Death Attitude Profile Research Articles

Patient Acceptance of Death and Symptom Control/Quality of Care Among Terminal Cancer Patients Under Inpatient Hospice Care: A Multicenter Cross-Sectional Study.

Patient attitude to death is associated with outcomes in hospice care settings. This Korean study investigated the association between terminal cancer patient death acceptance and symptom control and quality of care (QoC) as perceived by family caregivers (FCs). A multicenter cross-sectional survey was conducted in nine inpatient hospice care units, and the data of 108 dyads (terminal cancer patients who responded to the revised Death Attitude Profile and their primary FCs) were analyzed. Dyads were dichotomized into high and low groups by death-acceptance level. Multivariate regression models were used to examine the association between death acceptance and symptom severity/QoC as perceived by FCs. Patients in the high acceptance group were younger, educated to a higher level, more religious, and had better-functioning families. Patients with severe shortness of breath were less likely to accept the inevitability of death. FCs of patients with high acceptance of death were more satisfied with QoC, particularly in domains of individualized care and family relationships. In addition, the positive association between patient acceptance and FC satisfaction with care was significant in dyads of young or female patients, patients with a low education level, and patients not cared for by a spouse. Terminal cancer patient death acceptance is associated with symptom control and FC perceived QoC.

EVALUATION FOR NURSES IN KAP ANALYSIS FOR PALLIATIVE CARE PATIENTS WITH HEART FAILURE FACTOR

Heart failure is a prevalent and debilitating condition, requiring effective palliative care to manage symptoms and improve quality of life in terminal stages. Nurses play a critical role in delivering this care, but their knowledge, attitudes, and practices can influence outcomes significantly. Objective: To evaluate the knowledge, attitudes, and practices of nurses working with palliative care patients with heart failure. Methods: A cross-sectional study was conducted in the Nursing Department of Nishtar Hospital, Multan from April 2023 to April 2024. A total of 100 nurses working in the ICU and Cardiology department with heart failure patients admitted for palliative care were included in the study. Data was collected through questionnaires. Knowledge was assessed by the 30-item Palliative Care Quiz for Nursing, attitude regarding death was evaluated by a 32-item Death Attitude Profile and practice was assessed by 6-item perceptions of preparedness and ability to care for the dying (PPACD) R-I scale. Results: The mean knowledge score was 13.8 ± 2.55 with a satisfactory score in only 46% of participants. Only 29% were aware of symptom management in terminally ill patients. The mean attitude score was 133.6 ± 108.4 and the mean practice score was 16.2 ± 5.1. No significant association between knowledge scores and previous palliative care training was noted (r=0.1) but attitude scores were positively related to age and experience. The approach acceptance (r=0.292) and neutral acceptance (r=0.339) were significantly associated with practice. Conclusion: Nurses working in the palliative care unit possessed unsatisfactory knowledge, attitudes, and practices to manage patients with heart failure. Intervention programs and the inclusion of palliative care subjects in the curriculum can improve these results and avert the healthcare hazard.

NURSES’ KAP ANALYSIS FOR PALLIATIVE CARE PATIENTS WITH HEART FAILURE

Heart failure patients admitted for palliative care require specialized management to alleviate symptoms and enhance their quality of life. Nurses play a pivotal role in delivering palliative care; however, their knowledge, attitudes, and practices significantly influence patient outcomes. This study aims to assess these parameters in nurses working in intensive care and cardiology settings. Objective: T o evaluate the knowledge, attitudes, and practices of nurses working with palliative care patients with heart failure. Methods: A cross-sectional study was conducted in the Nursing Department of Nishtar Hospital, Multan from October 2023 to October 2024. A total of 100 nurses working in the ICU and Cardiology department with heart failure patients admitted for palliative care were included in the study. Data was collected through questionnaires. Knowledge was assessed by the 30-item Palliative Care Quiz for Nursing, attitude regarding death was evaluated by a 32-item Death Attitude Profile and practice was assessed by 6-item perceptions of preparedness and ability to care for the dying (PPACD) R-I scale. Results: The mean knowledge score was 13.8 ± 2.55 with a satisfactory score in only 46% of participants. Only 29% were aware of symptom management in terminally ill patients. The mean attitude score was 133.6 ± 108.4 and the mean practice score was 16.2 ± 5.1. No significant association between knowledge scores and previous palliative care training was noted (r=0.1) but attitude scores were positively related to age and experience. The approach acceptance (r=0.292) and neutral acceptance (r=0.339) were significantly associated with practice. Conclusion: Nurses working in the palliative care unit possessed unsatisfactory knowledge, attitudes, and practices to manage patients with heart failure. Intervention programs and the inclusion of palliative care subjects in the curriculum can improve these results and avert the healthcare hazard.

