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End-of-life care in natural disasters including epidemics and pandemics: a systematic review
  1. Marguerite Kelly1,
  2. Imogen Mitchell1,
  3. Iain Walker2,
  4. Jane Mears3 and
  5. Brett Scholz1
  1. 1 Medical School, Australian National University, Acton, Australian Capital Territory, Australia
  2. 2 Research School of Psychology, Australian National University, Acton, Australian Capital Territory, Australia
  3. 3 School of Social Science, Western Sydney University - Liverpool City Campus, Liverpool, New South Wales, Australia
  1. Correspondence to Marguerite Kelly, Medical School, Australian National University, Acton, ACT 2601, Australia; marguerite.kelly{at}


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.

  • terminal care
  • hospice care
  • COVID-19
  • supportive care
  • hospital care
  • home care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors MK designed the study, retrieved and screened the titles/abstracts and full texts of studies, assessed the quality of the included articles, undertook a narrative synthesis, and drafted and revised the article. BS consulted on the study design and analyses, and independently screened full texts. JM independently screened titles/abstracts, and independently assessed the quality of included articles. IM and IW checked the first 17% of data extraction for accuracy and consistency. BS, IM, IW and JM contributed to the development of the narrative synthesis and revised the article critically for clarity and intellectual content. All authors have approved this version for submission.

  • Funding This research is supported by an Australian Government Research Training Programme (RTP) Scholarship and a Dean’s Merit HDR Supplementary Scholarship from the Medical School, Australian National University.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.