Death Attitude Profile-Revised Research Articles

The Effect of Palliative Spiritual Care Education on Nursing Students' Perception of Spiritual Care and Attitudes towards Death in Turkey: A Quasi-Experimental Study.

The aim of this study was to assess nursing students' perceptions of spiritual care, their attitudes toward death, and the impact of a palliative spiritual care course on these perceptions and attitudes. This study employed a quasi-experimental design with a pre-test/post-test structure and two groups. Data were collected through the Spirituality and Spiritual Care Rating Scale and Death Attitude Profile-Revised. The study group consisted of 106 students experimental (n = 53) and control group (n = 53), who took the public health nursing course in the 2021-2022 academic year. There was a significant difference between the mean scores on the Spirituality and Spiritual Care Rating Scale, as well as the Death Attitude Profile-Revised, between the control group students and the experimental group students. The importance of spirituality and spiritual care should be emphasized in course content and internships by integrating relevant topics into the nursing curriculum and creating more training opportunities to help nurses develop skills for caring for dying patients and their families in palliative care units.

Gender Perspective on Neutral Acceptance of Death: A Study of Nepalese Youth

Background & Objective: This study explores gender differences in the neutral acceptance of death among Nepalese youth. Neutral acceptance is defined as the recognition of death as a natural and inevitable part of life without judgment or strong emotions. Methods: A cross-sectional, explanatory quantitative study was conducted among 196 college students using simple random sampling. Data were collected through the Death Attitude Profile—Revised (DAP-R), specifically focusing on neutral acceptance. The study employed statistical tests such as the Chi-Square test and independent samples t-test to assess gender differences in attitudes toward neutral acceptance. Results: The findings revealed significant gender differences in neutral acceptance of death. Female participants exhibited a higher mean score (M = 4.23) compared to males (M = 3.93). Statistical analysis (p = 0.003) confirmed that females are more likely to adopt a neutral acceptance of death than males. Conclusion & Recommendation: The study concludes that Nepalese females tend to exhibit a higher neutral acceptance of death than males, likely due to cultural and social factors that encourage emotional openness and caregiving roles. These findings suggest the need for further exploration of how gender influences death attitudes and coping mechanisms in Nepalese society. Novelty: This research fills a gap in understanding gender-specific differences in neutral death acceptance, shaped by societal norms and cultural factors. The study provides insights into how male and female perspectives on death vary, offering valuable information for mental health, policy, and cultural discussions around death and gender roles in Nepalese society.

Fear of Death Among the Youth: Gender Perspective in Nepalese Context

Background & Objective: Death is an inevitable truth though people perceive it differently. The study investigates the attitudes of Nepalese youth towards death, addressing a significant research gap in understanding how cultural, religious, and social factors shape their perceptions. Methods: A quantitative cross-sectional study was conducted with 196 college students using a random sampling technique. The Death Attitude Profile-Revised (DAP-R) was employed to measure attitudes toward death, utilizing a five-point Likert scale. The reliability and validity of the instrument were assessed through KMO and Bartlett's Test, factor loading values, and Cronbach’s Alpha. Key Findings: The results indicated a notable difference (p < 0.05) in death anxiety between genders, with females exhibiting higher levels of anxiety compared to males. The study found that a significant percentage of respondents expressed discomfort and anxiety regarding the concept of death, highlighting the need for targeted interventions. Conclusion & Recommendation: The findings underscore the necessity for educational programs that address death anxiety, particularly among young women. Future research should explore the underlying reasons for gender differences in death attitudes and consider cross-cultural comparisons to enhance the generalizability of the results. Implementing support programs could contribute to improved mental health and quality of life for the youth.

The Associations of Perceived Self-Efficacy with Emotional Intelligence, Personality, Resilience, and Attitudes Towards Death among Midwives.

