Background

Disease outbreaks and disasters can result in excess deaths and severe disruption of usual end-of-life care processes. We aimed to: i) synthesise evidence describing the experiences of health and social care staff providing end-of-life care during a disease outbreak or humanitarian disaster, ii) understand the impact on their mental health and wellbeing and, iii) identify means of support.

Methods

A systematic review with meta-synthesis was conducted including studies of health and social care staff providing end-of-life care during disease outbreaks (Ebola, COVID-19, SARs, MERs) or humanitarian disasters (2001–2020). MEDLINE (Ovid), Embase, PsycInfo, Web of Science, and grey literature databases were searched systematically, with forward and backward citation searching of included studies. Any research study designs, in any care settings, were included. Study quality was assessed using an appraisal tool relevant to each study design. Qualitative meta-synthesis was used to analyse the findings, which were then reported narratively. PROSPERO registration: CRD42020181444.

Results

Nineteen studies were included, including 10 Ebola studies and two COVID-19 studies. The analysis generated two superordinate themes: individual experience and organisational responsibilities. Individual experience comprised four themes: dignity in death, positive experiences, negative experience and support for staff. Organisational responsibilities comprised four themes: preparation, adaption, resources, and Personal Protective Equipment (PPE).

Discussion.

No studies quantitively measured the impact of providing end-of-life care on staff mental health and wellbeing, however qualitative studies described experiences in varied settings. Serious disease outbreaks and disasters can expose care staff to abnormally high levels of mortality and suffering. Health and social care systems need to proactively prepare for future events and enable peer support mechanisms that may help mitigate experiences of psychological distress in humanitarian crises.

中文翻译：

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大流行期间提供临终关怀对健康和社会护理人员的心理健康和福祉的影响：系统评价和荟萃分析

 背景

疾病爆发和灾难可能导致死亡人数过多，并严重扰乱通常的临终关怀流程。我们的目标是：i) 综合证据，描述在疾病爆发或人道主义灾难期间提供临终关怀的卫生和社会护理人员的经验，ii) 了解对其心理健康和福祉的影响，以及 iii) 确定支持。

 方法

进行了荟萃综合系统评价，包括对在疾病爆发（埃博拉、COVID-19、SAR、MER）或人道主义灾难（2001-2020）期间提供临终关怀的卫生和社会护理人员的研究。系统检索 MEDLINE (Ovid)、Embase、PsycInfo、Web of Science 和灰色文献数据库，并对纳入的研究进行前向和后向引文检索。任何护理环境中的任何研究设计都包括在内。使用与每个研究设计相关的评估工具来评估研究质量。使用定性荟萃分析来分析研究结果，然后进行叙述性报告。 PROSPERO 注册号：CRD42020181444。

 结果

纳入了 19 项研究，其中包括 10 项埃博拉研究和 2 项 COVID-19 研究。分析产生了两个重要主题：个人经验和组织责任。个人经历包括四个主题：死亡的尊严、积极经历、消极经历和对员工的支持。组织职责包括四个主题：准备、适应、资源和个人防护装备 (PPE)。

 讨论。

没有研究定量测量提供临终关怀对员工心理健康和福祉的影响，但定性研究描述了不同环境下的经历。严重的疾病爆发和灾难可能会使护理人员面临异常高的死亡率和痛苦。卫生和社会护理系统需要积极为未来事件做好准备，并启用同伴支持机制，以帮助减轻人道主义危机中的心理困扰。