The COVID-19 pandemic caused challenges across healthcare services. March to June 2020 was arguably where Queensland was most affected with lockdowns, restrictions, social distancing and uncertainty. The virus posed challenges for specialist palliative care services, namely maintaining compassion with the uncertainty around the workload and delivery of services. The aim of this study is to examine the impact of the COVID-19 pandemic on the palliative care service (PCS) at the Gold Coast Hospital and Health Service (GCHHS).

A retrospective audit of all patients admitted to the PCS within the GCHHS, from the period of March 1st to June 30th in 2019 and in 2020 were compared. All three arms of the service were examined: the inpatient unit, community team and consult liaison team. Data was collated from PCOC datasets, and from the GCHHS health analytics department. Human Research and Ethics Committee approval was sought, and exemption granted as this was a quality assurance study. 

No difference in the demographics or PCOC assessment scores was noted between years. The community service showed a reduction in home visits and outpatient clinic reviews, with a significant increase in telehealth reviews and home deaths (Table 1). The inpatient unit showed no significant difference in the number of admissions or length of stay (LOS) however complaint letters were nearly three times higher during the pandemic. There was no difference in number of referrals to the consult liaison team, however the LOS was significantly reduced by half during the pandemic. 

As the COVID-19 pandemic continues there is a need to reflect on lessons learned thus far. This audit demonstrated the increased use of technology to support patients and the need to consider other mechanisms to deliver care. The virus has affected healthcare delivery, and there is ongoing need for innovation to achieve effective, compassionate palliative care services.

Table 1. Service modality within the community palliative care service

	2019	2020
Cancer Referrals	359	429
Non cancer referrals	95	86
Home visits	303	154
Outpatient appointments	376	55
Telehealth consultations	702	1375
Home deaths	36	51

Background
The COVID-19 pandemic has resulted in health professionals facing unprecedented changes and challenges in practice. Responding to humanitarian crises such as COVID-19, involves saving lives and reducing suffering. As such, palliative care is an essential component of the response. 

Aims
To explore the health professionals’ perspectives of the role of palliative care during the COVID-19 pandemic by analysing their views and experiences expressed in articles and blogs located via Twitter. 

Method
The study utilised qualitative content analysis of 33 online articles and blogs written by health professionals and posted on Twitter between 1 February 2020 to 30 June 2020. The online articles were included if the URL was posted on Twitter and was written by a health professional.  

Results
Most of the health professionals had a background in palliative care (n=22) and were from Europe, North America, Oceania and Asia. The overarching themes were: 1) the concept of palliative care as an essential component of care; 2) positioning palliative care as every health professional’s business; and 3) palliative support and guidance for all health professionals during the COVID-19 pandemic. 

Conclusions
The loss of lives on a large scale during the pandemic has highlighted the importance of palliative care education and the need for increased support for all health professionals to manage death and dying. Equipping all health professionals with palliative care skills can be facilitated by specialist palliative care and in turn, reduce the workload of specialist palliative care and improve palliative care delivery to all in need.  

Background
In Australia by the end of 2020, there were 28,408 COVID-19 cases and 909 deaths due to COVID-19. Also, during 2020, palliative care services implemented major changes to prepare for the stark reality of the pandemic. The impact of these changes on experiences of care remains unknown.

Aim
To explore the impact of receiving care during the COVID-19 pandemic on patients and carers 

Methods
Our study was a mixed methods study with statistical analysis of national survey data to determine the type of impact of COVID-19 on experiences of care, and qualitative analysis to help elaborate upon quantitative results. Eligible participants were patients receiving specialist palliative care during September−December 2020, and their unpaid carers. 

Results/ Findings
Fifty-seven palliative care services participated in the study (39 inpatient, 18 community services). 523 patient and 476 carer surveys were analysed. Combined, most respondents reported that COVID-19 had no impact on their experiences of care (patients 70%, carers 62%). Nearly one in five reported a negative impact (patients 17%, carers 18%). This included concerns about infection control, poorer healthcare access and care quality, relationship/visitor burden, restrictions to personal freedoms, increased fear of contagion, plus cumulative stress and strain. A similar proportion of carers, although fewer patients, reported a positive impact on their experiences of care (patients 14%, carers 19%). Positive impacts included improved infection control, healthcare access and relationship/visitor management. 

Conclusion
Although most respondents felt that their experiences of care in 2020 did not change due to COVID-19, a polarising effect on experiences of care was evident. Improving infection control, healthcare access and visitation policies in specialist palliative care contexts may help. Tailored interventions to help support patients and carers with their fears about becoming infected with COVID-19, and the cumulative stress and strain due to COVID-19 may be useful.