Midwives' self-efficacy can significantly affect the provided care and, therefore, maternal and neonatal outcomes. The aim of the present study was to investigate associations of perceived self-efficacy with emotional intelligence, personality, resilience, and attitudes towards death among midwives in Greece. From 2020 to 2022, a total of 348 midwives were recruited in this descriptive cross-sectional study. The participants were employed as independent professionals, in public hospitals or regional health authorities. Data collection involved five research instruments: the General Self-Efficacy Scale (GSES), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Eysenck Personality Questionnaire (EPQ), the Connor-Davidson Resilience scale (CD-RISC), and the Death Attitude Profile-Revised (DAP-R) scale. The mean score for the GSES was 29.1 (SD = 4.2), suggesting a moderately elevated level of self-efficacy among midwives. The results revealed that higher scores on the GSES were significantly associated with higher scores on the Extraversion subscale (p < 0.001) and lower scores on the Neuroticism (p < 0.001) and Lie (p = 0.002) subscales of the EPQ. Additionally, high self-efficacy was significantly correlated with high emotional intelligence (p < 0.001), high neutral acceptance of death (p = 0.009), and high resilience (p < 0.001). These findings highlight the relationship between the self-efficacy of Greek midwives and various psychological factors, as well as the multifaceted nature of self-efficacy and its importance for midwives' psychological well-being and professional functioning.

Mediating effects of attitude on the relationship between knowledge and willingness to organ donation among nursing students.

The current rate of organ donation in China falls significantly below the global average and the actual demand. Nursing students play a crucial role in supporting and promoting social and public welfare activities. This study primary aims to analyze the levels of knowledge, attitudes, willingness toward organ donation, and attitudes toward death among nursing students, and investigate the mediating role of attitude in the relationship between knowledge and willingness. The secondary aims to identify factors that may influence the willingness. A convenience sample of nursing students completed online-administered questionnaires measuring the level of knowledge, attitudes, and willingness toward organ donation before and after clinical internship. Spearman correlation and mediation analyses were used for data analyses. Before the clinical internship, there were 435 nursing students who had not yet obtained their degrees and were completing their clinical internships. After the internship, this number decreased to 323. The mean score for knowledge before and after the clinical internship (7.17 before and 7.22 after, with no significant difference), the attitude (4.58 before and 4.36 after, with significant difference), the willingness (12.41% before and 8.67% after, with significant difference), the Death Attitude Profile-Revised (DAP-R) score (94.41 before and 92.56 after, with significant difference). The knowledge indirectly affected nursing students' willingness to organ donation through attitude. Knowledge had a direct and positive impact on attitudes (β = 1.564). Additionally, nursing students' attitudes positively affected their willingness (β = 0.023). Attitudes played a mediating role in the relationship between knowledge and willingness (β = 0.035). Additionally, attitude toward death, fear of death, and acceptance of the concept of escape were found to be correlated with their willingness. Organ donation willingness was found to be low among nursing students. Positive attitudes were identified as a mediating factor between knowledge and willingness. Additionally, DAP-R was a related factor. Therefore, it is recommended to focus on improving knowledge and attitude, as well as providing death education to help nursing students establish a positive attitude toward death. These efforts can contribute to the promotion of organ donation.

Investigation on the Attitudes and Perspectives of Medical and Nursing Staff About Euthanasia: Data From Four Regional Greek Hospitals.

The good and benefit of the patient are the main drivers of the decisions that health professionals are asked to make. However, the definition of the good and the actions required for benefit are not always simple and self-evident. The intractable ethical dilemma of euthanasia has been the subject of extensive debates over the years, and numerous studies have been carried out in an attempt to record the attitudes and opinions of both health professionals and the general population. This research aims to investigate the opinions and perspectives of the medical and nursing staff of the four regional hospitals regarding euthanasia and to detect the factors that advocate for and against it. Two hundred and eighteen medical and nursing staff members from four regional hospitals in Lasithi participated in the research, whose opinions and influencing factors were investigated using a questionnaire consisting of four sections. The first included demographic and general characteristics questions; the second was the Euthanasia Attitude Scale (EAS); the third was the Death Attitude Profile-Revised (DAP-R); and the last was the Daily Spiritual Experience Scale (DSES). The SPSS software version 25.0 (IBM Corp., Armonk, NY) was used to analyse the data. Of the total, 78.0% of the participants were women, with an average sample age of 44.5 years. 65.1% were married, 23.4% were physicians, while 76.6% were nurses. The mean Euthanasia Attitude score (70.89) is moderate, ranging from 30 to 120, with higher scores suggesting more favourable sentiments. Euthanasia was viewed positively by 24.3% of respondents. There was no significant difference in positive attitudes between medical and nursing staff. However, the nursing staff had significantly lower average levels of General Orientation for Euthanasia, for the Role of Healthcare Professionals in Euthanasia, Values & Ethics, or Daily Spiritual Experience, and conversely higher levels of scores on Patients' Rights Issues for Euthanasia or Death Acceptance. Health professionals were found to have moderate attitudes about euthanasia, with no significant difference between them, as well as moderate degrees of death and everyday spiritual experience. Overall, a more favourable euthanasia attitude was shown to be strongly associated with individuals who were single, divorced, or widowed, with less death acceptance or more neutral acceptance, but not with daily spiritual experience.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students.

