Palliative care in humanitarian crises: a review of the literature

Elysée Nouvet,Matthew Hunt,Stephanie Sanger,Laura Banfield,Gautham Krishnaraj,Mollie Sivaram,Lisa J Schwartz,Pedro Favila Escobio Rodriguez,Sonya De Laat,Kevin Bezanson

doi:10.1186/s41018-018-0033-8

Abstract

This paper presents findings from a systematic review of the literature (2005–2017) on palliative care in humanitarian crises (e.g., disasters, armed conflicts, epidemics). This review set out to describe palliative care needs, practices, barriers, and recommendations in humanitarian crisis settings. It contributes to current discussions within the field of humanitarian healthcare aimed at clarifying whether or not and how best to respond to palliative care needs in humanitarian crises.Analysis of 95 peer-reviewed and gray literature documents reveal a scarcity of data on palliative care needs and interventions provided in crises, challenges of care provision particularly due to inadequate pain relief resources and guidelines, a lack of consensus on the ethics of providing or limiting palliative care as part of humanitarian healthcare response, and the importance of contextually appropriate care. These findings suggest that more research and open discussion on palliative care in humanitarian crises are needed. This review contributes to defining palliative care needs in humanitarian crises, building consensus on humanitarian healthcare organizations’ ethical responsibilities towards individuals and families with palliative needs, and developing realistic and context-appropriate policies and guidelines.

Highlights

Palliative care is gaining acceptance as an important orientation for treatment in humanitarian crisis settings
Nouvet et al Journal of International Humanitarian Action (2018) 3:5 response. These include the establishment in November 2016 of a World Health Organization (WHO) working group to develop guidelines for palliative care provision in humanitarian emergencies, a research colloquium on palliative care for children in humanitarian emergencies in Geneva in November 2016, the formation in August 2016 of PALCHASE (Palliative Care in Humanitarian Situations & Emergencies)—an international network of practitioners and scholars advocating for research on and practice of palliative care in humanitarian crises, and the ongoing development of guidelines for pediatric palliative care by Médecins Sans Frontières (MSF) (Smith and Aloudat 2017) and Médecins du Monde (n.d.)
Our hope is that this literature review will help anchor policy development moving forward, while acting as a baseline of thinking about palliative care in humanitarian action in 2017 that can be re-assessed in future years

Summary

Introduction

Palliative care is gaining acceptance as an important orientation for treatment in humanitarian crisis settings. This review undertook to (1) provide detailed description of reported palliative care needs in crisis settings; (2) elucidate the values, ethics, and conditions that may limit or support the provision of palliative care by humanitarian healthcare actors; and (3) synthesize. Unclear in current action-oriented recommendations are the values and considerations that may support or limit explicit commitments to patients’ palliative care needs during humanitarian crises. Drawing on gray and scholarly literature from 2005 to June 30, 2017, we aim to provide a snapshot of needs and practices and think about the place and practical possibility of integrating palliative care in humanitarian response. Our hope is that this literature review will help anchor policy development moving forward, while acting as a baseline of thinking about palliative care in humanitarian action in 2017 that can be re-assessed in future years

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Conclusion