Acceptance status and influencing factors of advance care planning among elderly patients with chronic disease.

The aging population has become a severe public health issue both in China and globally. Over 180 million elderly people in China have chronic diseases, with 75% of them suffering from 2 or more chronic diseases, posing significant threats to their independence and quality of life, and imposing immense mental and disease burdens on patients and their families. So our research analyzes the influencing factors based on the current acceptance status of advance care planning (ACP) among elderly patients with chronic diseases. Using convenience sampling, 120 elderly inpatients from the geriatrics department of a tertiary hospital in Beijing, from June 2023 to March 2024, were selected. Surveys included a general information questionnaire, an ACP acceptance questionnaire, and the revised version of the Terminal Care Experience and Death Attitude Profile. The total ACP acceptance score among elderly patients with chronic diseases was 73.98 ± 9.84 points. Factors influencing ACP acceptance included fear of death, whether the patient had cared for a dying relative, duration of chronic illness, presence of complications, natural acceptance, and religious beliefs (P < .05). The acceptance level of ACP among elderly patients with chronic diseases is moderately high. Medical staff should provide more choices to enhance the life value of elderly patients with chronic diseases based on fully respecting their wishes.

Psychometric evaluation of the persian version of Existential Concern Questionnaire (ECQ) in Iranian general population: a cross-sectional study

BackgroundExistential anxiety is the anxiety that goes beyond objective threats and is related to a person’s existence. Due to the lack of appropriate instrument to measure all five domains of existential anxiety in the Iranian population, this study aimed to examine the psychometric properties of the Existential Concern Questionnaire (ECQ) in the Iranian general population.MethodsThis online cross-sectional survey was conducted from October 9 to December 11, 2023 in Tehran, Iran. We used an Internet-based data collection method. A total of 549 participants completed the questionnaires. The research instruments included the Existential Concern Questionnaire, Existential Anxiety Questionnaire, Meaning in Life Questionnaire, Short version of the Beck Depression Inventory, Intolerance of Uncertainty Scale-12, and Death Attitude Profile Revised. Confirmatory factor analysis, convergent validity, and concurrent validity were used to measure the validity of ECQ. Cronbach’s alpha and split-half methods were employed to assess the reliability of the ECQ.ResultsConfirmatory factor analysis showed a good fit of the unidimensional model (CMIN/DF: 2.802, RMR: 0.066, GFI: 0.914, NFI: 0.911, CFI: 0.941, PNFI: 0.769, PCFI: 0.794, RMSEA: 0.057). Also, the correlation of ECQ with other variables was as expected except for the search for meaning in life (r: 0.010, P = 0.808), which indicates the validity of this questionnaire. The reliability of the questionnaire was also acceptable (Cronbach’s Alpha: 0.935).ConclusionsThe results supported the validity and reliability of the ECQ. The mentioned questionnaire can be used in Iranian general population. Considering the importance of existential anxiety in etiology of some disorders, it is suggested that the future studies focus on validation of the ECQ in different clinical samples and cultures.

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

Background &amp; 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 &amp; 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.

WITHDRAWN: Empowering tomorrow's healers: Unveiling the impact of a palliative education program on nursing students' efficiency in caring for dying patients

WITHDRAWN: Empowering tomorrow's healers: Unveiling the impact of a palliative education program on nursing students' efficiency in caring for dying patients

Cross-Cultural Comparison of Older Adults' Emotional Responses Toward Death: A Pilot Study.

The current study reports preliminary findings from a pilot sample that sought to compare the emotional responses of older adults toward death in Egyptian and Spanish cultures. A cohort of 90 eligible older adults from Egypt and Spain were recruited using a cross-sectional descriptive design. Egyptian participants recorded a significantly higher score in approaching acceptance of death compared to their Spanish counterparts (mean = 21.57, SD = 9.4 and mean = 13.51, SD = 7.11, respectively). Post-hoc test showed there were differences in levels of valence (F[1,86] = 23.88, p < 0.001), indicating that older adults in Spain perceived such images as more unpleasant compared to Egyptian older adults. A significant difference related to death attitude profile scale was noted between Egyptian and Spanish older adults. Egyptian and Spanish older adults demonstrated different attitudes toward death in addition to differences in death anxiety and depression. This preliminary study validates the importance of developing effective nursing strategies to lessen anxiety and fear about death. [Research in Gerontological Nursing, 17(3), 112-120.].

