Volume : 13, Issue : 07, July – 2026
Title:
END-OF-LIFE CARE IN SAUDI ARABIA: A SYSTEMATIC LITERATURE REVIEW OF CLINICAL MANAGEMENT, COMMUNICATION, ETHICAL CHALLENGES, AND CULTURAL CONSIDERATIONS
Authors :
Renad Naji Alsaedi, Hissah Naif Al-Dhubayban
Abstract :
Background:End-of-life care in Saudi Arabia operates within a unique cultural and religious context that significantly influences clinical practice, communication patterns, and ethical decision-making. Despite growing recognition of palliative care needs, substantial gaps remain in understanding how Islamic principles, cultural norms, and healthcare system factors shape end-of-life care delivery. This systematic review synthesizes current evidence on clinical management practices, communication approaches, ethical challenges, cultural and religious considerations, and barriers and facilitators affecting end-of-life care in Saudi Arabian healthcare settings.
Methods:A comprehensive systematic literature review was conducted following PRISMA guidelines. Two databases (Google Scholar and PubMed) were searched using structured queries combining terms related to end-of-life care, palliative care, Saudi Arabia, clinical management, communication, ethical challenges, and cultural considerations. After deduplication, 93 unique records underwent two-stage screening: abstract screening (threshold ≥4.0) and full-text screening (threshold ≥4.5) against five inclusion criteria covering the Saudi Arabian population and setting, end-of-life and palliative management, communication and decision-making, socio-cultural and ethical factors, and systemic barriers and facilitators. Data extraction focused on six domains: study design and methods, key findings on clinical management, communication and decision-making findings, ethical challenges identified, cultural and religious considerations, and barriers and facilitators.
Results:From 122 initially identified records, 37 studies were included in the final synthesis after removing 29 duplicates, excluding 54 at abstract screening, and excluding 2 at full-text screening. The included studies revealed significant knowledge gaps among healthcare professionals regarding do-not-resuscitate orders and advance care planning, with substantial confusion between DNR and euthanasia. Communication challenges were pervasive, characterized by family-centered decision-making that often excluded patient autonomy, limited truth-telling practices, and inadequate training in communication skills. Ethical tensions emerged between Western biomedical principles and Islamic values, particularly regarding treatment withdrawal, informed consent, and patient autonomy. Cultural and religious considerations profoundly shaped care delivery, with Islamic principles emphasizing sanctity of life, family involvement, and spiritual care. Major barriers included insufficient palliative care training, resource limitations, lack of standardized policies, and organizational constraints, while facilitators included specialized palliative care services, interdisciplinary collaboration, and culturally adapted care models.
Conclusions:End-of-life care in Saudi Arabia requires culturally sensitive approaches that integrate Islamic principles with evidence-based palliative care practices. Significant improvements are needed in healthcare professional education, development of unified national policies, enhancement of communication training, and expansion of palliative care services. Future research should focus on patient and family perspectives, effectiveness of culturally adapted interventions, and implementation of advance care planning frameworks that respect both patient autonomy and family involvement within the Saudi cultural context.
Cite This Article:
Please cite this article in press Renad Naji Alsaedi et al., End-Of-Life Care In Saudi Arabia: A Systematic Literature Review Of Clinical Management, Communication, Ethical Challenges, And Cultural Considerations.,, Indo Am. J. P. Sci, 2026; 13(07).
