The impact of COVID-19 on palliative care workers across the world: A qualitative analysis of responses to open-ended questions
Open accessAbstract
Objective: With over two million deaths and almost 100 million confirmed cases, the COVID-19 pandemic has caused a “tsunami of suffering.” Health care workers, including palliative care workers, have been severely impacted. This study explores how the COVID-19 pandemic has impacted palliative care workers around the world and describes the coping strategies they have adopted to face their specific situation. Method: We conducted a qualitative analysis of written, unstructured comments provided by respondents to a survey of IAHPC members between May and June 2020. Free text was exported to MAX QDA, and a thematic analysis was performed by reading the comments and developing a coding frame. Results: Seventy-seven palliative care workers from 41 countries submitted at least one written comment, resulting in a data corpus of 10,694 words and a total of 374 coded comments. Eight main themes are emerged from the analysis: palliative care development, workforce impact, work reorganization, palliative care reconceptualization, economic and financial impacts, increased risk, emotional impact, and coping strategies. Significance of results: The pandemic has had a huge impact on palliative care workers including their ability to work and their financial status. It has generated increased workloads and placed them in vulnerable positions that affect their emotional well-being, resulting in distress and burnout. Counseling and support networks provide important resilience-building buffers. Coping strategies such as team and family support are important factors in workers’ capacity to adapt and respond. The pandemic is changing the concept and praxis of palliative care. Government officials, academia, providers, and affected populations need to work together to develop, and implement steps to ensure palliative care integration into response preparedness plans so as not to leave anyone behind, including health workers.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The COVID-19 pandemic led to increased stress, distress, and burnout across the health and social care workforce, including palliative care.
“The COVID-19 pandemic led to increased stress, distress, and burnout across the health and social care workforce,9–12 including palliative care13–16 and exacerbated the need for healthcare staff support internationally.13–17”
From Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing. (2023) · cites this paper as [14]
Staff caring for people with an advanced progressive illness are at risk of stress, distress and burnout.
“Staff caring for people with an advanced progressive illness are at risk of stress, distress and burnout.”
From Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. (2023) · cites this paper as [14]
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.05.026 · Cited by 3,617 · see citing works
The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence
Monaghesh, E., & Hajizadeh, A. (2020) · BMC Public Health · doi:10.1186/s12889-020-09301-4 · Cited by 1,941 · see citing works
Redefining Palliative Care—A New Consensus-Based Definition
Radbruch, L., Lima, L. D., Knaul, F. M., Wenk, R. D., Ali, Z. V., Bhatnaghar, S., Blanchard, C. L., Bruera, E. D., Buitrago, R., Burlá, C., et al. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.04.027 · Cited by 1,264 · see citing works
Self-citationQualitative research methods in health technology assessment: a review of the literature.
Murphy, Dingwall, Greatbatch, Parker, & Watson (1998) · Health Technology Assessment · doi:10.3310/hta2160 · Cited by 1,107 · see citing works
Toward Integrating Qualitative and Quantitative Methods: An Introduction
Steckler, A., McLeroy, K. R., Goodman, R. M., Bird, S. T., & McCormick, L. (1992) · Health Education Quarterly · doi:10.1177/109019819201900101 · Cited by 697 · see citing works
"Any other comments?" Open questions on questionnaires – a bane or a bonus to research?
O’Cathain, A., & Thomas, K. J. (2004) · BMC Medical Research Methodology · doi:10.1186/1471-2288-4-25 · Cited by 658 · see citing works
Wu, Y., Wang, J., Luo, C.-G., Hu, S., Lin, X., Anderson, A. E., Bruera, E., Yang, X.-X., Wei, S., & Qian, Y. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.04.008 · Cited by 530 · see citing works
Risk factors for Covid-19 severity and fatality: a structured literature review
Wolff, D., Nee, S., Hickey, N. S., & Marschollek, M. (2020) · Infection · doi:10.1007/s15010-020-01509-1 · Cited by 511 · see citing works
Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017
Clark, D., Baur, N., Clelland, D., Garralda, E., López–Fidalgo, J., Connor, S. R., & Centeno, C. (2019) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2019.11.009 · Cited by 428 · see citing works
Barriers to Access to Palliative Care
Hawley, P. (2017) · Palliative Care Research and Treatment · doi:10.1177/1178224216688887 · Cited by 333 · see citing works
Pastrana, T., Jünger, S., Ostgathe, C., Elsner, F., & Radbruch, L. (2008) · Palliative Medicine · doi:10.1177/0269216308089803 · Cited by 279 · see citing works
Self-citationThe key role of palliative care in response to the COVID-19 tsunami of suffering
Radbruch, L., Knaul, F. M., Lima, L. D., de Joncheere, C., & Bhadelia, A. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30964-8 · Cited by 235 · see citing works
Self-citationPandemic palliative care: beyond ventilators and saving lives
Arya, A., Buchman, S., Gagnon, B., & Downar, J. (2020) · Canadian Medical Association Journal · doi:10.1503/cmaj.200465 · Cited by 179 · see citing works
Deaths from COVID-19 in healthcare workers in Italy—What can we learn?
