{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:33:37Z","timestamp":1787020417944,"version":"build-2736575974"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nurs"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hospices and specialized palliative home care services provide care for people with serious, life-threatening illnesses and those at the end of their lives. Disasters cause severe disruptions that exceed the capacity of structures and processes in a society. Given the increasing frequency and impact of disasters, it is crucial that these services maintain their functions for as long as possible, even under adverse conditions, to protect the people entrusted to their care. The aim of this research was therefore to examine whether and to what extent hospices and specialized palliative home care services in Germany are already prepared for disasters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used an explorative, quantitative cross-sectional design. The intention was to conduct a full nationwide survey among nurses in team-leading roles in all hospices and specialized palliative home care services in Germany. A self-developed semi-standardized online questionnaire assessed perceived disaster awareness, organizational preparedness, and staff preparation. Descriptive statistics were used to analyze the survey data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 189 nurses in team-leading roles from all parts of Germany responded to the online survey (29% response rate). Overall, respondents considered disaster preparedness to be an important topic, but this has rarely been reflected in corresponding initiatives. 62% of respondents stated that their service does not have a business continuity plan, or that they were unaware of such a plan. An above-average share of respondents expressed the view that the nursing staff of these services should fulfil additional tasks before, during, and after disasters to ensure the safety of those in their care. Although nurses were generally considered competent to carry out these tasks, 70% of respondents agreed that further preparation for disasters was necessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our survey data suggest that hospices and specialized palliative home care services in Germany need to improve their disaster preparedness to ensure they can continue to provide specialized hospice and palliative care in times of adversity. This requires organizational initiatives in collaboration with other healthcare and civil protection services, as well as personnel development measures. Nurses in leadership positions could play a key role in this.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12912-026-04456-8","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T18:56:28Z","timestamp":1771613788000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Disaster preparedness in hospices and specialized home palliative care services in Germany: a cross-sectional survey of team-leading nurses"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-0500","authenticated-orcid":false,"given":"Julia","family":"Ballmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4664-5210","authenticated-orcid":false,"given":"Michael","family":"K\u00f6hler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6435-3193","authenticated-orcid":false,"given":"Sabine","family":"Pleschberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1856-9337","authenticated-orcid":false,"given":"Michael","family":"Ewers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"issue":"6","key":"4456_CR1","first-page":"278","volume":"16","author":"L Radbruch","year":"2009","unstructured":"Radbruch L, Payne S. White Paper on standards and norms for hospice and palliative care in Europe: part 1. Recommendations from the European Association for Palliative Care. Eur J Palliat Care. 2009;16(6):278\u201389.","journal-title":"Eur J Palliat Care"},{"key":"4456_CR2","unstructured":"WHO: Palliative Care Infografic. 