Factors associated with psychological distress among end-of-life care volunteers: a systematic review of quantitative and qualitative evidence

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level; individual study p-values not synthesised

• Effect Size: No pooled effect sizes reported; moderate-strength evidence for negative association between death anxiety and volunteer health/well-being, and negative association between volunteer training and depression

• Primary Outcome: Factors associated with psychological distress (anxiety, death anxiety, depression, burnout, perceived stress) among EOL care volunteers

• Nnt Or Sensitivity: Not applicable; no NNT, sensitivity, or hazard ratio calculable from the evidence synthesis approach used. Algorithmic evidence-strength ratings (moderate strength) serve as the primary summary metric

• Confidence Interval: Not reported; no formal meta-analysis conducted

Clinical Application

The finding of a protective association between training and depression is immediately actionable in principle — volunteer training programmes are feasible, low-cost, and already recommended in many palliative care frameworks. However, the evidence is insufficient to specify optimal training content, duration, or format. Service-level factors identified in qualitative evidence (supervision, peer support, organisational culture) are also modifiable but require organisational commitment. In Australia, EOL care volunteering operates within a well-developed hospice and palliative care sector, supported by organisations such as Palliative Care Australia and state-based hospice networks. Volunteer programmes are governed by organisational policies rather than TGA or PBS frameworks, as this is a psychosocial rather than pharmacological intervention domain. RACGP guidelines on palliative care emphasise the importance of the multidisciplinary team, including volunteers, but specific guidance on volunteer psychological support is limited. The findings support advocacy for structured training and supervision standards for EOL volunteers in Australian healthcare settings, consistent with the National Palliative Care Standards. The relatively small and methodologically diverse evidence base means Australian programme managers should treat these findings as hypothesis-generating rather than prescriptive. Volunteers providing direct care or support in hospice, palliative care, and end-of-life settings across community and institutional contexts. Findings are most directly applicable to organised volunteer programmes with structured oversight.

Abstract

BACKGROUND: Volunteers are integral to end-of-life care, providing emotional, spiritual, and practical support. However, they often face emotionally demanding situations with limited training and supervision compared to professionals. Given the limited and fragmented literature on psychological distress experienced by end-of-life volunteers, this systematic review aimed to synthesise existing quantitative and qualitative evidence to identify factors associated with psychological distress. METHODS: We conducted a systematic literature review including qualitative and quantitative evidence. Five databases (MEDLINE, EMBASE, PsycINFO, Cochrane Database and Web of Science) were searched for original studies, complemented by citation and reference searches. Study quality was assessed using the Qualsyst tool. Quantitative findings were synthesised using an algorithm to evaluate evidence strength, and qualitative data were integrated through thematic meta-synthesis. RESULTS: Twenty-six studies (20 quantitative and 6 qualitative studies) met inclusion criteria. Quantitative research examined 49 volunteer-related, 18 service-related, and one volunteer-patient-interaction-related factor associated with anxiety, death anxiety, depression, burnout, and/or perceived stress. Moderate-strength evidence indicated that death anxiety was negatively associated with better health and well-being but unrelated to age, volunteer experience, or training. Furthermore, depression was negatively associated with volunteer training. Qualitative evidence was scarce, but highlighted additional patient-, interaction-, and service-level mechanisms. CONCLUSION: This review identifies a small, methodologically diverse evidence base on factors associated with psychological distress in end-of-life care volunteers. Quantitative evidence suggests a potential protective association between training and depression, though substantial heterogeneity limits firm conclusions. Limited qualitative evidence revealed patient-, interaction- and service-level factors that are rarely captured quantitatively. Robust theory-guided longitudinal studies are needed to better understand distress and resilience in this under-researched group.

References

1. 1.Mebus, L., Pedrosa, D. J., & Pedrosa, A. J. (2026). Factors associated with psychological distress among end-of-life care volunteers: a systematic review of quantitative and qualitative evidence. BMC Palliative Care. https://doi.org/10.1186/s12904-024-01415-5