Narrative Nursing–Based Palliative Intervention for Terminally Ill Patients: A Quasi-Experimental Study

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer—A cross-sectional survey in China

Background: Women with breast cancer suffer high levels of stress due to their disease-induced emotional, cognitive, behavioral and physical problems which increase their metacognitive beliefs, death anxiety, and rumination, disrupt the treatment process, and exert a negative impact. The present study aimed to investigate the effectiveness of positive thinking training on perceived stress, metacognitive beliefs, and death anxiety in women with breast cancer in Ahvaz in 2019. Methods: This was a quasi-experimental study with pretest-posttest control group design. Statistical population consisted of all women with breast cancer visiting Shafa Health Center of Ahvaz in 2019, among whom 30 women were selected as the sample using convenience sampling. Cancer patients were randomly divided into intervention (n=15) and control (n=15) groups. The research instruments included the Perceived Stress Scale, the Metacognitions Questionnaire (MCQ-30), and the Scale of Death Anxiety (SDA). Univariate and multivariate analysis of covariance were used to analyze data. Results: Results suggested that positive thinking training reduced perceived stress, metacognitive beliefs and death anxiety in women with breast cancer in the intervention group compared with those in the control group (P<0.001). Conclusion: According to the results of the study, positive thinking training was effective in reducing perceived stress, metacognitive beliefs, and death anxiety in women with breast cancer.

BackgroundVarious factors have been found to be associated with high levels of death anxiety experienced by oncology nurses. The aim of this study was to use a person-oriented approach to examine the death anxiety patterns of Chinese oncology nurses and to analyze the differences in anxiety characteristics and their associated influencing factors.MethodsA cross-sectional survey regarding palliative care among registered oncology nurses was conducted in Jiangsu Province, China.Latent class analyses was applied to identify their patterns of death anxiety. The score of PCQN-C (The Chinese version of the Palliative Care Quiz for Nursing) and FATCOD-B-C (The Chinese version of the Frommelt Attitude Toward Care of the Dying scale), the demographic and working characteristics were further analyzed through covariance analysis (ANCOVA) and multivariate (or logistic) regression across the subgroups.ResultsA two-potential-category model was selected based on the fit index. The results showed that 79% of oncology nurses belonged to the high pressure and pain group and 21% belonged to the low death anxiety group. The high pressure and pain group had significantly higher scores in the dimensions of emotion, stress and pain, time awareness, and cognition compared to the low death anxiety group. Factors influencing the high pressure and pain group included shorter working years, non-national or provincial oncology nursing specialists, non-national palliative care specialists, never discussing the topic of death with patients or family members, no palliative care related training, and PCQN and FATCOD scores.ConclusionsOur study suggests that oncology nurses’ death anxiety can be divided into two categories: low death anxiety and high stress pain, and certain factors, such as being female, having a short work experience, and lacking palliative care-related training, increase the likelihood of death anxiety.

Illness perception is crucial in how patients navigate health challenges. Investigating if it predicts hopelessness and death anxiety is vital, especially in palliative care where these burdens are common. This descriptive, cross-sectional study was conducted with 129 patients receiving treatment in the palliative care clinics of a university hospital. Patient Identification Form, Illness Perception Questionnaire, Beck Hopelessness Scale, and Death Anxiety Scale were used as data collection tools. The findings revealed that patients generally have a negative perception of their illness, with moderate levels of hopelessness and high levels of death anxiety. A statistically significant positive correlation was observed between illness perception, death anxiety, and hopelessness. Furthermore, illness perception was found to predict 80.1% of the variation in hopelessness levels and 64.7% of the variation in death anxiety levels among patients. These findings underscore the importance of addressing psychological factors as part of comprehensive palliative care management.

Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time. We studied 206 patients with advanced cancer (mean age=59.6, 61% female) participating in an intervention trial. Patients completed self-report measures for demoralization, anxiety, perceived relatedness, attachment insecurity, and death anxiety. Our mediated path model included perceived relatedness and death anxiety at baseline as predictors, attachment avoidance at baseline as mediator, and demoralization and anxiety at 6-month follow-up (N=125) as outcomes. Attachment avoidance partially mediated the relationship between death anxiety and demoralization (β=0.07, 95% CI 0.02-0.12) and anxiety (β=0.05, 95% CI 0.001-0.10). Findings for perceived relatedness were less conclusive. Its indirect effects through attachment avoidance were significant for both outcomes (demoralization: β=-0.07, 95% CI -0.13 to -0.02, anxiety: β=-0.05, 95% CI -0.11 to -0.003). Due to its trait-like quality, attachment avoidance may play a less central role in explaining the course of existential distress over time than previous research indicated. Addressing change-sensitive relational concerns in psychosocial interventions may be more effective to alleviate existential distress.

