Maintaining Home-Based End-of-Life Care During Disasters: A Systematic Review of Hospice Nursing Roles in Preparedness, Communication, and Care Continuity
Paulina Kasperska-DębowskaPurpose:
Home-based hospice and palliative care services depend on coordinated clinical assessment, medication access, caregiver support, and communication systems that can be disrupted by disasters and public health emergencies. This review synthesized evidence on how hospice and home-based palliative care nurses contribute to disaster preparedness, response, and continuity of end-of-life care.
Methods:
A systematic review was conducted using PubMed/MEDLINE, CINAHL, Scopus, Web of Science, Cochrane Library, Google Scholar, and citation searching. Eligible sources addressed hospice, home-based palliative care, community palliative care, or end-of-life care in disaster, emergency preparedness, evacuation, pandemic, public health emergency, or large-scale service disruption contexts and included nursing-relevant findings. Heterogeneous evidence was synthesized narratively.
Results:
Thirty sources were included. Nurses contributed to patient risk stratification, emergency planning, communication redundancy, visit prioritization, medication and equipment continuity, caregiver teaching, telehealth triage, ethical decision-making, evacuation support, and workforce safety. Nursing roles were often embedded within organizational or interdisciplinary descriptions rather than specified as distinct management responsibilities.
Conclusions:
Disaster preparedness in home-based end-of-life care should be treated as a routine component of care management, not only as regulatory compliance. Home health and hospice organizations should use nurse-informed risk stratification, caregiver-centered emergency plans, explicit ethical guidance, communication backups, medication and equipment contingency planning, and staff safety protocols to preserve comfort and continuity during emergencies.