to do their own research to get vaccinated.

Recommended Content:

MHS Toolkits and Branding Guidance | MHS Toolkits and Branding Guidance | Coronavirus | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

MHS Minute: December 2020

Video
12/28/2020
MHS Minute: December 2020

See how MHS is leading a phased approach to offer 11.1 million Department of Defense personnel the first COVID-19 vaccines. To learn more about the safety and efficacy behind COVID-19 vaccines, go to: https://www.health.mil/Military-Health-Topics/Combat-Support/Public-Health/Coronavirus/COVID-19-Vaccine-Efforts.

Recommended Content:

COVID-19 Vaccine Efforts | Coronavirus | MHS Toolkits and Branding Guidance

MHS COVID Response

Video
12/21/2020
MHS COVID Response

The men and women of the Military Health System spent 2020 working to protect beneficiaries' health during the coronavirus pandemic. Here are just a few of our accomplishments.

Recommended Content:

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

Heroes Behind the Mask

Video
12/17/2020
Heroes Behind the Mask

A tribute to those across the Military Health System who deserve recognition and thanks for their hard work during this pandemic.

Recommended Content:

Coronavirus | Coronavirus | Coronavirus and the COVID-19 Vaccine

COVID-19 Response

Video
12/14/2020
COVID-19 Response

USPHS Lt. Courtney Labitzky, assigned to the Javits New York Medical Station (JNYMS), talks about their position at JNYMS in support of the Department of Defense COVID-19 response, April 29, 2020. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army Video by Cpl. Rachel Thicklin)

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

MHS Minute: November 2020

Video
11/27/2020
MHS Minute: November 2020

During Warrior Care Month, we reflect on the strength and resilience of our nation's wounded, ill, and injured service members, and recognize the caregivers who support their recovery and rehabilitation.

Recommended Content:

Warrior Care | Coronavirus | Warrior Care

COVID-19 Response2

Video
11/27/2020
COVID-19 Response2

Army Spc. Sean Colangelo, assigned to the Javits New York Medical Station (JNYMS), talks about their position at JNYMS in support of the Department of Defense COVID-19 response, April 23, 2020. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army Video by Cpl. Rachel Thicklin)

Recommended Content:

Coronavirus | Coronavirus | Coronavirus and the COVID-19 Vaccine

COVID-19 Response

Video
11/27/2020
COVID-19 Response

Army Pfc. David Alvarado, assigned to the Javits New York Medical Station (JNYMS), talks about their position at JNYMS in support of the Department of Defense COVID-19 response, April 24, 2020. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army Video by Cpl. Rachel Thicklin.)

Recommended Content:

Coronavirus | Coronavirus | Coronavirus and the COVID-19 Vaccine

MHS Minute: Heroes Behind the Mask

Video
10/8/2020
MHS Minute: Heroes Behind the Mask

In the face of a global threat, healthcare heroes across the MHS have donned their mask, and served on the front line of the battle against COVID-19. Tune in to this month's "MHS Minute" to learn more!

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine | Coronavirus

The Military Health System Celebrates Labor Day

Video
9/4/2020
The Military Health System Celebrates Labor Day

Labor Day pays tribute to the American workforce. This year, we pay tribute to the Military Health System Workforce.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

MHS Minute: A Call to Action for Convalescent Plasma Donation

Video
8/24/2020
MHS Minute: A Call to Action for Convalescent Plasma Donation

Have you recovered from COVID-19, or tested positive for antibodies? Consider donating convalescent plasma. For eligibility requirements, and to find a donor center near you, go to https://www.militaryblood.dod.mil/Donors/COVID-19andBloodDonation.aspx

Recommended Content:

Coronavirus | Convalescent Plasma Collection Program | Coronavirus and the COVID-19 Vaccine | Armed Services Blood Program

Convalescent Plasma Donation PSA featuring Lt. General Place

Video
7/10/2020
Convalescent Plasma Donation PSA featuring Lt. General Place

Lt. Gen Place asks servicemembers DoD-wide to consider dontating plasma in the fight against COVID-19.

Recommended Content:

Coronavirus | Convalescent Plasma Collection Program | Coronavirus and the COVID-19 Vaccine | Armed Services Blood Program

MHS Minute: DoD Focused on COVID-19 Testing and Treatment

Video
6/25/2020
MHS Minute: DoD Focused on COVID-19 Testing and Treatment

Have you recovered from COVID-19, or tested positive for antibodies? Consider donating convalescent plasma. To learn how, go to https://www.militaryblood.dod.mil/

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

MHS Minute: Military Leading the Charge on COVID-19 Research

Video
5/28/2020
MHS Minute: Military Leading the Charge on COVID-19 Research

The military continues to serve on the front lines of research and treatment in response to the COVID-19 pandemic. Tune in to the MHS Minute to learn more.

Recommended Content:

Coronavirus
<< < 1 2 3 4 5  ... > >> 
Showing results 46 - 60 Page 4 of 6
Refine your search
Last Updated: May 17, 2021

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.