Background and Objectives: Concerns about death may negatively affect the health-related quality of life. The relationship between death anxiety and spiritual well-being in life-threatening diseases is still a matter that needs to be addressed, especially in patients with gynecologic cancer. This research was conducted to study the relationship between death anxiety and spiritual well-being in patients with gynecologic cancer. Materials and Methods: This descriptive-correlational study was conducted on 230 women with gynecologic cancer selected through convenience sampling from Shohada-e Tajrish Hospital, affiliated to Shahid Beheshti University of Medical Sciences, in Tehran, Iran, from April to May 2016. The data collection instruments included a demographic questionnaire, the 15-item Templer Death Anxiety Scale and the Spiritual Well-Being Scale. The data were analyzed in SPSS-22 using descriptive (mean, standard deviation, frequency and percentage) and inferential ( Pearson’s correlation coefficient and the linear regression model) statistics. Results: The average scores of death anxiety and spiritual well-being were 48.57±12.55 and 95.27±14/40. There was a significant relationship between death anxiety and spiritual well-being (r =-0.35, p=0.001). The results of the regression analysis showed that age (b=-0.23, p=0.001) and stage of cancer (b=-5.176, p=0.001) are the only significant predictors of death anxiety. This model explained 40.3% of the variance in death anxiety. In this model, age (b=0.220, p=0.021), marital status (b=2.985, p=0.043) and stage of cancer (b=2.649, p=0.001) were significant predictors of spiritual well-being. The model explained 18% of the variance in spiritual well-being in the patients. Conclusion: This study shows a significant relationship between death anxiety and spiritual well-being in patients with gynecologic cancer. It is therefore necessary for healthcare providers to address certain demographic variables such as age, marital status and disease progression for regulating death anxiety and improving the patients’ spiritual well-being.

Death Anxiety in Patients With Advanced Cancer and Their Family Caregivers

Public Awareness and Perceptions of Palliative and Comfort Care

Patients with advanced cancer can suffer from serious distress like death anxiety and depression, in addition to facing a reduced quality of life. Death education interventions have been shown to improve these outcomes, but their effectiveness remains unclear, especially in the advanced stages. This meta-analysis aimed to examine the efficacy of death education interventions on death anxiety, depression, and quality of life in advanced cancer sufferers, and to explore the influence of the intervention site, duration, the age of participants, and dyadic relationships with caregivers on the effectiveness of these interventions. A meta-analysis of randomized controlled trials was performed. A systematic search of 10 electronic databases identified 19 eligible RCTs with 1531 participants. Data were extracted and analyzed via Review Manager 5.4. Subgroup analyses were performed on the basis of the intervention site, duration, age of participants, and presence of caregivers. In comparison to the control intervention, the death education intervention notably alleviated death anxiety (SMD = -2.11, 95% CI: -5.91 to -0.89, p = 0.008) and depression (SMD = -0.45, 95% CI: -0.72 to -0.18, p = 0.001). Quality of life (SMD = 0.86, 95% CI: 0.39-1.33, p = 0.0003) was also significantly improved. Subgroup analyses revealed that interventions with longer durations, conducted in professional settings, and targeting younger patients were more likely to be effective in reducing depression and enhancing the quality of life. Interventions without family companionship were more effective in improving depression, while interventions with family companionship were more effective in improving quality of life. Death education interventions are effective at improving death anxiety, depression, and quality of life in patients with advanced cancer. Tailoring interventions to individual features and cultural backgrounds is crucial to achieving the best effect. Death education is an effective and important intervention measure that can help patients with advanced cancer better cope with death anxiety and depressive emotions and improve their quality of life. Clinical medical workers should select appropriate death education programs based on the specific conditions of patients and provide necessary support and guidance. CRD42024565376.

Present study investigated the relationships among psychosocial, spiritual well being and death anxiety among advance stage cancer patients in order to improve the prognosis and quality of life as well as reduce their sufferings. By studying various well beings and death anxiety, it would be possible to identify the psychological needs of cancer patients in order to help the treatment of cancer patients and make them mentally strong to cope with their disease. Data was collected from Sample of 80 advance stage cancer patients, from six exclusive cancer hospitals of western and central zones of India. Patients were identified as advance stage patients as per clinical details (treatment history, diagnostic profile & records) and diagnosis was done by treating doctors of the hospital. Results were analyzed to identify the psychological needs of cancer patients. Obtained results were analyzed using SPSS for descriptive and variance analysis followed by multiple correlation. Results revealed negative correlation between psychosocial well being and death anxiety and also same results were found between spiritual well being and death anxiety. It indicates that enhancing the psychosocial and spiritual well being of cancer patients can reduce their death anxiety and promote better quality of life. Palliative care and Cognitive Behaviour therapy can play a very important role in this regard.

Background: Death depression is one of the components of death-related distress, characterized by a form of sadness related to the individual’s death, other people’s death, and/or the concept of death in general. Objectives: The current research aimed to investigate death obsession, death anxiety, and depression as predictors of death depression among married nurses in Iran. Methods: The sample consisted of 146 married female nurses from different wards of governmental hospitals, as well as Mehr and Arya private hospitals, affiliated to Ahvaz Jundishapur University of Medical Sciences. The participants responded to the death depression scale-revised (DDS-R), death anxiety scale, death obsession scale, as well as the short-form of Beck depression inventory (BDI-13). Results: The findings indicated that death obsession, depression, and particularly death anxiety (β, 0.47), were predictors of death depression. The three predictive variables could explain 0.62 of variance in death depression. Conclusions: Different factors can affect death depression, including obsessions and anxieties related to death. Therefore, these concerns should be reduced dramatically in hospital settings, as stressful environments.

