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Research ArticleOriginal Article
Open Access

Tele-clinics in palliative care during the COVID-19 outbreak

Tertiary care cancer center experience

Nabil A. Almouaalamy, Amal A. Jafari and Alaa M. Althubaiti
Saudi Medical Journal April 2022, 43 (4) 394-400; DOI: https://doi.org/10.15537/smj.2022.43.4.20210808
Nabil A. Almouaalamy
From the Oncology Department (Almouaalamy), Princess Noorah Oncology Center, Ministry of National Guard - Health Affairs; from King Abdullah International Medical Research Centre (Almouaalamy, Althubaiti); from the College of Medicine (Almouaalamy, Althubaiti), King Saud bin Abdulaziz University for Health Sciences; and from the Nursing Department (Jafari), King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.
ABFM, SSC-FM
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  • For correspondence: [email protected]
Amal A. Jafari
From the Oncology Department (Almouaalamy), Princess Noorah Oncology Center, Ministry of National Guard - Health Affairs; from King Abdullah International Medical Research Centre (Almouaalamy, Althubaiti); from the College of Medicine (Almouaalamy, Althubaiti), King Saud bin Abdulaziz University for Health Sciences; and from the Nursing Department (Jafari), King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.
RN, MSc
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Alaa M. Althubaiti
From the Oncology Department (Almouaalamy), Princess Noorah Oncology Center, Ministry of National Guard - Health Affairs; from King Abdullah International Medical Research Centre (Almouaalamy, Althubaiti); from the College of Medicine (Almouaalamy, Althubaiti), King Saud bin Abdulaziz University for Health Sciences; and from the Nursing Department (Jafari), King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.
MSc, PhD
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  • Figure 1
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    Figure 1

    - Percent of virtual visits during COVID-19 period.

Tables

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    Table 1

    - Demographics and clinical characteristics of the study participants (N=167).

    CharacteristicDescriptive statistics
    Age, years; median (range)68 (18-108)
    Gender
    Female79 (47.3)
    Male88 (52.7)
    Marital status
    Married132 (79.0)
    Other35 (21.0)
    Area of residency
    Western region152 (91.0)
    Other15 (9.0)
    Code status
    Full code80 (47.9)
    Support care53 (31.7)
    Comfort care34 (20.4)
    Diagnosis
    Cancer165 (98.8)
    Non-cancer2 (1.2)
    Palliative / follow-up patients
    Palliative patient46 (27.5)
    Follow-up patient121 (72.5)
    Number of visits; median (range)2 (1-10)
    Number of admissions; median (range)1 (0-9)
    No admission65 (38.9)
    One admission or more102 (61.1)
    Number of ER visits, median (range)1 (0-21)
    No ER visit62 (37.1)
    One or more ER visit105 (62.9)
    Specialty
    Medical oncology service72 (43.1)
    Gynae-oncology17 (10.2)
    Hematology19 (11.4)
    Radiation28 (16.8)
    Non-oncology service31 (18.6)

    Values are presented as number and percentages (%).

      • View popup
      Table 2

      - Acute respiratory illness score and type of visits recorded during seven months of COVID-19 period in the palliative center.

      CharacteristicsDescriptive statistics
      ARI score, median (range)0 (0–12)
      ARI score
      0332 (74.3)
      1-392 (20.6)
      >323 (5.1)
      Type of visit
      Virtual visit234 (52.3)
      Non-virtual visit213 (47.7)
      Show up90 (42.2)
      Walk-in, inpatient, or other123 (57.8)

      Total is computed over the study period (N=447). Values are presented as number and percentage (%) unless otherwise stated. ARI: acute respiratory illness

        • View popup
        Table 3

        - Comparison of patients’ characteristics and clinical variables between types of visit groups.

        CharacteristicsType of visitP-value
        At least one virtual visit (N=124)No virtual visit (N=43)
        Age, years; median (range)68 (18-108)66 (36-88)0.74*
        Gender
        Female55 (69.6)24 (30.4)0.20†
        Male69 (78.4)19 (21.6) 
        Marital status
        Married99 (75)33 (25)0.67†
        Other25 (71.4)10 (28.6) 
        Area of residency
        Western region112 (73.7)40 (26.3)0.76†
        Other12 (80)3 (20) 
        Code status
        Full code67 (83.8)13 (16.3)<0.001†
        Support care41 (77.4)12 (22.6) 
        Comfort care16 (47.1)18 (52.9) 
        Diagnosis
        Cancer123 (74.5)42 (25.5)0.45‡
        Non-cancer1 (50)1 (50) 
        Palliative / follow-up patients
        Palliative Patient29 (63)17 (37)0.041†
        Follow-up Patient95 (78.5)26 (21.5) 
        Number of visits, median (range)3 (1-10)1 (1-6)<0.00*
        Number of admissions
        No admission56 (86.2)9 (13.8)0.005†
        One admission or more68 (66.7)34 (33.3) 
        Number of ER visits
        No ER visit52 (83.9)10 (16.1)0.029†
        One or more ER visit72 (68.6)33 (31.4) 
        Specialty
        Medical oncology service55 (76.4)17 (23.6)0.17‡
        Gyne-oncology11 (64.7)6 (35.3) 
        Hematology17 (89.5)2 (10.5) 
        Radiation22 (78.6)6 (21.4) 
        Non-oncology service19 (61.3)12 (38.7) 

        Values are presented as number and percentage (%) unless otherwise stated. *Mann-Whitney U test for independent samples. †Pearson’s Chi-square test, ‡Fisher’s exact test

          • View popup
          Table 4

          - Multiple logistic regression analysis for variables associated with the type of visit.

          CharacteristicsOR95% CIP-value
          Code status
          Support care1.30.5–3.20.60
          Comfort care6.02.3–14.9<0.001
          Number of visits0.60.5-0.90.001

          OR: odd ratio, CI: confidence interval

            • View popup
            Table 5

            - Comparison of number of admissions and number of ER visits by code status over the study period.

            CharacteristicsCode statusP-value
            Full codeSupport codeComfort code
            Admission
            None45 (69.2)12 (18.5)8 (12.3)<0.001
            One or more admissions35 (34.3)41 (40.2)26 (25.5) 
            ER visits
            None38 (61.3)13 (21)11 (17.7)0.022*
            One or more42 (40)40 (38.1)23 (21.9) 

            Values are presented as number and percentage (%). Admission and emergency room (ER) visits over the study period. Only significant comparisons are presented. *Pearson’s Chi-square test

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            Saudi Medical Journal: 43 (4)
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            1 Apr 2022
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            Tele-clinics in palliative care during the COVID-19 outbreak
            Nabil A. Almouaalamy, Amal A. Jafari, Alaa M. Althubaiti
            Saudi Medical Journal Apr 2022, 43 (4) 394-400; DOI: 10.15537/smj.2022.43.4.20210808

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            Tele-clinics in palliative care during the COVID-19 outbreak
            Nabil A. Almouaalamy, Amal A. Jafari, Alaa M. Althubaiti
            Saudi Medical Journal Apr 2022, 43 (4) 394-400; DOI: 10.15537/smj.2022.43.4.20210808
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