2019. [ https:\/\/www.who.int\/multi-media\/details\/infographic_palliative_care ]."},{"issue":"1","key":"4456_CR3","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12916-017-0860-2","volume":"15","author":"SN Etkind","year":"2017","unstructured":"Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, Murtagh FEM. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med. 2017;15(1):102. https:\/\/doi.org\/10.1186\/s12916-017-0860-2.","journal-title":"BMC Med"},{"key":"4456_CR4","unstructured":"Pleschberger S. Palliativversorgung. Kapitel 49, 4th Edition edn. M\u00fcnchen: Elsevier; 2022."},{"key":"4456_CR5","unstructured":"DHPV. Zahlen zur Hospiz- und Palliativarbeit [https:\/\/www.dhpv.de\/zahlen_daten_fakten.html]"},{"key":"4456_CR6","unstructured":"GKV. Rahmenvereinbarung nach \u00a7 39a Abs. 1 Satz 4 SGB V \u00fcber Art und Umfang sowie Sicherung der Qualit\u00e4t der station\u00e4ren Hospizversorgung vom 13.03.1998, i. d. F. vom 18.11.2024. In. Edited by Spitzenverband G; 2024."},{"issue":"1","key":"4456_CR7","first-page":"22","volume":"17","author":"L Radbruch","year":"2010","unstructured":"Radbruch L, Payne S. White Paper on standards and norms for hospice and palliative care in Europe: part 2. Recommendations from the European Association for Palliative Care. Eur J Palliat Care. 2010;17(1):22\u201333.","journal-title":"Eur J Palliat Care"},{"key":"4456_CR8","unstructured":"Hofrath C, Meng M, Dorin L. Monitoring zur Umsetzung der Pflegeausbildungen. Ergebnisse der ersten Erhebungswelle 2022\/2023 aus dem BIBB-Pflegepanel; 2024."},{"key":"4456_CR9","unstructured":"GKV. Rahmenvertrag nach \u00a7 132d Abs. 1 Satz 1 SGB V zur Erbringung von spezialisierter ambulanter Palliativversorgung (SAPV) vom 26.10.2022. GKV-Spitzenverband; 2022."},{"key":"4456_CR10","unstructured":"UN. Sendai Framework for Disaster Risk Reduction 2015\u20132030; 2015."},{"key":"4456_CR11","unstructured":"UNDRR. The Sendai Framework Terminology on Disaster Risk Reduction. Disaster; 2017."},{"key":"4456_CR12","doi-asserted-by":"publisher","unstructured":"Plagg B, Ballmann J, Ewers M. Hospice and palliative care during disasters: a systematic review. Healthc (Basel). 2023;11(17). https:\/\/doi.org\/10.3390\/healthcare11172382.","DOI":"10.3390\/healthcare11172382"},{"issue":"2","key":"4456_CR13","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1177\/08258597231176410","volume":"39","author":"JE Baker Rogers","year":"2024","unstructured":"Baker Rogers JE. Hospices and Emergency Preparedness Planning: A Scoping Review of the Literature. J Palliat Care. 2024;39(2):161\u201372. https:\/\/doi.org\/10.1177\/08258597231176410.","journal-title":"J Palliat Care"},{"issue":"1","key":"4456_CR14","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1186\/s12912-025-03131-8","volume":"24","author":"MP da Silva Mendon\u00e7a","year":"2025","unstructured":"da Silva Mendon\u00e7a MP, Costa Mendon\u00e7a Lima MI, Tavares Costa Ponte D, Franco Costa AL, Rocha Rego Oliveira AF, Salgadinho Melo CM, Macedo Couto CV, Oliveira Martins T, Carreiro Jorge AS. Palliative care nurses\u2019 perspectives on managing a disaster situation: a focus group study. BMC Nurs. 2025;24(1):474. https:\/\/doi.org\/10.1186\/s12912-025-03131-8.","journal-title":"BMC Nurs"},{"issue":"3","key":"4456_CR15","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1177\/1049909113481401","volume":"31","author":"E McGrady","year":"2014","unstructured":"McGrady E, Blanke SJ, Swanson C. Hospice patient evacuation: a case for using a checklist for safe disaster response. Am J Hosp Palliat Care. 2014;31(3):260\u20138. https:\/\/doi.org\/10.1177\/1049909113481401.","journal-title":"Am