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China. The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes. Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention. This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Investigating the Relationship Between Spiritual Health, Meaning in Life, and Death Attitudes among COVID-19 Patients Discharged from ICUs: A Cross-Sectional Study in Iran.

The COVID-19 pandemic has been shown to affect both physical and mental health. Because of this mental health burden, it is important to pay attention to issues such as the relationship between spiritual health, death attitudes and meaning in life - all issues made more prominent during the pandemic. This study was conducted to determine the correlation between these three factors - spiritual health, meaning in life, and death attitudes, among patients with COVID-19 discharged from the intensive care units of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran.This cross-sectional, descriptive-analytical study was conducted between April 2020 and August 2021 with 260 participants. The data collection instruments were a demographic characteristics questionnaire, Polotzin and Ellison's Spiritual Health Questionnaire, The Meaning in Life Questionnaire (MLQ), and Death Attitude Profile-Revised (DAP-R).The correlation between meaning in life, spiritual health, and death attitudes was determined by Spearman's correlation coefficient. The research results showed that there is an inverse and significant correlation between spiritual health and death attitudes (p = 0.01); an inverse, but insignificant correlation between existential health and subscales of death attitudes, except for the subscales of approach acceptance and neutral acceptance (p > 0.05); and an inverse, but insignificant, correlation between spiritual health and death attitudes, (p > 0.05). In addition, there was an inverse and significant correlation between the presence of meaning in life and escape acceptance (p = 0.002); an inverse and significant correlation between the search for meaning in life and neutral acceptance (p = 0.007); and an inverse and significant correlation between the meaning in life and death attitudes (p = 0.04). Besides, the findings showed an inverse but insignificant correlation between all spiritual health subscales and the meaning in life subscales (p > 0.05). Spiritual health has an inverse correlation with death attitudes.Also, there is an inverse correlation between the total score of spiritual health and death attitudes. Regarding the subscales of spiritual health, there is an inverse correlation between existential health and death attitudes subscales, except for approach acceptance and neutral acceptance. Also, the results showed an inverse and significant correlation between meaning in life and death acceptance and avoidance subscales, and there was an inverse and significant correlation between the meaning in life and death attitudes. Finally, the increase in spiritual health reduces patients' risks of thinking about death. The research results double the significance of the role of nurses, especially those dealing with critically ill patients and those who have experienced severe disease conditions.

Psychometric Properties of the Serbian Version of the Death Attitudes Profile- Revised (DAP-R) Instrument.

The Death Attitude Profile-Revised (DAP-R), one of the most widely used scales for assessing death attitudes is a multidimensional questionnaire capable of measuring a wide range of attitudes towards death. The aim of our study was to assess the reliability and validity of the Serbian version of the DAP-R. The study was conducted in October 2022 and included a total of 547 students of the Faculty of Medicine University of Belgrade (FMUB). Based on Cronbach's alpha coefficient values, our data show good reliability of the DAP-RSp (Serbian version). In our study, the confirmatory factor analysis showed a good fit of the data to the original factor structure with minor discrepancy; compared to the original version (five factors), our analysis yielded one more factor (six factors in total), however, almost all items had factor loading >0.3 on the appropriate scale.

