Biopsychosocial and Spiritual Implications of Patients With COVID-19 Dying in Isolation

Thushara Galbadage; Brent M Peterson; David C Wang; Jeffrey S Wang; Richard S Gunasekera

doi:10.3389/fpsyg.2020.588623

Biopsychosocial and Spiritual Implications of Patients With COVID-19 Dying in Isolation

Front Psychol. 2020 Nov 17:11:588623. doi: 10.3389/fpsyg.2020.588623. eCollection 2020.

Authors

Thushara Galbadage¹, Brent M Peterson¹, David C Wang², Jeffrey S Wang³, Richard S Gunasekera⁴

Affiliations

¹ Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States.
² Rosemead School of Psychology, Biola University, La Mirada, CA, United States.
³ Southern California Permanente Medical Group, Department of Infectious Diseases, Anaheim, CA, United States.
⁴ Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States.

Abstract

Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about patients' psychological and spiritual well-being with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to adequately address these patients' needs, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness, and shared decision making with patients' families.

Keywords: Coronavirus; biopsychosocial-spiritual; death; end-of-life; family; isolation; palliative care; spiritual.