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.

Hemşirelik Son Sınıf Öğrencilerinin Palyatif Bakımda Etik Konulara Yönelik Tutumları

Objective: This study aimed to evaluate decisions of senior undergraduate nursing students on palliative care cases. Methods: The study was conducted with Kocaeli University Faculty of Health Sciences Nursing Department senior students in February 2018. The sample group consisted of 101 students who filled out the forms completely. Data were collected via the ‘Death Attitude Profile’, and ‘Melbourne Decision Making Questionnaire’ and a questionnaire including open-ended “what would you do if you were the nurse” questions about five imaginary cases on ethical issues in palliative care. The thematic text analysis method was used to analyze the open‐ended questions. Results: Of the students participating in the study, 77 (76.2%) were female and 24 (23.8%) were male. A majority reported the necessity of respecting refusal of treatment (89.0%), do not resuscitate if it is futile (76.6%), protecting the patient from futile interventions (74.2%), pain management for patients in pain (71.4%), and telling the patient the truth (59.4%). However, 40.6% in truth telling case, 32.7% in the DNR case, 28.6% in pain management case, 20.6% in futile intervention case and 10.9% in refusal of treatment case reported that they would not do anything. Conclusion: Most of the nursing students’ attitudes towards cases were ethically appropriate. However, it is worrying that in some cases close to half of students would not take action. Thus, we suggest that in nursing education ethical issues regarding palliative care should be presented in a way that nurses would have the courage to take appropriate actions.

Nurses´ Attitudes Towards Dying and Death

Introduction. Death means the irreversible termination of the organism’s vital activities. Dying presents an irreversible state of an incurable disease from which death is expected in due time. The experience of meaning in life is defined as the degree to which an individual understands and sees significance in his life, how and to what extent he feels purpose in life. Aim. The aim of this research was to determine the role of demographic characteristics (gender, age, level of education, religiosity), their relationship with the experience of meaning in the life of nurses, and the relationship between the attitudes of nurses towards death and dying with the experience of meaning in life. Methods. The research was conducted in the period from May to June 2022. The survey was composed of three parts, and was posted on the Facebook social network in the group named Nurses together. A total of 240 participants took part in the research, of which 185 were female nurses and 55 were male nurses, with an average age of 33.05 years (SD=10.10). The instruments that were used in the research were the Purpose in Life Test and Death Attitude Profile – Revised. Results. The obtained results do not indicate that women perceive their life as more meaningful compared to men. Also, healthcare professionals with a higher level of education perceive their life to be significantly more meaningful compared to healthcare professionals with secondary education. Regarding the relationship between the experience of meaning in life and some concepts of acceptance of death, it has been proven that a greater experience of meaning in life can be found in respondents who consider death as a natural process of the journey towards the afterlife. The degree of religiosity was not significantly related to the perception of the meaning of life.Conclusion. Further research is needed to investigate the determinants of mortality in order to more scientifically determine the perception of the experience of meaning in life and attitudes towards death and dying among nurses. The importance of such research is reflected in the effort to raise awareness of the usefulness of the experience of meaning in life in the complete functioning of the individual and the quality of life.

UNDERSTANDING THE RELATIONSHIP BETWEEN COPING STYLES AND DEATH ANXIETY IN OLDER ADULTS

Abstract Research suggests that death anxiety stems from fear of pain, worry about loved ones, and uncertainty about what comes after death. Understanding the relationship between coping styles and attitudes towards death in older adults may help identify individuals who need support with death anxiety. This study explored the relationships between coping styles (active, disengaged, social) and death anxiety (fear, avoidance). We used the Death Attitude Profile Revised and three subscales from the Brief Coping Orientation to Problems Experienced (COPE) Inventory. We conducted linear regressions to determine which coping styles were associated with fear of death and death avoidance. In post-hoc analyses, we investigated the role of spirituality-based coping as a two-item subscale from the active coping scale. All models controlled for age, sex, marital and educational status. The sample included 87 community-dwelling older adults (Mage=72.72 (SD=5.88); 56.32% female; 86.21% White). Higher levels of disengaged coping were significantly associated with greater fear of death and death avoidance (p &amp;lt; .05). Use of social support coping was significantly associated with less fear of death (β = -.10, p &amp;lt; .05). Spirituality-focused coping was associated with lower death avoidance (p &amp;lt; .05). Disengaged coping may indicate higher death anxiety, whereas spirituality and social support coping strategies may indicate lower death anxiety. Our findings have implications for identifying individuals in need of extra support during critical points in the healthcare process. They may also inform design and implementation of psychosocial interventions for communication about healthcare goals in the context of serious or terminal illness.

