Association between clinician-reported resource constraints and perceived goal-concordant care among hospitalized patients with COVID-19 and life-threatening illness

Visitor restrictions, caregiver separation, and disruptions to palliative care services were common during the COVID-19 pandemic. While these challenges have been widely described, less is known about whether clinicians perceived such resource constraints to be associated with goal-concordant care (GCC) among patients with COVID-19 and life-threatening illness. To examine associations between resource constraints and perceived GCC among hospitalized patients with COVID-19 and life-threatening illness. We conducted a retrospective cohort study using a Canadian multicentre registry of patients with suspected or confirmed COVID-19 and concurrent life-threatening illness (September 2020 to December 2021). Analyses were restricted to hospitalized patients. Associations between clinician-reported resource constraints and perceived GCC were examined using multivariable logistic regression. Among 455 hospitalized patients, 174 (38.2%) had clinician-reported caregiver availability and/or visitation barriers, and 101 (22.2%) had limitations in home care and/or palliative care unit (PCU) access. Patients affected by caregiver or visitation barriers experienced greater functional decline during illness than those without reported barriers (mean PPS decline 61.5 vs. 44.2 points, p<0.001). In adjusted analyses, caregiver/visitation barriers were associated with lower odds of perceived GCC (OR 0.37, 95% CI 0.22-0.63). Home care/PCU access limitations were also associated with lower odds of perceived GCC (OR 0.54, 95% CI 0.30-0.97). Clinician-reported caregiver/visitation barriers and home care/PCU access limitations were associated with lower odds of perceived GCC. These findings extend previous descriptive literature by quantifying associations between clinician-perceived resource constraints and care alignment. Greater functional decline among patients affected by caregiver/visitation barriers suggests these constraints may have been particularly relevant among patients experiencing rapid deterioration.