• Sabah Boufkhed, Richard Harding, Tezer Kutluk, Abdullatif Husseini, Nasim Pourghazian, and Omar Shamieh.
• Cicely Saunders Institute, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom. Electronic address: sabah.boufkhed@kcl.ac.uk.
• J Pain Symptom Manage. 2021 Feb 1; 61 (2): e13-e50.

ContextEvidence from prior public health emergencies demonstrates palliative care's importance to manage symptoms, make advance care plans, and improve end-of-life outcomes.ObjectiveTo evaluate the preparedness and capacity of palliative care services in the Middle-East and North Africa region to respond to the COVID-19 pandemic.MethodsA cross-sectional online survey was undertaken, with items addressing the WHO International Health Regulations. Nonprobabilistic sampling was used, and descriptive analyses were conducted.ResultsResponses from 43 services in 12 countries were analyzed. Half of respondents were doctors (53%), and services were predominantly hospital based (84%). All but one services had modified at least one procedure to respond to COVID-19. Do Not Resuscitate policies were modified by a third (30%) and unavailable for a fifth (23%). While handwashing facilities at points of entry were available (98%), a third had concerns over accessing disinfectant products (37%), soap (35%), or running water (33%). The majority had capacity to use technology to provide remote care (86%) and contact lists of patients and staff (93%), though only two-fifths had relatives' details (37%). Respondents reported high staff anxiety about becoming infected themselves (median score 8 on 1-10 scale), but only half of services had a stress management procedure (53%). Three-fifths had plans to support triaging COVID-19 patients (60%) and protocols to share (58%).ConclusionParticipating services have prepared to respond to COVID-19, but their capacity to respond may be limited by lack of staff support and resources. We propose recommendations to improve service preparedness and relieve unnecessary suffering.Copyright © 2020. Published by Elsevier Inc.

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