Lapolla, P., Mingoli, A., & Lee, R. (2020) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.241 · Cited by 128 · see citing works
The impact of COVID‐19 on the hospice and palliative care workforce
Kates, J., Gerolamo, A., & Pogorzelska‐Maziarz, M. (2021) · Public Health Nursing · doi:10.1111/phn.12827 · Cited by 74 · see citing works
“Is It Safe for Me to Go to Work?” Risk Stratification for Workers during the Covid-19 Pandemic
Larochelle, M. R. (2020) · New England Journal of Medicine · doi:10.1056/nejmp2013413 · Cited by 66 · see citing works
Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic
Pettus, K. I., Cleary, J. F., Lima, L. D., Ahmed, E., & Radbruch, L. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.04.153 · Cited by 58 · see citing works
Self-citationExistential distress among healthcare providers caring for patients at the end of life
Pessin, H., Fenn, N. Q., Hendriksen, E., DeRosa, A. P., & Applebaum, A. J. (2015) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000116 · Cited by 41 · see citing works
Hovenga, E. J. S., Hovel, J., Klotz, J., & Robins, P. (1998) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1998.0050269 · Cited by 10 · see citing works
Presence as a personal project in palliative care: transcending personality
du Plessis, E. (2017) · Nursing and Palliative Care · doi:10.15761/npc.1000137 · Cited by 3 · see citing works
Flagged first, then by citations
3 of the 24 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Garcia, A. C. M., Ferreira, A. C. G., Silva, L. S. R., da Conceição, V. M., Nogueira, D. A., & Mills, J. (2022) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2022.03.003 · Cited by 60 · see citing works
Bradshaw, A., Dunleavy, L., Garner, I., Preston, N., Bajwah, S., Cripps, R., Fraser, L. K., Maddocks, M., Hocaoglu, M., Murtagh, F. E., et al. (2022) · Journal of the Royal Society of Medicine · doi:10.1177/01410768221077366 · Cited by 51 · see citing works
Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective
Wong, P. T. P., & Yu, T. T. F. (2021) · Medicina · doi:10.3390/medicina57090924 · Cited by 50 · see citing works
Nestor, S., O’Tuathaigh, C. M. P., & Brien, T. O. (2021) · Palliative Medicine · doi:10.1177/02692163211028065 · Cited by 42 · see citing works
Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge
Sherman, M., & Klinenberg, É. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116471 · Cited by 41 · see citing works
Gibson Watt, T., Gillanders, D., Spiller, J. A., & Finucane, A. M. (2023) · Palliative Medicine · doi:10.1177/02692163231183101 · Cited by 32 · see citing works
The use of natural language processing in palliative care research: A scoping review
Sarmet, M., Kabani, A., Coelho, L. P., Reis, S. S., Zeredo, J. L. L., & Mehta, A. K. (2022) · Palliative Medicine · doi:10.1177/02692163221141969 · Cited by 34 · see citing works
May, S., Gabb, F., Ignatyev, Y., Ehrlich-Repp, J., Stahlhut, K., Heinze, M., Allsop, M. J., Stanze, H., & Muehlensiepen, F. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19106240 · Cited by 21 · see citing works
Rivera‐Núñez, Z., Jiménez, M. E., Crabtree, B. F., Hill, D., Pellerano, M. B., Devance, D., Macenat, M., Lima, D., Gordon, M., Sullivan, B., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0262606 · Cited by 20 · see citing works
Tackling the Pandemic a Year Later: Burnout Among Home Palliative Care Clinicians
Ercolani, G., Varani, S., Ostan, R., Franchini, L., Yaaqovy, A. D., Pannuti, R., Biasco, G., & Bruera, E. D. (2021) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2021.12.027 · Cited by 20 · see citing works
Hospice and Palliative Care during Disasters: A Systematic Review
Plagg, B., Ballmann, J., & Ewers, M. (2023) · Healthcare · doi:10.3390/healthcare11172382 · Cited by 18 · see citing works
Awal, M. R., & Asaduzzaman (2024) · Higher Education Skills and Work-based Learning · doi:10.1108/heswbl-09-2023-0249 · Cited by 17 · see citing works