Death attitudes and associated factors among health professional students in China.

China is entering an era of aging population with an increased mortality rate among this category of population. Health professional students' attitudes toward death directly affect their quality of palliative care in their future careers. It is thus important to understand their death attitudes and associated factors to guide future educational and training development. This study aimed to investigate death attitudes and analyze the associated factors among health professional students in China. In this cross-sectional study, 1,044 health professional students were recruited from 14 medical colleges and universities. The Chinese version of the Death Attitude Profile-Revised (DAP-R) was used to evaluate their death attitudes. A multiple linear regression model was used to analyze the influencing factors of attitudes toward death. Health professional students tended to accept death more neutrally. Multivariate analysis showed that their negative death attitudes were associated with age (β = -0.31, p < 0.001) and religious belief (β = 2.76, p = 0.015), while positive death attitudes were associated with age (β = -0.42, p < 0.001), hearing of Advance Care Plan (ACP) (β = 2.21, p = 0.001), and attending funeral/memorial services (β = 2.69, p = 0.016). Our study stresses the importance of including death and palliative care education in healthcare courses among health professional students in China. Incorporation of ACP education along with experiences of funeral/memorial services may help promote health professional students' positive attitudes toward death and improve the quality of palliative care in their future careers.

Nursing Students’ Knowledge, Attitudes and Death Attitude Regarding Palliative Care: A Descriptive Correlational Study

Nursing staff are the main implementers of palliative care and nursing students are the main reserve of palliative care staff, and the importance of palliative care education in China is increasing. A questionnaire-based, cross-sectional survey was surveyed from November 2020 and January 2021 in Chongqing China. The survey included the Revised Chinese version of the Palliative Care Quiz for Nursing, palliative care attitude questionnaire and the Chinese version of the Death Attitude Profile-Revised. The final sample consisted of 1168 nursing students (response rate = 91.5%). The median knowledge was 11.00 (9.00, 12.00), and among the four areas of knowledge, the use of pain medication and psychosocial and spiritual care were less correct, 29.9% and 43.3%, respectively. 63.10% of students scored seven points or more on attitudes regarding palliative care and they had highest scores on neutral acceptance in the attitude of death. In addition, we only found a correlation between knowledge and attitudes. The results of this study showed that nursing students' attitudes toward palliative care and death are positive and should be continued and sustained, but there are still deficiencies in hospice knowledge, and we should increase education and learning content in this problematic area. Therefore, it is strongly recommended that systematic and comprehensive palliative care education be introduced into the Chinese nursing curriculum.

Loneliness, spiritual well-being, and death perception, as well as their risk factors in urological cancer patients.

Cancer patients commonly suffer from loneliness, poor spiritual status, and fear of death; however, these evaluations are rarely revealed in urological cancer patients. Thus, this study aimed to assess the loneliness, spiritual well-being, and death perception, as well as their risk factors in urological cancer patients. A total of 324 urological (including renal, bladder, and prostate) cancer patients and 100 healthy controls were included. The University of California and Los Angeles loneliness scale (UCLA-LS), functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp), and death attitude profile-revised (DAP-R) scores were evaluated. The results showed that the UCLA-LS score was higher, but the FACIT-Sp score was lower in urological cancer patients than in healthy controls. According to the DAP-R score, fear of death, death avoidance, and approaching death acceptance were elevated, but neutral acceptance was lower in urological cancer patients than in healthy controls. Among urological cancer patients, the UCLA-LS score was highest but the FACIT-Sp score was lowest in bladder cancer patients; regarding the DAP-R score, fear of death and death avoidance were highest, but approaching death acceptance was lowest in bladder cancer patients. Interestingly, single/divorced/widowed status, bladder cancer diagnosis, higher pathological grade, surgery, systemic treatment, and local treatment were independent factors for higher UCLA-LS score or lower FACIT-Sp score. In conclusion, urological cancer (especially bladder cancer) patients bear increased loneliness and reduced spiritual well-being; they also carry higher fear of death, death avoidance, and approaching death acceptance but lower neutral acceptance of death.