J Hosp Palliat Care"},{"key":"4456_CR16","doi-asserted-by":"publisher","first-page":"S82","DOI":"10.1097\/acm.0000000000004528","volume":"97","author":"CA Leaver","year":"2022","unstructured":"Leaver CA, Stanley JM, Goodwin Veenema T. Impact of the COVID-19 Pandemic on the Future of Nursing Education. Acad Med. 2022;97:S82\u20139. https:\/\/doi.org\/10.1097\/acm.0000000000004528.","journal-title":"Acad Med"},{"key":"4456_CR17","doi-asserted-by":"publisher","unstructured":"Goniewicz K, Barten DG. Advancing emergency preparedness in a postpandemic world: global collaboration and innovative approaches for hospitals. Emerg Crit Care Med. 2024;4(3). https:\/\/doi.org\/10.1097\/EC9.0000000000000099.","DOI":"10.1097\/EC9.0000000000000099"},{"key":"4456_CR18","unstructured":"WHO. PAHO: Hospital Safety Index Guide For Evaluators \u2013\u20092nd ed.; 2015."},{"key":"4456_CR19","unstructured":"NHS. NHS Emergency Preparedness Resilience and Response Framework Version 3; 2022."},{"issue":"4","key":"4456_CR20","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1089\/hs.2015.0003","volume":"13","author":"ES Toner","year":"2015","unstructured":"Toner ES, Ravi S, Adalja A, Waldhorn RE, McGinty M, Schoch-Spana M. Doing Good by Playing Well with Others: Exploring Local Collaboration for Emergency Preparedness and Response. Health Secur. 2015;13(4):281\u20139. https:\/\/doi.org\/10.1089\/hs.2015.0003.","journal-title":"Health Secur"},{"key":"4456_CR21","unstructured":"ICN. Core Competencies in Disaster Nursing Version 2.0. https:\/\/www.icn.ch\/sites\/default\/files\/inline-files\/ICN_Disaster-Comp-Report_WEB.pdf"},{"key":"4456_CR22","unstructured":"Leiner DJ. SoSci Survey (Version 3.7.06) https:\/\/www.soscisurvey.de"},{"issue":"5","key":"4456_CR23","doi-asserted-by":"publisher","first-page":"4447","DOI":"10.3390\/ijerph20054447","volume":"20","author":"RK Patel","year":"2023","unstructured":"Patel RK, Pamidimukkala A, Kermanshachi S, Etminani-Ghasrodashti R. Disaster Preparedness and Awareness among University Students: A Structural Equation Analysis. Int J Environ Res Public Health. 2023;20(5):4447. https:\/\/doi.org\/10.3390\/ijerph20054447.","journal-title":"Int J Environ Res Public Health"},{"key":"4456_CR24","unstructured":"WHO, UK Health Protection Agency. Partners: Disaster Risk Management for Health Overview; 2011."},{"key":"4456_CR25","unstructured":"European Union: Disaster preparedness. 2023. https:\/\/civil-protection-humanitarian-aid.ec.europa.eu\/what\/humanitarian-aid\/disaster-preparedness_en"},{"issue":"1","key":"4456_CR26","doi-asserted-by":"publisher","first-page":"135","DOI":"10.24298\/hedn.2024-PROC04","volume":"12","author":"M Ewers","year":"2025","unstructured":"Ewers M, K\u00f6hler M. Consensus-based adaptation of the ICN Core Competencies in Disaster Nursing for German-speaking countries. Health Emerg Disaster Nurs. 2025;12(1):135\u20139. https:\/\/doi.org\/10.24298\/hedn.2024-PROC04.","journal-title":"Health Emerg Disaster Nurs"},{"issue":"4","key":"4456_CR27","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1017\/S1049023X16000492","volume":"31","author":"SJ Lane","year":"2016","unstructured":"Lane SJ, McGrady E. Nursing Home Self-assessment of Implementation of Emergency Preparedness Standards. Prehosp Disaster Med. 2016;31(4):422\u201331. https:\/\/doi.org\/10.1017\/S1049023X16000492.","journal-title":"Prehosp Disaster Med"},{"issue":"1","key":"4456_CR28","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12904-023-01137-0","volume":"22","author":"M Kelly","year":"2023","unstructured":"Kelly M, Mitchell I, Walker I, Mears J, Scholz B. I can\u2019t make all this work. End of life care provision in natural disasters: a qualitative study. BMC Palliat Care. 2023;22(1):21. https:\/\/doi.org\/10.1186\/s12904-023-01137-0.","journal-title":"BMC Palliat Care"},{"key":"4456_CR29","doi-asserted-by":"publisher","first-page":"105509","DOI":"10.1016\/j.ijdrr.2025.105509","volume":"124","author":"D Delforge","year":"2025","unstructured":"Delforge D, Wathelet V, Below R, Sofia CL, Tonnelier M, van Loenhout JAF, Speybroeck N. EM-DAT: the Emergency Events Database. Int J Disaster Risk Reduct. 