REFERENCES:
1. Alhatim NA, AlShehery MZ: Exploring the challenges in palliative care as perceived by the Saudi physicians: a cross-sectional study. Cureus. 2024. 10.7759/cureus.66579
2. Alghamdi, Alzahrani, Alswat, et al.: Family Medicine Residents’ Knowledge and Attitudes About End-of-Life Care in Taif City, Saudi Arabia. Cureus. 2023. 10.7759/cureus.50652
3. Alsolami FN, Alharbi IM, Alsulami JNBJ, et al.: Assessment of knowledge and attitudes toward palliative care and end-of-life decision-making in Saudi Arabia: a cross-sectional study. Cureus. 2023. 10.7759/cureus.45781
4. Alwazzeh MJ, Aljoudi AS, Subbarayalu AV, et al.: Knowledge gaps, attitudes, and practices regarding end-of-life medical care among physicians in an academic medical center. Electronic journal of general medicine. 2023. 10.29333/ejgm/12901
5. Alrimali AM, Alreshidi NM: Evaluating ICU nurses’ education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study. BNJ (Belitung Nursing Journal). 2024. 10.33546/bnj.3040
6. Basubrin: Assessing Medical Students’ Understanding of Do-Not-Resuscitate (DNR) Orders. Cureus. 2024. 10.7759/cureus.69132
7. Felemban, Merzoug, Alshammari, Alshammari, Alruwaili: Knowledge, attitudes, and applied practices regarding “Do Not Attempt Resuscitation” among healthcare workers in Aljouf, Saudi Arabia: a multicenter cross-sectional questionnaire-based survey. Resuscitation Plus. 2026. 10.1016/j.resplu.2026.101411
8. Alsayed EF, Tayeb BO, Boker A: Advanced medical directives or written living wills among Saudi intensive care units, current practice and need for optimization: Opinion of trainees. Saudi Critical Care Journal. 2022. 10.4103/sccj.sccj_13_22
9. Alshammari FA, Sim J, McErlean G, Lapkin S: Registered Nurses’ beliefs about end‐of‐life care: A mixed method study. Nursing open. 2023. 10.1002/nop2.2027
10. Qutob, Aljarba, Alhusaini, et al.: The Perspective of the General Population in Saudi Arabia towards Do-N ot-Resuscitate (DNR) Orders: A Cross-Sectional Study. Healthcare (Basel, Switzerland). 2023. 10.3390/healthcare11142073
11. Alshehri H, Wolf A, Öhlén J, Olausson S: Healthcare professionals’ perspective on palliative care in intensive care settings: An interpretive descriptive study. Global qualitative nursing research. 2022. 10.1177/23333936221138077
12. Mani ZA: Bridging cultural gaps in end-of-life care: the experiences of interna tional charge nurses in Saudi Arabia. BMC Nursing. 2024. 10.1186/s12912-024-02514-7
13. Alodhailah AM, Almutairi A, Alshaibany FF, Eid T: Nurses’ Roles in Supporting Family End-of-Life Decision-Making in Inte nsive Care Units: A Phenomenological Study.
14. Alanazi NH: Intensive care unit nurses’ experiences in caring for End-of-Life pati ents in Saudi arabia: A qualitative study. International Journal of Environmental Research and Public Health. 2024. 10.3390/ijerph21070931
15. Alsalamah, Alsalamah, Aldrees, Alslamah, Yousif, Fawaz: Barriers and Facilitators of Working with Dying Patients among Novice Nurses in Saudi Arabia. Healthcare (Basel, Switzerland). 2022. 10.3390/healthcare10112259
16. Almalki N, Boyle B, O’Halloran P: What helps or hinders effective end-of-life care in adult intensive ca re units in Middle Eastern countries? A systematic review. BMC Palliative Care. 2024. 10.1186/s12904-024-01413-7
17. Ibrahim, Zaghamir: Palliative and end-of-life nursing care in Saudi Arabia: A systematic review of nursing practices, challenges, and patient-family outcomes. Palliative & supportive care. 2026. 10.1017/S147895152610203X
18. Woodman A, Waheed KB, Rasheed M, Aḥmad S: Current state of ethical challenges reported in Saudi Arabia: a system atic review & bibliometric analysis from 2010 to 2021. BMC Medical Ethics. 2022. 10.1186/s12910-022-00816-6
19. Mobarki K, Guo P, Mobarki MI, et al.: End‐of‐Life Care Experiences, Attitudes and Perceptions of Intensive C are Clinicians in Middle Eastern Countries: A Systematic Integrative R eview. Nursing in Critical Care. 2025. 10.1111/nicc.70201
20. Alqahtani AJ, Crossland L: Caring at the crossroads: Exploring end-of-life challenges for advance d heart failure patients in saudi emergency departments. Australasian Emergency Care. 2025. 10.1016/j.auec.2025.09.004
21. Alqahtani AJ, Mitchell GK, Crossland L, Alyami HM: Enhancing end-of-life care for advanced heart failure patients in Saud i Arabian emergency departments (EDs): Perspectives of ED staff on cha llenges. 10.1016/j.auec.2025.01.004
22. Callaghan S, Sadler K, Abudari G: Goals of care and advance directives: A 1-year retrospective analysis of a tertiary centre in Saudi Arabia.