Terminal Dönem Hasta Yakınlarının Ölüme ve Saygın Ölüm İlkelerine İlişkin Tutumları Arasındaki İlişki

Aim: The aim of this study is to determine the relationship between the attitudes of the relatives of terminal stage patients towards death and principles about dying with dignity. &#x0D; Material and Method: This descriptive cross-sectional study was carried out with 308 patient relatives between 20 December 2021 and 21 March 2022. The data were collected using a “Patient Information Form”, ‘Death Attitude Profile-Revised (DAP-R)’ and ‘Assessment Scale of Attitudes towards Principles about Dying with Dignity’ (ASAPDD). Descriptive statistics, Student t test, One-Way ANOVA test, Kruskal Wallis test, Mann Whitney-U test, Pearson correlation and regression analysis were used to analyze the data.&#x0D; Results: The mean age of the relatives of the patients participating in the study was 34.88±2.32, 86.0% were female. 38.6% of the relatives of the patients stated that the patient in the intensive care unit was their mother/father, and 44.1% stated that the patient stayed in the intensive care unit for 3-7 days. The mean DAP-R total score was 107.30±25.1 and the ASAPDD total score was 30.62±10.70. A positive and highly significant relationship was found between DAP-R and ASAPDD. &#x0D; Conclusions: It was determined that as the attitudes of the relatives of the patients towards death became negative, the level of adopting the principles about die with dignity increased. Health professionals should provide death counseling to the relatives of patients in order to increase the quality of life of patients in the terminal period.

Spanish Version of the Death Attitude Profile-Revised. Translation and Validation Into Spanish.

The Death Attitude Profile-Revised (DAP-R) was developed in English-speaking cultures with the aim of measuring attitudes towards death. This measure consists of 32 items, grouped into five factors (Fear of Death, Avoidance of Death, Neutral Acceptance, Approach Acceptance, and Escape Acceptance). The DAP-R was translated and adapted to Spanish (DAP-RSp), and the psychometric properties were analyzed accross a general sample. The face validity was evaluated by 20 experts in palliative care. N = 417 (X = 39.06years) took part in the validation. DAP-RSp showed adequate internal consistency (Cronbach's alpha ranging from 0.67 for Neutral Acceptance to 0.95 for Escape a Acceptance, and 0.88 for the total), a multitrait scaling analysis and a confirmatory factor analysis reproduced the five dimensions of the original scale. The Spanish version of the DAP-R can be used as a valid scale to assess attitudes towards death in Spanish speaking population.

Nursing Students' Compassion and Their Attitudes Toward Death and the Care of the Dying: An Intervention Study ın Turkey.

This pretest-posttest quasi-experimental study investigated the effect of an educational intervention on nursing students' compassion levels and their attitudes toward death and the care of the dying. Data were collected using the Death Attitude Profile - Revised (DAP-R), the Frommelt Attitude Toward Care Of The Dying (FATCOD) Scale, and the Compassion Scale (CS). The intervention improved participants' DAP-R scores. Participants had higher posttest FATCOD scores than the pretest scores. However, the difference was statistically insignificant. Participants had high CS scores. There was a slight increase in CS scores after the intervention. The results showed that the intervention improved participants' attitudes toward death and the care of the dying. The results also showed that compassion was an important factor.

Nurses' Attitudes Towards Death and Its Relationship With Anxiety Levels.

This study examined nurses' attitudes towards death, anxiety levels, and socio-demographic characteristics affecting their attitudes towards death. Three hundred and eighty-four nurses participated in the study. A questionnaire form, the Death Attitude Profile-Revised (DAP-R), and the Penn State Worry Questionnaire were applied to the nurses. Nurses' attitudes towards death were positive and their level of fear of death was low. Approach acceptance was high in younger ones; the escape acceptance score was higher in single ones. The neutral acceptance score was higher in those who received training on death. A statistically significant positive correlation was found between nurses' anxiety level and escape acceptance score. There was a statistically significant positive correlation between the length of working years of nurses and the escape acceptance and approach acceptance. Nurses should be prepared for and supported on death with in-service training. It will be useful to provide these training programs to nursing students during their education process.