2025;124:105509. https:\/\/doi.org\/10.1016\/j.ijdrr.2025.105509.","journal-title":"Int J Disaster Risk Reduct"},{"key":"4456_CR30","doi-asserted-by":"publisher","first-page":"100323","DOI":"10.1016\/j.joclim.2024.100323","volume":"18","author":"D Harris","year":"2024","unstructured":"Harris D, Chekuri B, Schroll A, Shah N, Swende L, Uzuegbu C, Young P. The impact of climate change on hospice and palliative medicine: A scoping and narrative review. J Clim Change Health. 2024;18:100323. https:\/\/doi.org\/10.1016\/j.joclim.2024.100323.","journal-title":"J Clim Change Health"},{"key":"4456_CR31","unstructured":"World Health Organization (WHO). Strategic toolkit for assessing risks: a comprehensive toolkit for all-hazards health emergency risk assessment; 2021."},{"issue":"4","key":"4456_CR32","doi-asserted-by":"publisher","first-page":"igab038","DOI":"10.1093\/geroni\/igab038","volume":"5","author":"LJ Peterson","year":"2021","unstructured":"Peterson LJ, Dobbs D, June J, Dosa DM, Hyer K. You Just Forge Ahead: The Continuing Challenges of Disaster Preparedness and Response in Long-Term Care. Innov Aging. 2021;5(4):igab038. https:\/\/doi.org\/10.1093\/geroni\/igab038.","journal-title":"Innov Aging"},{"key":"4456_CR33","doi-asserted-by":"publisher","first-page":"137","DOI":"10.20965\/jdr.2023.p0137","volume":"18","author":"T Kanno","year":"2023","unstructured":"Kanno T, Umemoto M, Ishida C, Iguchi A, Okada R, Kanesaka T. Collective Knowledge and Experience for Resource-Focused Business Continuity Plans Foundation: Survey on How Home-Visit Nursing Operators in Japan Coped with the COVID-19 Pandemic. J Disaster Res. 2023;18:137\u201350. https:\/\/doi.org\/10.20965\/jdr.2023.p0137.","journal-title":"J Disaster Res"},{"key":"4456_CR34","doi-asserted-by":"publisher","unstructured":"Lessinnes S, K\u00f6hler M, Ewers M. Evidence of disaster planning by home care providers: an integrative literature review. Int J Environ Res Public Health. 2023;20(9). https:\/\/doi.org\/10.3390\/ijerph20095658.","DOI":"10.3390\/ijerph20095658"},{"issue":"4","key":"4456_CR35","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1159\/000494971","volume":"65","author":"T Wyte-Lake","year":"2019","unstructured":"Wyte-Lake T, Claver M, Tubbesing S, Davis D, Dobalian A. Development of a Home Health Patient Assessment Tool for Disaster Planning. Gerontology. 2019;65(4):353\u201361. https:\/\/doi.org\/10.1159\/000494971.","journal-title":"Gerontology"},{"key":"4456_CR36","unstructured":"GKV Spitzenverband. Bericht des GKV-Spitzenverbandes zur F\u00f6rderung der Koordination in Hospiz- und Palliativnetzwerken durch Netzwerkkoordinatoren - Entwicklung der Netzwerkstrukturen und deren F\u00f6rderung; 2025."},{"key":"4456_CR37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2016.10.003","author":"A Al Thobaity","year":"2017","unstructured":"Al Thobaity A, Virginia P, Brett W. What are the most common domains of the core competencies of disaster nursing? A scoping review. Int Emerg Nurs. 2017. https:\/\/doi.org\/10.1016\/j.ienj.2016.10.003.","journal-title":"Int Emerg Nurs"},{"issue":"1","key":"4456_CR38","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1186\/s12912-024-02226-y","volume":"23","author":"A Al Thobaity","year":"2024","unstructured":"Al Thobaity A. Overcoming challenges in nursing disaster preparedness and response: an umbrella review. BMC Nurs. 2024;23(1):562. https:\/\/doi.org\/10.1186\/s12912-024-02226-y.","journal-title":"BMC