23. Family satisfaction with the end-of-life discussions and resuscitation orders for patients with severe COVID-19: a multicenter study in Saud i Arabia. BMC medical ethics. 2025. 10.1186/s12910-025-01248-8
24. Sadler, Altarifi, Callaghan, et al.: Intensity of Care at the End-of-Life in Pediatrics: A Single Center An alysis With Implications for Advanced Care Planning in Saudi Arabia. The American journal of hospice & palliative care. 2026. 10.1177/10499091251339615
25. Sultan, Jong d, Alsaywid, Nooijer d: A Qualitative Study of Stakeholders’ Perspectives of Implementing Inte rprofessional Shared Decision-Making Education in Palliative Care. Cureus. 2023. 10.7759/cureus.44039
26. Almazyad, Aljofan, Abouammoh, et al.: Enhancing Expert Panel Discussions in Pediatric Palliative Care: Innov ative Scenario Development and Summarization With ChatGPT-4. Cureus. 2023. 10.7759/cureus.38249
27. Almalki N, Boyle B, O’Halloran P: What helps or hinders end-of-life care in adult intensive care units i n Saudi Arabia? A mixed-methods study protocol. Healthcare. 2024. 10.3390/healthcare12232489
28. Alrashidi N: … ICU NURSES’EDUCATION, PRACTICE, AND COMPETENCE IN PALLIATIVE AND END -OF-LIFE CARE IN SAUDI ARABIA: A CROSS-SECTIONAL ….
29. Alzahrani AA, Alonazi F, AlOtaibi NH: Family Perception Toward Bereavement Services in Palliative Care Medic ine, King Fahad Medical City, Riyadh City.
30. Alodhialah AM, Almutairi M: Exploring palliative care access among older adults in Saudi Arabia: i mplications for nursing practice. BMC Nursing. 2025. 10.1186/s12912-025-03658-w
31. Copans J: Challenges to end-of-life care for advanced heart failure patients in emergency departments in Saudi Arabia. 2022. 10.14264/d6143e2
32. Al S, Sroor, Ghareeb, Alhassanin, Ateya: Discussion of the do-not-resuscitate (DNR) orders with the family care givers of cancer patients: An example from a major cancer center in Sa udi Arabia. Palliative & supportive care. 2024. 10.1017/S1478951523001876
33. Hasan MK: Challenges associated with end-of-life care in Saudi Arabia. 2023. 10.5772/intechopen.110283
34. Alodhialah, Almutairi, Almutairi: Ethical and Legal Challenges in Caring for Older Adults with Multimorb idities: Best Practices for Nurses. Healthcare (Basel, Switzerland). 2024. 10.3390/healthcare12161585
35. AbuYahya O, Abuhammad S, Hamoudi B, Reuben R, Yaqub M: The do not resuscitate order (DNR) from the perspective of oncology nu rses: a study in Saudi Arabia. International Journal of Clinical Practice. 2021. 10.1111/IJCP.14331
36. Muaygil, Abouammoh, Madkhali, Almana, Aldekhyyel: Truth-telling and devastating disclosures Navigating the tension betwe en ethical and cultural obligations in Saudi Arabia. BMC medical ethics. 2025. 10.1186/s12910-025-01307-0
37. Ali, Abdelaal, Abdelqader, Albarqi: Fasting at Life’s End: Exploring the Spiritual and Medical Tensions in Palliative Care. Nursing & health sciences. 2025. 10.1111/nhs.70247