A comparison of symptom management and utilization of specialist palliative care in the early COVID-19 pandemic: A multi-site retrospective chart review
Bibliographic record
Abstract
Background: COVID-19 is associated with high rates of morbidity and mortality. Previous work has described symptom management provided by specialists in palliative care for COVID-19 patients. However, there is a paucity of literature describing primary level palliative care provided by general internal medicine teams or reasons for referral to specialists.Objective: Our aim was to describe and compare the following outcomes for patients dying of COVID-19: (1) symptom management by acute care providers and palliative care specialists, and (2) utilization of palliative care consultation across two acute care hospitals in Toronto, Ontario during the onset of the COVID-19 pandemic.Methods: We undertook a retrospective chart review of 45 adult inpatients diagnosed with COVID-19 between 23 January 2020 to 19 May 2020 who died, and/or those who had a palliative care consultation.Findings: Forty-one of the 45 patients died. Common symptoms were shortness of breath and agitation. For these symptoms, pharmacologic management was not significantly different for patients seen by palliative care compared to those without consultation. Most consultations were for end-of-life care. There were significantly more palliative care consults for COVID-19 patients at one hospital (P=.001).Conclusion: The findings highlight the significant discrepancy in involvement of specialist palliative care between settings. More research is needed to validate the initial findings from this small sample size, understand the needs of palliative care providers in this setting, and appreciate the factors influencing consultation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".