Analysis of Nurses' Attitudes toward Patient Death.

(1) The aim of the study was to analyze nurses’ attitudes toward a patient’s death, taking into account the emotions they experience and the general perception of death. (2) The study involved 516 nurses from the West Pomeranian Voivodeship in Poland. The research was carried out using the diagnostic survey method using The Death Attitudes Profile Revisited (DAP-R-PL), the Scale of Fear and Fascination with Death, and a demographic questionnaire. (3) Research has shown that nurses accept the phenomenon of death as a natural process of human life; however, they adopt the attitude of fear of death. Most of the respondents experienced: sadness (73.4%), helplessness (58.5%), and regret (43.6%) due to the patient’s death. (4) Both age, sex, marital status, and place of residence significantly influenced the attitudes of nurses toward the patient’s death. Therefore, it is important to provide psychological support or special education in the case of dealing with the fear of death.

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.

Yoğun Bakım Hemşirelerinin Etik Duyarlılık Düzeylerinin Ölüme Karşı Tutumları Üzerine Etkisi: Tanımlayıcı Araştırma

Objective: This study was conducted descriptively to determine the effect of ethical sensitivity levels of intensive care nurses on their attitudes towards death and to examine the influencing factors. Material and Methods: This study was carried out with the participation of 171 intensive care nurses between March 2017 and July 2017 in 4 hospitals affiliated to the Health Directorate in Samsun city center. The data were collected using the nurses' characteristics form prepared by the researcher, the ''Moral Sensitivity Questionnaire (MSQ)'' and the ''Death Attitudes Profile (DAP)''. The data were evaluated using frequency, mean, standard deviation, the Mann-Whitney U test, Kruskal- Wallis test, independent samples t-test, one-way analysis of variance and Spearman correlation analysis. Results: While the nurses' MSQ total mean score value was 77.5±18.8, the total mean score of DAP was 115.1±20.2. The study found that the difference between the MSQ mean score and the variables of gender, education level, satisfaction with their unit and holding an intensive care certificate was statistically significant. The difference between the DAP mean score and the variable of the unit worked in was found to be statistically significant (p<0.05). A weak negative significant correlation was found between the mean scores of MSQ and DAP (r=-0.200, p<0.05). Conclusion: The results showed that the moral sensitivity levels of the nurses and their attitudes towards death were moderate. It was determined that a positive attitude towards death could be developed with an increase in moral sensitivity. It is recommended that nurses serving in critical areas such as intensive care be given training at frequent intervals on ethics and death.

Dying in the emergency service: nurses' attitudes before and after the first critical period of COVID-19.

Background:Death is an increasingly frequent event in hospitals, and nurses are the health professionals who live with this reality the most. The pandemic caused by COVID-19 made this event more present, showing that nurses’ attitudes toward death may influence the care provided to people at the end of life. The objective of this study was to analyze the attitudes of nurses in the emergency service toward death, before and after the first critical period of the pandemic by COVID-19 in Portugal.Methods:A quantitative, comparative, and cross-sectional study was conducted in a hospital in Northern Portugal at 2 different moments: the first in February 2018 and the second in May 2020, after the first critical period of the pandemic by COVID-19. In both moments, data were collected using a self-completion questionnaire, which included the Death Attitude Profile Assessment Scale.Results:The attitudes fear, avoidance, closeness, and escape did not show significant differences. In neutral/neutral acceptance, differences were found between the first and second moments of data collection (P = .01), with a lower mean after the critical period of the pandemic.Conclusions:The results obtained in 2018 and 2020 showed slight changes in attitudes toward death. The need to invest in the training and preparation of nurses who deal directly with death and the dying process was evident. Nurse managers should promote spaces for reflection and team training on death, aiming to reduce the professionals’ suffering and anxiety.

