Back to Top Skip to main content Skip to sub-navigation

Palliative care provides comfort to COVID-19 patients, families

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:

COVID-19 Vaccine Toolkit | 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...

Get to Know the COVID-19 Vaccines - Main Infographic

Infographic
6/9/2021
An infographic describing the COVID-19 Vaccines, How they Work and Safety Monitoring Processes

This infographic pulls all three COVID-19 topics together in one graphic: Getting to Know the COVID-19 Vaccines, How they Work and Safety Monitoring

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

How COVID-19 Vaccines Work

Infographic
6/9/2021
Describes how the mRNA and viral vector vaccines work to educate beneficiaries about the COVID-19 vaccines.

This graphic showing how the mRNA and viral vector vaccines work to educate beneficiaries about the COVID-19 vaccines. Graphics are informational and provide facts on how they work in our bodies.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

Get to Know the COVID-19 Vaccines

Infographic
6/9/2021
Assures beneficiaries that the COVID-19 vaccines will not give you the virus, does not affect our DNA, and is safe.

This graphic that assures beneficiaries that the vaccines will not give you the virus, does not affect our DNA, and is safe. Graphics include a person receiving the vaccine and a comparison graphic of COVID-19 trials versus other trials.

Recommended Content:

Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Toolkit | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

COVID-19 Vaccines Safety Monitoring

Infographic
6/9/2021
Graphic that assures beneficiaries that the COVID-19 vaccines are monitored for safety. Has information on how they are being reviewed. Graphics include doctors in a laboratory and a doctor with a shield fending off the virus. The MHS and TRICARE logos are on the bottom right.

Graphic that assures beneficiaries that the COVID-19 vaccines are monitored for safety. Has information on how they are being reviewed. Graphics include doctors in a laboratory and a doctor with a shield fending off the virus.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

Get to Know the COVID-19 Vaccines (Combined)

Publication
6/9/2021

The Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson) COVID-19 vaccines were developed to prevent infection from the virus that causes COVID-19. Learn about the vaccines, how they work and safety precautions.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | Getting the COVID-19 Vaccine | COVID-19 Vaccine Efforts

Get to Know the COVID-19 Vaccines

Publication
6/9/2021

The Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson) COVID-19 vaccines were developed to prevent infection from the virus that causes COVID-19.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

How COVID-19 Vaccines Work

Publication
6/9/2021

Learn how the different COVID-19 vaccines work.

Recommended Content:

COVID-19 Vaccine Toolkit | Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

COVID-19 Vaccine Safety Monitoring

Publication
6/9/2021

The FDA and CDC continue to monitor the safety of COVID-19 vaccines. CDC has an independent group of experts that reviews all the safety data as it comes in and provides regular safety updates.

Recommended Content:

Get to Know the COVID-19 Vaccines | COVID-19 Vaccine Toolkit | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

VAX Facts about Getting the COVID Vaccine at the Same Time as Others

Publication
6/9/2021

Printable PDF of VAX Fact Infographic

Recommended Content:

COVID-19 Vaccine Toolkit | COVID-19 Vax Facts

Got Your 6 - June 6, 2021

Video
6/7/2021
Video screen image for the June 6, 2021 Got Your Six video

"Got Your 6" is TRICARE's COVID-19 vaccine video series that delivers important information and updates, three times a month. It includes the latest information about DoD vaccine distribution, the TRICARE health benefit, and vaccine availability for a DoD-affiliated, and TRICARE beneficiary audience.

Recommended Content:

COVID-19 Vaccine Efforts | COVID-19 Vaccine Toolkit

Facemask Required

Infographic
6/4/2021
COVID-19 poster showing doctors and patients in a health care setting wearing masks. The sign reads, "Masks are required in health care settings even if you're fully vaccinated. Please make sure your mask is on."

While the CDC relaxed mask requirements for vaccinated people, you're still required to wear masks in health care settings. Print this poster and put it around your facility to let patients and visitors know the requirements.

Recommended Content:

COVID-19 Vaccine Toolkit

Army’s 773rd administers mobile COVID-19 testing during DEF21

Article
6/4/2021
Three military personnel, wearing masks and lab coats, pose for a picture in an Albanian lab.

Approximately 800 Army Reserve soldiers from the U.S. and Europe participated in DEFENDER-Europe 21.

Recommended Content:

Health Readiness | Coronavirus | COVID-19 Vaccine Toolkit | Readiness Capabilities

Mental Health Panel Discusses Impact of COVID-19

Article
6/3/2021
Military personnel wearing face mask speaking on a panel

Walter Reed Bethesda hosts mental health panel to discuss the impacts of COVID-19.

Recommended Content:

COVID-19 Vaccine Toolkit | Mental Health Awareness Month | Coronavirus | Psychological Fitness

Based on data, MHS experts encourage vaccines for adolescents

Article
6/1/2021
Sister and brother smiling at each other

With the Pfizer vaccine approved for youth ages 12 to 15, MHS adolescents are lining up to get the COVID-19 vaccine.

Recommended Content:

COVID-19 Vaccine Toolkit | Coronavirus | COVID-19 Vaccine Efforts | Children's Health | Vaccine Eligibility

“Shots in arms” – OPT planned & coordinated to meet COVID-19 mission

Article
5/28/2021
Military personnel sitting around a table talking

The Department of Defense’s COVID-19 Operational Planning Team has been the quiet force behind the DOD’s vaccination effort since November.

Recommended Content:

COVID-19 Vaccine Toolkit | Coronavirus
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 39

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.