Necessary discussions: The development of online resources to support advance care planning in nursing homes in a COVID-19 context

Background: The COVID-19 pandemic has resulted in high mortality in care homes. Little is known about provision of palliative and end of life care in care homes during the pandemic. Aims: To explore how care homes responded to COVID-19 with regards to palliative and end of life care. Methods: A systematic review of Medline, Embase, PsycINFO and Web of Science. Eligible papers focused on palliative care in care homes during the COVID-19 pandemic. Narrative analysis, with findings synthesised according to physical, social, psychological and spiritual domains of care. Results: Out of 521 papers, a total of 21 papers were included in the final review. 15 papers included the physical aspect of palliative care specifically regarding symptom control and anticipatory prescribing. 10 papers explored psychological needs, particularly regarding mental health conditions. 13 papers discussed the social aspect such as visitor restrictions, advanced care planning and hospital transfers. 7 papers explored the spiritual aspect including anticipatory grief and bereavement care. Only 4 papers out of the 21 discussed all 4 aspects of palliative care. Conclusion: Internationally, little research has focused on understanding provision of palliative and end of life care in care homes during COVID-19 pandemic. Most of the research published has focused on narrow areas of palliative care such as advanced care planning around future hospital transfers. More research is needed for provision of guidelines and policies to promote a holistic approach to palliative care in care homes during the pandemic.