Special Report: Dedicated Palliative Care Team for Spanish-Speaking ICU Patients During COVID-19
Key findings
- In response to the high number of Latinx and Spanish-speaking patients admitted to the ICU at Massachusetts General Hospital due to COVID-19 in April through June 2020, an ad hoc Spanish-speaking team provided enhanced palliative care services
- For the 22 patients the team enrolled for any disease, the most common services during initial visits were information-giving (77%), coping support (59%), and goals of care discussions (45%)
- Despite the extra work to establish the service, clinical team members reported their experience with the Spanish care team increased motivation and resiliency amid the stress and uncertainty of the COVID-19 pandemic
- 68% of patients changed their code status during the hospitalization
- Palliative care services rely on precise word choice and highly skilled communication, so hospitals that don't have multiple Spanish-speaking palliative care specialists available should work closely with local interpreter services
During the spring 2020 peak of COVID-19, Latinx patients represented more than 40% of patients admitted to Massachusetts General Hospital with SARS-CoV-2 infection versus 9% of admissions previously. The respective figures for Spanish-speaking individuals were 40% and 6%. Many of these patients were essential workers who had been unable to socially distance themselves.
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A hospital-wide Spanish Language Care Group was formed to make Spanish-speaking physicians available to help staff and patients' families. However, specialized palliative care communication skills were needed for a rapidly increasing number of Latinx and Spanish-speaking patients and families.
Carine Davila, MD, MPH, and Mark Stoltenberg, MD, MPH, MA, attending physicians in the Division of Palliative Care and Geriatric Medicine at Mass General, and colleagues worked with ICU leaders to create a dedicated palliative care team for Spanish-speaking ICU patients. They describe its implementation and results in the Journal of Pain and Symptom Management.
Developing the Program
The Spanish Palliative Care Initiative had five core components:
- A multidisciplinary team comprising five Spanish-speaking specialty palliative care clinicians: three physicians, one nurse practitioner, and one board-certified chaplain
- Structural changes—The team ensured at least one of its members was on inpatient service each week; limited the nurse practitioner's outpatient clinical load to urgent visits, so she had protected time to join ICU rounds twice weekly; and instituted weekly warm hand-offs among members
- Patient identification pathways included chart review, joint rounding in the ICUs, referrals from the Spanish Language Care Group, and traditional inpatient consults
- Screening—To direct limited resources to patients with the highest needs, team members searched medical records to determine potential patients' age, medical comorbidities, number of days intubated, evidence of multiorgan failure, and complex psychosocial dynamics
- Processes—Team members communicated with families and ICU teams frequently each week. They also trained members of the Spanish Language Care Group on communication strategies and how to conduct serious illness conversations, building on work already underway at Mass General at the time
Results of a Chart Review
From April 21, 2020, to the initiative's conclusion on June 14, 2020, the team enrolled 22 patients (55% male, median age 55, age range 21−82). The most common diagnoses were COVID-19 (59%) and cancer (14%).
Team members saw patients at an average of eight visits (range, 1−22). The most common services during initial consults were information-giving (77%), coping support (59%), and goals of care discussions (45%). 68% of patients changed their code status during hospitalization.
Anecdotally, the program did not take a substantial physical or emotional toll on team members. The work did not require volunteered time, and it provided motivation, meaning, and increased resiliency amid the stress and uncertainty of the early days of the pandemic.
Generalizability
This model would not be wholly replicable in hospitals that don't have multiple Spanish-speaking palliative care clinicians available. That reinforces the need to work closely with interpreter services locally because specialist palliative care relies on precise word choice and highly skilled communication.
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