The relationship between death attitude and professional identity in nursing students from mainland China

Professional identity reduces the risk of job burnout in nurses, and attitudes towards death might be a factor affecting nurses' professional identity. Little research has been conducted to directly investigate the relationship between professional identity and death attitudes in nursing students. In addition, there are cultural differences in the formation of death attitudes. It is necessary to explore attitudes towards death in Chinese nursing students and investigate the relationship between death attitudes and professional identity. To investigate the relationship between professional identity and death attitudes in nursing students in mainland China. A cross-sectional study. A total of 2119 nursing students from mainland China were included in this survey. The survey was conducted online. The questionnaire included the Chinese version of the Professional Identification Scale and the Chinese version of the Death Attitude Profile - Revised to measure the nursing students' professional identity and attitudes towards death. The survey also collected the participants' age, gender, institution type, place of residence and self-assessed health state. The professional identity of the nursing students (average scores: 33.68±5.12) from mainland China was above an intermediate level, and their attitudes towards death were positive overall (escape acceptance: 3.37±0.96, approach acceptance: 3.36±0.79, fear of death: 2.88±0.77, death avoidance: 2.74±0.84, neutral acceptance: 2.29±0.77). Among the nursing students, professional identity was correlated with attitudes towards death. Specifically, professional identity was positively correlated with approach acceptance (p<0.001), escape acceptance (p<0.001) and neutral acceptance (p<0.001) but negatively correlated with fear of death (p<0.001) and death avoidance (p<0.001). The nursing students with relatively low professional identity showed stronger death anxiety than those with relatively high professional identity (p<0.001). The outcome of this study suggests that education on life and death and internship experience in palliative care contribute to the development of a high level of professional identity in nursing work.

Attitudes of Polish-speaking and English-speaking medical students towards death during the COVID-19 pandemic

Introduction and purposeLast year, since the spread of COVID-19 pandemic, medical students have faced new challenges, related to growing numbers of people who are and will be hospitalized as well as deaths among patients in healthcare facilities. The purpose of this study, is analysis and comparison of attitudes of Polish-speaking and English-speaking students towards death, during the COVID-19 pandemic.Material and methodThe study was conducted in an electronic form on a group of Polish and foreign exchange students of medical faculties. In total, 277 people aged 19 to 38, including 141 of Polish nationality and 136 of non-Polish nationality, participated in the study. The study used a sociodemographic questionnaire and the Death Attitude Profile (DAP-R-PL). The questionnaire consists of 5 aspects, that relate to different attitudes towards death: fear of death, death avoidance, neutral acceptance, approach acceptance and escape acceptance.ResultsThe most common attitude represented in both groups was neutral acceptance of death. Polish students obtained higher results in scales fear of death and escape acceptance compared to foreing students. The results showed, that the strongest corelation occurs between escape acceptance and fear of death.ConclusionsIn most cases, adaptative beliefs towards death shown by both groups of respondents indicates, that they will handle working with dying patients. However, higher degree of fear of death and escape acceptance amongst Polish students indicates the need to introduce thanatology education into course of studies.

Traumatic experiences and resilience: Associations with mental health, death attitudes, and religion in university students

Resilience may be related to mental health and profound beliefs and attitudes. Utilizing a survey design, we examined relationships among resilience, clinical syndromes, death attitudes, and religion. Mexican university students (N = 161) answered a sociodemographic questionnaire, the Global Post-Traumatic Stress Scale, the Millon Multiaxial Inventory, the Connor-Davidson Resilience Scale, and the Death Attitudes Profile. Pearson correlation analyses showed that resilience correlated inversely with clinical syndromes and fear of death and positively with approach acceptance. Religion entailed higher death attitudes and resilience. Regression analysis revealed that lower anxiety, alcohol use, persistent depression, and higher delusion and death approach acceptance explained resilience.

The COVID-19 pandemic and nurses' attitudes toward death.

Objective:to analyze nurses’ attitudes toward death in a hospital context after the critical period of the COVID-19 pandemic in Portugal.Method:this quantitative, descriptive, exploratory study was conducted in a university hospital and addressed 995 nurses. Revised Death Attitude Profile (DAP-R) was used to collect data, which were analyzed using analytical and inferential statistics.Results:the nurses most frequently agreed with the statements concerning the Neutral/Neutrality Acceptance and Fear. Age, marital status, profession, and unit of work influenced the nurses’ attitudes toward death. During the critical pandemic period, the nurses providing care to patients with COVID-19 presented the following means: Fear (28.89/±8.521) and Avoidance Acceptance (18.35/±7.116), which were higher than the mean obtained in the Escape Acceptance dimension, with significant differences (p=0.004).Conclusion:the nurses held Fear and Avoidance attitudes, revealing the need to qualify and support Nursing workers to cope with the death of those they provide care and manage pandemics and catastrophes.