Delivering home-based palliative care during COVID-19 in Taiwan: a qualitative study with interdisciplinary team members.

Abstract

Background: The COVID-19 pandemic disrupted palliative care globally, but its impact on home-based palliative care (HBPC) within universal healthcare systems, particularly in Asian contexts, remains understudied. Taiwan's National Health Insurance system supports a well-established HBPC program. This background offers a unique lens to examine how interdisciplinary teams adapted HBPC delivery during different pandemic phases.

Methods: This qualitative study used telephone-based semi-structured interviews with 14 HBPC providers from two medical centers: one in a rural area and one in an urban area. Transcripts were analyzed using inductive thematic analysis. The study design and reporting were guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Four themes related to the impact of the COVID-19 pandemic on the delivery of HBPC were identified: (1) variation in impacts across time, (2) divergent views of the impact on the uptake of HBPC, (3) difficulties in providing adequate care under restrictions, and (4) disrupted care coordination.

Conclusion: Despite Taiwan's well-established palliative care programs, HBPC delivery faced ethical, clinical, and coordination challenges during the pandemic. This experience reveals an urgent need to strengthen virtual care infrastructure, establish clearer interdisciplinary coordination protocols, and provide sustained support for caregivers. These lessons should inform future public health preparedness strategies to ensure that infection control measures do not come at the expense of holistic, patient- and family-centered palliative care.