Nursing students' attitudes towarddeath and stigma towardindividuals who attempt suicide.

This study was conducted to assess the stigmatizing attitudes of nursing students towardindividuals who had made suicide attempts as well as these students' attitudes towarddeath. The universe of this descriptive and cross-sectional study consisted of 650 students studying in the fall semester of the 2017-18 academic year. No sample selection was made and a total of 560 students who agreed to participate in the study were reached. The Stigma of Suicide Scale (SOSS) and the Death Attitude Profile-Revised (DAP-R) were used as data collection tools. We found that the students had a moderately positive attitude towarddeath and, in terms of the DAP-R, they exhibited more Neutral Acceptance and Approach Acceptance. It was determined that the stigma against suicide decreased when positive attitudes towarddeath increased. To reduce stigmatizing attitudes towardsuicide, it is important to ensure that students learn about both death and suicide earlier during their education, to design forms of training that aim to eliminate negative beliefs and attitudes towardsuicide attempts and to ensure that this training is sustainable.

Attitudes and Experiences Towards Death of Healthcare Professionals Working in Neonatal Intensive Care Units

Death is an integral part of neonatal intensive care units' (NICUs) environment and little it is known about NICU's staff death concepts. To investigate attitudes and experiences towards death of healthcare professionals (HPs) working in NICUs. Totally 131 participants from six hospitals were included in the study. Research instruments were a questionnaire designed by the authors and the scale Death Attitude Profile-Revised. Gender, marital and educational status, frequent contact with end of life neonates and provision of neonatal end of life care during the research period correlated significantly with dimensions of DAP-R. Impact of NICU neonatal deaths on personal life correlated negatively with fear of death and positively with escape acceptance. Evaluating the interrelationships among personal characteristics, attitudes and experiences towards death among NICU HPs may increase our understanding concerning working with dying neonates and provide direction for educational intervention and continuing professional support.

The effect of immunosuppressive therapy after liver transplantation on activities of daily living and fear of death during the COVID-19 pandemic

BackgroundIn our study, we aimed to investigate the effect of immunosuppressive therapy after liver transplantation on activities of daily living and fear of death during the COVID-19 pandemic. MethodsThis study was conducted as a cross-sectional study with the participation of 213 liver transplant patients hospitalized in the liver transplant center of a university hospital. The data analysis was performed with IBM SPSS (Statistical Package for the Social Sciences) Statistics 25. ResultsKatz's Activities of Daily Living (ADL) were semi-independent and the total score was 11.07 ± 1.59, and the Death Attitude Profile-Revised (DAP-R) total score was 152.23 ± 5.34. It was determined that the DAP-R score was around 150 points in the minimum and maximum score ranges of Katz ADL after liver transplantation. ConclusionsHigh fear of death threatens resilience and can make patients feel lonely, helpless, sad, abandoned and stressed. Clinicians should spend more time with their patients.

Breaking bad news to cancer patients and their families: Attitudes toward death among Turkish physicians and their communication styles

Objectives: To investigate how Turkish oncologists’ attitudes toward death influence their emotional states, outlooks, and communication styles when breaking bad news to cancer patients and/or their families. Design: Cross-sectional study using self-completed questionnaires. Methods: The study sample consisted of 35 physicians working at an oncology department. Physicians completed a quantitative one-time survey developed by the authors and the Death Attitude Profile-Revised (DAP-R). Results: Thirty-one physicians completed the survey and the DAP-R. A mean of 13.39 ± 8.82 minutes was allocated for breaking bad news; 87.1% of the participants avoided using the word “cancer” and 42% avoided using the word “death”. The attitudes characterized by “death avoidance” and “fear of death” were found to be related to the emotional difficulty experienced by the physicians, and were also associated with less eye contact with the patient, and less attention paid to the language used while breaking bad news. Conclusions and implications: It is important for physicians to be aware of how their attitudes toward death affect their communication with patients during bad news. They should be provided in-service professional education, and therapeutic support.