Boland, J. W., Kabir, M., Spilg, E. G., Webber, C., Bush, S. H., Murtagh, F., & Lawlor, P. G. (2023) · Palliative Medicine · doi:10.1177/02692163231153067 · Cited by 16 · see citing works
Finucane, A. M., Hulbert-Williams, N. J., Swash, B., Spiller, J. A., Wright, B., Milton, L., & Gillanders, D. (2023) · Palliative Medicine · doi:10.1177/02692163221143817 · Cited by 15 · see citing works
“We are Human too.”: The Challenges of Being an End-of-Life Doula
Hahn, S. J., Butler, E. A., & Ogle, K. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231160900 · Cited by 15 · see citing works
The Impact of COVID-19 on Palliative Care: Perspective of Healthcare Professionals
Tavares, P., Rodrigues, C., & Neto, I. G. (2021) · Cureus · doi:10.7759/cureus.19522 · Cited by 14 · see citing works
Turning the Lens Inward: The Psychological Elements of Clinician Well Being
Shalev, D., Traeger, L. N., Doyle, K. E., Kiser, S. B., Brenner, K. O., Rosenberg, L. B., Jacobsen, J. C., Seaton, M., & Jackson, V. A. (2022) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0548 · Cited by 13 · see citing works
COVID‐19 and hospice community palliative care in New Zealand: A qualitative study
Frey, R. A., & Balmer, D. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.13810 · Cited by 12 · see citing works
Lluch-Sanz, C., Galiana, L., Tomás, J. M., Oliver, A., Vidal‐Blanco, G., & Sansó, N. (2022) · Current Psychology · doi:10.1007/s12144-022-03958-3 · Cited by 11 · see citing works
Harrison, M., Rhodes, T., & Lancaster, K. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-063867 · Cited by 12 · see citing works
Covid-19 Front-Liners: Experiences of Palliative Care Providers in a Tertiary Hospital
Okyere, J., Mensah, A. B., & Kissah-Korsah, K. (2022) · SAGE Open Nursing · doi:10.1177/23779608221132172 · Cited by 12 · see citing works
Seibel, K., Couné, B., Mueller, M., Boehlke, C. S., Simon, S. T., Bausewein, C., & Becker, G. (2022) · Palliative Medicine · doi:10.1177/02692163211059690 · Cited by 9 · see citing works
Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study
Ramos, J. M., Moreno, Ó., Gomez-Martinez, N., Priego, M., Climent‐Grana, E., Martí‐Pastor, A., Portilla, J., Sánchez‐Martínez, R., & Merino, E. (2021) · Medicina · doi:10.3390/medicina57090873 · Cited by 9 · see citing works
Arnal, A. C. I., Galiana, L., Sánchez‐Ruiz, J., & Sansó, N. (2023) · Healthcare · doi:10.3390/healthcare12010004 · Cited by 7 · see citing works
The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care
Hodiamont, F., Schatz, C., Schildmann, E. K., Syunyaeva, Z., Hriskova, K., Rémi, C., Leidl, R., Tänzler, S., & Bausewein, C. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01151-2 · Cited by 7 · see citing works
Early Impacts of COVID-19 on Select Hospices: Operations, Care Delivery, and Service Utilization
Shugarman, L. R., McMillan, L., Mitchell, H., Shah, K., Kirby, T., McManus, R., Woods, K., & Landefeld, S. L. (2022) · Journal of Palliative Care · doi:10.1177/08258597221105149 · Cited by 5 · see citing works
Palliative care and COVID-19: a bibliometric analysis
Bernardis, A., González-Jaramillo, V., Ebneter, A. S., & Eychmüller, S. (2023) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2022-004108 · Cited by 5 · see citing works
Reynolds, A., & Jahromi, A. H. (2021) · Palliative & Supportive Care · doi:10.1017/s1478951521000717 · Cited by 5 · see citing works
Bußmann, A., & Pomorin, N. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01292-4 · Cited by 5 · see citing works
COVID-19: An opportunity to rethink advance care planning conversations in acute serious illness
Auriemma, C. L., Eneanya, N. D., & Courtright, K. R. (2022) · Palliative Medicine · doi:10.1177/02692163211072276 · Cited by 5 · see citing works
Finucane, A., Hulbert-Williams, N. J., Swash, B., Spiller, J. A., Lydon, B., & Gillanders, D. (2022) · AMRC Open Research · doi:10.12688/amrcopenres.13035.2 · Cited by 2 · see citing works
Krikorian, A., Siegert, A., Soto, M. M. R., Palacio, C., Vargas, J. J., Cubides, S. L. P., & Mesa, C. (2023) · Psicooncología · doi:10.5209/psic.88671 · Cited by 2 · see citing works
