End-of-life care in natural disasters including epidemics and pandemics: a systematic review

Background Natural disasters are becoming more frequent and severe, and place additional strains on end-of-life care services and users. Although end-of-life and palliative care are considered essential components of disaster planning and response, there are gaps in understandings about their real-life application, and how natural disasters impact end-of-life care. Objective To synthesise existing evidence of the impacts of natural disasters (eg, bushfires, communicable pandemics, etc) on end-of-life care. Methods A systematic review with a narrative synthesis was undertaken. The review was registered on PROSPERO (registration: CRD42020176319). PubMed, Scopus, PsycINFO, Science Direct and Web of Science were searched for studies published in English between 2003 and 2020, with findings explicitly mentioning end-of-life care impacts in relation to a natural disaster. Articles were appraised for quality using a JBI-QARI tool. Results Thirty-six empirical studies met the inclusion criteria and quality assessment. Findings were synthesised into three key themes: impacts on service provision, impacts on service providers and impacts on service users. This review demonstrates that natural disasters impact profoundly on end-of-life care, representing a stark departure from a palliative care approach. Conclusions Clinical practitioners, policy makers and researchers must continue to collaborate for viable solutions to achieve universal access to compassionate and respectful end-of-life care, during natural disasters. Using models, policies and practices already developed in palliative care, involving those most impacted in disaster planning and anticipating barriers, such as resource shortages, enables development of end-of-life care policies and practices that can be rapidly implemented during natural disasters.