mortality disproportionally affects nursing homes, creating enormous
pressures to deliver high-quality end-of-life care. Comprehensive
palliative care should be an explicit part of both national and global
COVID-19 response plans. Therefore, we aimed to identify, review, and
compare national and international COVID-19 guidance for nursing homes
concerning palliative care, issued by government bodies and professional
associations. We performed a directed documentary and content analysis
of newly developed or adapted COVID-19 guidance documents from across
the world. Documents were collected via expert consultation and
independently screened against prespecified eligibility criteria. We
applied thematic analysis and narrative synthesis techniques. We
identified 21 eligible documents covering both nursing homes and
palliative care, from the World Health Organization (n = 3), and eight individual countries: U.S. (n = 7), The Netherlands (n = 2), Ireland (n = 1), U.K. (n = 3), Switzerland (n = 3), New Zealand (n = 1), and Belgium (n = 1).
International documents focused primarily on infection prevention and
control, including only a few sentences on palliative care–related
topics. Palliative care themes most frequently mentioned across
documents were end-of-life visits, advance care planning documentation,
and clinical decision making toward the end of life (focusing on
hospital transfers). There is a dearth of comprehensive international
COVID-19 guidance on palliative care for nursing homes. Most have a
limited focus both regarding breadth of topics and recommendations made.
Key aspects of palliative care, that is, symptom management, staff
education and support, referral to specialist services or hospice, and
family support, need greater attention in future guidelines.