Attitudes of the General Population, Cancer Patients, their Family Caregivers, and Physicians toward Dying and Death: A Nationwide Survey

Young Ho Yun,Jung Lim Lee,Ah Reum An,Eun Joo Kang,Tae You Kim,Yu Jung Kim,Na-Ri Lee,Jung Hun Kang,Kyung Hae Jung,Bhumsuk Keam,Jung Hye Kwon,Yoon Jung Chang,Jihye Lee,Jiyeon Choo,Soon Nam Lee,Hwan‐Jung Yun ,Jin Ah Sim ,Hyungbo Shim ,Kyoung Nam Kim ,Seong Ho Yoo ,Siyoung Kim ,Young Rok

doi:10.5539/gjhs.v9n10p201

Abstract

Little is known about people’s attitudes toward death. We aimed to examine attitudes toward death and to investigate their associations with health status in various participant groups. We administered nationwide questionnaires to a total of 4,107 individuals including general Korean population, cancer patients, family caregivers, and physicians. Association of attitudes toward five aspects of dying and death—the ending of life, fearing death because it is painful, anticipating an afterlife, preparing to practice charity and being remembered—and physical, mental, social, and spiritual health status were also analyzed. Attitudes differed. Most (63.4%-76.2%) accepted that death is the ending of life, 45.6%-58.8% feared a painful death, 47.6%-55.0% anticipated an afterlife, 88.5%-93.0% expected to forgive, and 89.9%-94.1% expected to be remembered after death. The general population, cancer patients, and family caregivers had similar attitudes but had more positive attitudes than physicians on the ending of life, fearing a painful death, and anticipating an afterlife. Accepting death as the ending of life and fear of death pain were inversely associated with mental, social, spiritual, or general health status, but participants anticipating an afterlife, expecting to forgive, or expecting to be remembered showed better social, spiritual, or general health status. This nationwide study of various participant groups shows that attitudes toward dying and death were associated with mental, social, spiritual, or general health, but not physical health status. These data suggest that sensitive and skillful discussions of death and dying might contribute to peaceful end of life.

Highlights

Despite the advances of medical diagnosis and treatment, people age (G, 1993) and die in the natural course of a critical disease (Chochinov, Hack, McClement, Kristjanson, & Harlos, 2002)
Psychosocial, and spiritual concerns all arise toward the time of death (Chochinov, 2006), but little research focuses on the influence of the attitudes toward death and dying on cancer patients, their family caregivers, and their physicians (Chochinov, 2006; Griffith et al, 2013)
Because we found differences in attitudes toward dying and death between the non-physician groups and the physician group in univariate analysis, we assessed whether belonging to the physician group was associated with attitudes toward dying and death using models adjusted for propensity scores for being a physician, which we calculated from prediction models including terms for sociodemographic factors

Summary

Introduction

Despite the advances of medical diagnosis and treatment, people age (G, 1993) and die in the natural course of a critical disease (Chochinov, Hack, McClement, Kristjanson, & Harlos, 2002). Since discussing death and dying is considered a social taboo in our culture, we are separated from the actual circumstances of death even of those close to us. This deprives us of the opportunity to deepen our thoughts and achieve a psychological resolution about matters of living and dying. Psychosocial, and spiritual concerns all arise toward the time of death (Chochinov, 2006), but little research focuses on the influence of the attitudes toward death and dying on cancer patients, their family caregivers, and their physicians (Chochinov, 2006; Griffith et al, 2013). Patients with a sense of psychosocial and spiritual well-being might be able to better cope with advancing illness and to find meaning and hope (Chochinov, 2006)

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Discussion

Conclusion