Dying in the midst of a pandemic: a qualitative study of bereaved relatives’ experiences about their family members deaths

Background: COVID-19 has caused an ongoing pandemic crisis and it has a great impact on health care worldwide. The situation in the Czech Republic was well controlled at the first wave of COVID-19 because of strict restrictions but it got worse during the second wave. Aim: The goal of this study was to compare the impact of the pandemic of COVID-19 on end-of-life care during the first and the second wave. Methods: This study was an online questionnaire survey to assess experiences of end-of-life care during the pandemic among health care professionals providing care for dying patients either during the first wave (March 2020 - May 2020) and the second wave (October 2020 - February 2021). Data were collected online using snowball and convenience sampling using dissemination through relevant professional organisations and personal contact. The questionnaire was an abbreviated version of the international Care Of the Dying Evaluation (iCODE) questionnaire with additional questions about the impact of COVID-19. The differences in 2 waves were compared using Cramer's V. Results: 136 health care professionals completed the survey at the first wave and 116 at the second wave, most of them were nurses (58 % and 84 %). Experience from both surveys did not differ regarding nursing care which was considered sufficient (88 % vs 89 %). In both samples, only 10 % of professionals thought that end-of-life care had to be limited because of the pandemic. In the second wave, there was a significant decrease in the reported level of comfort provided for patients (p= 0.01), in the level of emotional support for family carers (p= 0.005) and significantly fewer professionals thought that their patients died at the right place (64 % vs 47 %). Conclusion: This study shows that although the medical aspect of endof- life care might have not been affected during the pandemic, psychosocial care has been affected and it might have a long-lasting impact on relatives, as well as on professionals.