Effect of Ruling Decision on the Outcome of Construction Litigation Cases
Jaafer, S., & Lamanna, A. J. (2023) · Journal of Legal Affairs and Dispute Resolution in Engineering and Construction · doi:10.1061/jladah.ladr-1028 · Cited by 2 · see citing works
Horvath, M., Kizito, S., Ghiaseddin, R., Irumba, L. C., Mwesiga, M. D., & Ahern, L. N. (2024) · Palliative & Supportive Care · doi:10.1017/s1478951524000889 · Cited by 2 · see citing works
Peters, J., Heckel, M., Breindl, E., & Ostgathe, C. (2024) · Palliative Medicine Reports · doi:10.1089/pmr.2024.0057 · Cited by 2 · see citing works
Urban, R. W., & Winters, R. (. (2025) · Journal of Emergency Nursing · doi:10.1016/j.jen.2025.03.010 · Cited by 1 · see citing works
Milman, D., & Sternadori, M. M. (2022) · Journal of Communication Inquiry · doi:10.1177/01968599221116389
Evaluating a specialist palliative care service in a community setting
Cushen-Brewster, N., Malloy, E., Black, J., Strudwick, R. M., Driscoll-Evans, P., Zeppetella, G., & Bengtson, K. (2023) · British Journal of Healthcare Management · doi:10.12968/bjhc.2023.0015 · Cited by 1 · see citing works
Zhao, D. W., Robinson, S. G., Pozzar, R. A., Leiter, R. E., Walsh, C., Siemens, I., Lovrics, E., Cellarius, V., Mahtani, R., & Jia, Z. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08564-y · Cited by 1 · see citing works
A qualitative analysis of college women’s experiences with dieting
Weinstock, M., Vashro, T. N., Henning, T., & Mazzeo, S. E. (2024) · Journal of American College Health · doi:10.1080/07448481.2024.2355169 · Cited by 1 · see citing works
Palliative Care Training Gaps Remain in Chronic Disease Management Post-COVID-19
Disler, R., Madhuvu, A., Ly, L., Pascoe, A., Hickson, H., Wright, P. J., Subramaniam, S., Glenister, K., Donesky, D., Smallwood, N., et al. (2025) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2025.02.011 · Cited by 1 · see citing works
Finucane, A., Hulbert-Williams, N., Swash, B., Spiller, J. A., Lydon, B., & Gillanders, D. T. (2021) · AMRC Open Research · doi:10.12688/amrcopenres.13035.1
Sandsdalen, T., Helgesen, A. K., Grøndahl, V. A., Bååth, C., Larsson, M., Johansson, C. M., Olsson, C., Tillfors, M., Österlind, J., Hov, R., et al. (2025) · BMC Palliative Care · doi:10.1186/s12904-024-01644-8
Guay, D., Bravo, G., Marcoux, I., Allard, É., & Daneault, S. (2025) · Cahiers francophones de soins palliatifs · doi:10.7202/1119903ar
Hodiamont, F., Schatz, C., Schildmann, E. K., Syunyaeva, Z., Hriskova, K., Rémi, C., Leidl, R., Tänzler, S., & Bausewein, C. (2023) · Figshare · doi:10.6084/m9.figshare.22624963
Bußmann, A., & Pomorin, N. (2024) · Figshare · doi:10.6084/m9.figshare.26633460
Hodiamont, F., Schatz, C., Schildmann, E. K., Syunyaeva, Z., Hriskova, K., Rémi, C., Leidl, R., Tänzler, S., & Bausewein, C. (2023) · Figshare · doi:10.6084/m9.figshare.22624960
Reddy, M., Rao, S., & Sangeetha, N. (2026) · BMC Palliative Care · doi:10.1186/s12904-026-02019-x
- Authors
- Pastrana, T., De Lima, L., Pettus, K., Ramsey, A., Napier, G., Wenk, R., & Radbruch, L.
- Affiliations
- RWTH Aachen University (DE)
- University Hospital Bonn (DE)
- Venue
- Palliative and Supportive Care
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-03-02
- Volume
- 19
- Issue
- 2
- Pages
- 187-192
- ISSN
- 1478-9515 (ISSN-L)
- 1478-9523
- PMC
- PMC7985903
- OpenAlex
- W3135439493
- Cited by
- 48
- References
- 24
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 15 · 2022: 16 · 2021: 7
- FWCI
- 9.29
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Palliative & Supportive Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- COVID-19 pandemic, palliative care workers, healthcare workers, coping strategies, burnout, emotional well-being, workforce impact, work reorganization, occupational risk, resilience, social support networks, palliative care integration, pandemic preparedness
- MeSH terms
- COVID-19, SARS-CoV-2, Health Personnel, Humans, Palliative Care, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
