"Backlash!"? A qualitative exploration of hospice palliative care staff's ongoing experiences of "living with covid".

Background: "Living with covid" has meant that the SARS-CoV-2 virus has become a background concern for many in the United Kingdom. However, people with terminal conditions remain some of those at higher risk of Covid-19 affecting the quality-of-life left, as well as the amount of life. Little is known about how staff manage the ongoing risks and challenges-to themselves and those they seek to support-when providing palliative care in the context of an airborne transmissible virus.

Objective: To explore the experiences of UK hospice staff of "living with covid" to identify how Covid-19 continues to affect their work and well-being.

Design: An interpretivist qualitative interview study.

Methods: Reflexive thematic analysis of semi-structured online interviews with 12 staff recruited from three hospices in the West Midlands, UK.

Results: We explored how participants' accounts of "living with covid" included several ambivalences: Participants not only sought to assert the importance of not forgetting that time but also wished to "move-on." This included moving Covid-19 to the "background" through embedding systemic adaptions and lessons learnt, while also recognizing that they had to address issues relating to Covid-19 "case-by-case." Finally, participants' wish to move-on and a mostly reactive approach to mitigations meant that they were unable to meaningfully reconcile how asymptomatic transmission promotes patients' quality-of-life left.

Conclusion: Recollections of the difficulties of the Covid-19 public health emergency were part of a "backlash" to any future consideration of mitigations for airborne transmissible viruses and helped justify a "living with (getting) covid" approach. However, this also created uncertainty of how best to support patients who are vulnerable to having the quality and amount of life left compromised by viral infection. The pandemic has brought renewed impetus to re-examine hospice palliative care's ideals and practices in the context of airborne transmissible viruses.