Nurs"},{"key":"4456_CR39","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15965","author":"Y Almukhlifi","year":"2021","unstructured":"Almukhlifi Y, Crowfoot G, Wilson A, Hutton A. Emergency healthcare workers\u2019 preparedness for disaster management: An integrative review. J Clin Nurs. 2021. https:\/\/doi.org\/10.1111\/jocn.15965.","journal-title":"J Clin Nurs"},{"issue":"8","key":"4456_CR40","doi-asserted-by":"publisher","first-page":"3774","DOI":"10.1097\/ms9.0000000000001041","volume":"85","author":"A Salam","year":"2023","unstructured":"Salam A, Wireko AA, Jiffry R, Ng JC, Patel H, Zahid MJ, Mehta A, Huang H, Abdul-Rahman T, Isik A. The impact of natural disasters on healthcare and surgical services in low- and middle-income countries. Ann Med Surg (Lond). 2023;85(8):3774\u20137. https:\/\/doi.org\/10.1097\/ms9.0000000000001041.","journal-title":"Ann Med Surg (Lond)"},{"key":"4456_CR41","doi-asserted-by":"publisher","first-page":"100993","DOI":"10.1016\/j.ienj.2021.100993","volume":"56","author":"O Ghazi Baker","year":"2021","unstructured":"Ghazi Baker O. Preparedness assessment for managing disasters among nurses in an international setting: Implications for nurses. Int Emerg Nurs. 2021;56:100993. https:\/\/doi.org\/10.1016\/j.ienj.2021.100993.","journal-title":"Int Emerg Nurs"},{"issue":"1","key":"4456_CR42","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.outlook.2018.10.005","volume":"67","author":"TG Veenema","year":"2019","unstructured":"Veenema TG, Lavin RP, Bender A, Thornton CP, Schneider-Firestone S. National nurse readiness for radiation emergencies and nuclear events: A systematic review of the literature. Nurs Outlook. 2019;67(1):54\u201388. https:\/\/doi.org\/10.1016\/j.outlook.2018.10.005.","journal-title":"Nurs Outlook"},{"key":"4456_CR43","doi-asserted-by":"publisher","DOI":"10.17226\/25982","volume-title":"The Future of Nursing 2020\u20132030: Charting a Path to Achieve Health Equity","author":"National Academies of Sciences","year":"2021","unstructured":"National Academies of Sciences. Engineering, and Medicine: Nurses in Disaster Preparedness and Public Health Emergency Response. The Future of Nursing 2020\u20132030: Charting a Path to Achieve Health Equity. Washington, DC: National Academies; 2021. https:\/\/doi.org\/10.17226\/25982."},{"key":"4456_CR44","doi-asserted-by":"crossref","unstructured":"D\u00f6ring N. Datenerhebung. In: Forschungsmethoden und Evaluation in den Sozial- und Humanwissenschaften. edn. Edited by D\u00f6ring N. Berlin, Heidelberg: Springer Berlin Heidelberg; 2023:321\u2013570.","DOI":"10.1007\/978-3-662-64762-2_10"}],"container-title":["BMC Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12912-026-04456-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-026-04456-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-026-04456-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:34:29Z","timestamp":1781634869000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12912-026-04456-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4456"],"URL":"https:\/\/doi.org\/10.1186\/s12912-026-04456-8","relation":{},"ISSN":["1472-6955"],"issn-type":[{"value":"1472-6955","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"assertion":[{"value":"13 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in full compliance with the ethical principles set out in the Declaration of Helsinki for medical research involving human subjects, and was approved by the Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Ethics Committee as part of the CRISPALL project (EA2\/258\/24). All participants were provided with detailed information about the study, had their questions answered by the principal investigator, and signed the informed consent form.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"285"}}