The Role and Response of Palliative Care and Hospice Services in Epidemics and Pandemics: A Rapid Review to Inform Practice During the COVID-19 Pandemic

J Pain Symptom Manage. 2020 Jul;60(1):e31-e40. doi: 10.1016/j.jpainsymman.2020.03.029. Epub 2020 Apr 8.


Cases of coronavirus disease 2019 (COVID-19) are escalating rapidly across the globe, with the mortality risk being especially high among those with existing illness and multimorbidity. This study aimed to synthesize evidence for the role and response of palliative care and hospice teams to viral epidemics/pandemics and inform the COVID-19 pandemic response. We conducted a rapid systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in five databases. Of 3094 articles identified, 10 were included in this narrative synthesis. Included studies were from West Africa, Taiwan, Hong Kong, Singapore, the U.S., and Italy. All had an observational design. Findings were synthesized using a previously proposed framework according to systems (policies, training and protocols, communication and coordination, and data), staff (deployment, skill mix, and resilience), space (community provision and use of technology), and stuff (medicines and equipment as well as personal protective equipment). We conclude that hospice and palliative services have an essential role in the response to COVID-19 by responding rapidly and flexibly; ensuring protocols for symptom management are available, and training nonspecialists in their use; being involved in triage; considering shifting resources into the community; considering redeploying volunteers to provide psychosocial and bereavement care; facilitating camaraderie among staff and adopting measures to deal with stress; using technology to communicate with patients and carers; and adopting standardized data collection systems to inform operational changes and improve care.

Keywords: COVID-19; coronavirus; end of life; hospice; palliative care; pandemic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy*
  • Epidemics*
  • Hospice Care* / methods
  • Humans
  • Observational Studies as Topic
  • Palliative Care* / methods
  • Pandemics*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy*