Don't bring COVID home for Christmas - analysing emerging themes during COVID-19 through lenses of care homes and universities in Finland, Northern Ireland, Scotland and Sweden.

BACKGROUND: In autumn of 2020, the UK Secretary of State for Health and Social Care pleaded with young people to 'not kill your gran' when returning home, after he confirmed the surge in coronavirus cases at that time was associated with students away from home for the first time. Meanwhile residents continued to die in care homes across the NPA Region. AIMS: To examine the impact of COVID-19 on communities through the twin lenses of University Campuses and Care Homes from November 2020 to March 2021.To generalise findings to society as a whole through the NPA Covid-19 themes of clinical aspects, health and wellbeing, technology solutions, citizen engagement/community response and economic impacts. METHODS: Surveys and 1:1 interviews via zoom or telephone gathered data. Informed consent was obtained from all participants including students, care home residents, the families of care home residents and care home workers. They were recruited via flyers and completing a Survey Monkey questionnaire. RESULTS: Mistakes made at Government level is also a common feature. In Scotland and Northern Ireland this was centred around the movement of people from hospital into the care home sector without sufficient testing, preparedness (PPE/isolation) or resources, whilst in Sweden and Finland it focused more on a reliance on soft law. The project was selected to be presented virtually at the European Regions week as well as at the the Arctic Circle Assembly in Iceland in October 2021. DISCUSSION: Among students, there was little awareness that they might be asymptomatic and could infect vulnerable contacts by bringing COVID home for Christmas In care homes, residents continued to die, and experiments took place using digital interventions to monitor social distancing and afford more access for family members.

Evaluation design of the patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard (InAdvance): a randomised controlled trial.

BACKGROUND: Palliative care aims to contribute to pain relief, improvement with regard to symptoms and enhancement of health-related quality of life (HRQoL) of patients with chronic conditions. Most of the palliative care protocols, programmes and units are predominantly focused on patients with cancer and their specific needs. Patients with non-cancer chronic conditions may also have significantly impaired HRQoL and poor survival, but do not yet receive appropriate and holistic care. The traditional focus of palliative care has been at the end-of-life stages instead of the relatively early phases of serious chronic conditions. The 'Patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard' (InAdvance) project implements and evaluates early palliative care in the daily clinical routine addressing patients with complex chronic conditions in the evolution towards advanced stages. The objective of the current study is to evaluate the acceptability, feasibility, effectiveness and cost-effectiveness of this novel model of palliative care in the relatively early phases in patients with chronic conditions. METHODS: In this study, a single blind randomised controlled trial design will be employed. A total of 320 participants (80 in each study site and 4 sites in total) will be randomised on a 1:1 basis to the Palliative Care Needs Assessment (PCNA) arm or the Care-as-Usual arm. This study includes a formative evaluation approach as well as a cost-effectiveness analysis with a within-trial horizon. Study outcomes will be assessed at baseline, 6 weeks, 6 months, 12 months and 18 months after the implementation of the interventions. Study outcomes include HRQoL, intensity of symptoms, functional status, emotional distress, caregiving burden, perceived quality of care, adherence to treatment, feasibility, acceptability, and appropriateness of the intervention, intervention costs, other healthcare costs and informal care costs. DISCUSSION: The InAdvance project will evaluate the effect of the implementation of the PCNA intervention on the target population in terms of effectiveness and cost-effectiveness in four European settings. The evidence of the project will provide step-wise guidance to contribute an increased evidence base for policy recommendations and clinical guidelines, in an effort to augment the supportive ecosystem for palliative care. TRIAL REGISTRATION: ISRCTN, ISRCTN24825698 . Registered 17/12/2020.