This study aimed to investigate the relationship between death anxiety and QoL in a sample of Iranian heart failure (HF) patients. A cross-sectional correlational design was employed to examine this relationship in a sample of 296 HF patients. Participants were recruited using convenience sampling from teaching hospitals in Kermanshah City, western Iran, between October and December 2023. Data were collected using a demographic questionnaire, the Templer Death Anxiety Scale (TDAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Participants reported moderate to high levels of death anxiety (Mean [SD] = 7.54 [2.35]) on the TDAS and moderate to poor QoL (Mean [SD] = 36.24 [12.26]) on the MLHFQ. The statistical methods used in this study included descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Pearson correlation coefficient, multiple linear regression analysis, and the Kolmogorov-Smirnov test. All statistical analyses were performed using SPSS version 26, with a significance level set at 0.05. A significant positive correlation was found between death anxiety and QoL (r = 0.329, p < .001), indicating that higher levels of death anxiety were associated with lower QoL. These results underscore the importance of addressing death anxiety in HF patients to improve their QoL. Interventions targeting the reduction of death anxiety and the enhancement of QoL are essential for optimizing care for this vulnerable population. The study recommends the implementation of psychological interventions, support groups, comprehensive counseling, education, and regular assessments for this purpose.

Harmony found: Serenity's crucial role in alleviating death anxiety through attachment styles among community-dwelling older adults

Death anxiety, defined as the distress associated with the awareness of mortality, has profound psychological and cultural impacts. Western societies often respond to death salience through avoidance and medicalization, reinforcing defensive strategies described by Terror Management Theory. This project aimed to investigate whether mindfulness can serve as a buffer against death anxiety. A structured literature review was conducted using PsycINFO, PubMed, the Portland State University Library, and Google Scholar between January 2025 and April 2025. One study found that mindfulness moderated the effects of death anxiety on health-related quality of life in people living with HIV. Two experiments linked mindfulness to reduced negative affect and defensive reactions following mortality salience. Six additional studies conducted with cancer patients found that mindfulness-based interventions improved mood, stress, psychological flexibility, spiritual well-being, and even blood pressure, and immune and endocrine function. Psychological mechanisms such as cognitive defusion, emotional regulation, acceptance of impermanence, reduced rumination, and psychological flexibility are proposed to mediate these effects. Mindfulness offers a non-defensive framework for engaging with existential realities, aligning with existential theories such as Frankl's logotherapy and operationalized through approaches like Acceptance and Commitment Therapy. Mindfulness-based interventions, including MBSR and ACT, show promise for application in hospice, palliative care, and grief contexts. While mindfulness may not eliminate death anxiety, it provides a means of experiencing existential fears with greater openness and resilience. Future research should focus on longitudinal studies, cultural generalizability, clarification of mindfulness constructs, and clinical trials specifically targeting death anxiety outcomes.

e24213 Background: ACP and their SC experience psychological distress living with future uncertainty regarding their cancer. Yet, little is known how existential DA adversely impacts the psychological well-being and overall survival of ACP participating in Phase I trials and their SC. Methods: A prospective study of ACP enrolling in phase I trials and their SC were assessed at baseline (T1) and one month (T2) using quantitative symptom measures including: depression (CES-D), state anxiety (STAI-S), quality of life/qol (FACIT-Pal), and global health (SF-36). Semi-structured interviews evaluated DA: suffering; meaning, and worry re death. Results: To date, 158 participants (79 Phase I ACP and 79 SC) have been separately interviewed at T1 and T2. For the total population: median age 62 (28-79y); 50% male; 100% married; 89% Ca; 69% &gt; HS educ; 59% GI dx; ACP median survival 8.2 month (.51-18.8) 53% income &lt; $65,000 yr. At T1, 83% of ACP experienced worry re death, and 77% reported suffering. For SC at T1, 75% reported worry re ACP death; 88% worried re own death; and 85% reported experiencing suffering and 84% lost meaning during the ACP illness. For both ACP and SC, rates remained consistent for both ACP and SC. At T2, ACP with worry re death had higher STAI-S (32±11 v. 28±9, p = 0.04) and CES-D scores (12±10 v. 11±10, p = 0.03). SC with self-reported suffering had higher STAI-S anxiety (38±15 v. 34±12, p = 0.02) at T2. Regression analyses revealed ACP with worry had worsening FACIT-Pal QOL over time. Also, SC with suffering at T2 was negatively associated with SF-36 scores. Regarding survival, ACP with DA had shorter survival compared to ACP without DA (4.4 v. 6.9 months, p = 0.02). Conclusions: Phase I ACP and SC report worry re death and suffering negatively impacting their psychological well-being and survival. Supportive couple-based, dyadic psychological interventions for ACP-SC designed to address DA coping are needed.