Identifying the consequences of restrictive visitor policies on palliative care providers, their patients and caregivers

Background: Restrictive institution visitor policies were implemented to minimize infection risks during the COVID-19 pandemic. Little data exists on the relationship between these policies and the provision of palliative care(PC). Aim: To describe the experiences and reflections of PC physicians on the effects of restrictive visitor policies. Methods: Semi-structured interviews were conducted with physicians about their experience providing PC in institutions with restrictive visitor policies. Thematic analysis was used to describe and interpret overarching themes. Results: Twelve specialized PC and 11 primary PC were interviewed. Interim analysis of 16 coded interviews demonstrates 4 main thematic categories including patient, caregiver, provider, and system effects. Patient-related items included isolation, dying alone, lack of caregiver advocacy and forced care decisions to allow for visitor presence. Caregiver factors included the inability to support or provide care to patients, poor communication with care teams, poor illness understanding, the need to make distanced care decisions, and challenges in identifying visitors. Provider factors included increased time and effort on communication, lack of caregiver input on patient status, increased complaints, the need to be a caregiver surrogate, visitor advocate or gatekeeper. System effects included the increased interest to be provided care in the community and the lack of interest in palliative care units. These factors were often exacerbated by several issues including the lack of clear evidence on their validity, and inconsistent enforcement or interpretation of policies at the unit, which led to patient and caregiver anger and distrust, and provider frustration. Conclusion: Preliminary analysis highlights substantial negative consequences of restrictive visitor policies at the patient, caregiver, provider and system levels which were exacerbated by their lack of evidence and inconsistent enforcement.