[A Study on the Life Attitudes, Fear of Death, and Dying Care Abilities of Nursing Assistants in Long-Term Care Institutions].

BACKGROUND: End-of-life care in long-term care institutions is increasingly important. Nursing assistants are the primary care workforce, and their end-of-life care capabilities affect the quality of care provided to residents as well as residents' physical and mental health. PURPOSE: This study was designed to explore the life attitudes, fear of death status, end-of-life care abilities and experience, and coping styles of nursing assistants in long-term care institutions in the eastern region and the effects of these variables on care. METHODS: A cross-sectional, mixed-methods research design was used. The study included 165 nursing assistants working in long-term care facilities in Taitung and Hualien counties. The study questionnaire included items covering life attitudes, fear of death, and dying care abilities. In addition, in-depth interviews were conducted with 12 of the participants. RESULTS: Most of the participants held positive attitudes toward life and reported having a low to moderate fear of death. A significant and positive correlation between life attitude and dying care ability was identified (r = .426, p < .001). Although average ability to provide physical care to residents at end of life was found to be relatively good, ability to provide emotional support and allow residents to express their emotions was generally poor. The scales of fear of death, life attitude toward love and care, ideals, and high school education were identified as significant predictors of dying care ability, together explaining 22.8% of the variance. The interview results were summarized into five major themes that also echoed the quantitative results. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Attitudes toward life and fear of death partially were shown to influence the dying care ability of the nursing assistants in this study. Dying care skills should be strengthened in nursing assistants, and they should be encouraged to explore the meanings of life and death through on-the-job education. Also, long-term care institutions should show concern for and support their nursing assistants by sponsoring case discussions, care experience sharing sessions, and support groups.

What enhances the quality of death and dying? A perspective from patients with terminal cancer.

AIM: This study aimed to determine which factors improve the quality of dying and death from the point of view of patients with cancer who are nearing the end of their lives. The goal was to find out what they think are necessary conditions for a good death and how they would like to be cared for and supported at the end of their lives. METHODS: This study used an exploratory research approach. Purposive sampling was used to select 21 participants from two hospices in Bengaluru and Hyderabad (Karunashraya and Sparsh), and Karnataka Cancer Hospital in Bangalore, India. Semi-structured interviews were undertaken to obtain data from the patients. Thematic analysis was used to examine the data. RESULTS: Four themes were identified: 1) Spirituality and religiosity, 2) socioemotional support, 3) Breaking silence about the stage of the disease and 4) Preparation for and embracing death. There were distinct sub-themes within some of these that were highlighted using quotes from the participants. CONCLUSIONS: The study provided a comprehensive understanding of end-of-life care, the criteria for a high-quality end of life, strategies for achieving it, and the quality of the dying process and death in advanced cancer patients. Studying patients' experiences will help inform a more robust intervention strategy and action plan to improve the quality of end-of-life care in the Indian community.

[End-of-life decision-making]. / Entscheidungen am Lebensende.

The article begins with a reflection on the intertwined nature of life and death; this reflection should also serve to sensitize us to the proactive and reactive expressions of a person's life at the end of life. It will be shown that attachment to life can also manifest itself in the case of depression, fear and exhaustion: One must not lose sight of their potential existence. The existing commitment to life allows us to better understand why the remaining time of life may be perceived as something precious; this may be in contrast to statements made in the living will. A distinction is made between subjectively, objectively and socially defined criteria for a good life in the borderline situation of a serious illness leading to death; their comparison is central to the end-of-life decision-making process. In addition to physical and neurocognitive illnesses, suicidality is at the centre of the article.

Exploring patient death experiences among Iranian nursing students.

Patient death can be a stressful experience for nursing students, leading to various undesirable psychological and emotional effects. However, research documenting these experiences remains limited. This study explores the experiences of Iranian nursing students when facing patient death. This qualitative study employed a purposive sample of 14 undergraduate nursing students. Data was collected through semi-structured interviews and analyzed using conventional content analysis. Lincoln and Guba's (2004) criteria guided the data management process. Data analysis revealed three primary categories with six corresponding subcategories. These categories encompassed the significance of death, reactions to death, and the transformation of professional perspectives. Subcategories included positive and negative meanings attributed to death, emotional and behavioral responses, and the positive and negative effects on participants. The findings reveal that experiencing patient death significantly impacts nursing students psychologically and emotionally. Consequently, it is recommended that nursing curricula incorporate essential training modules addressing appropriate responses to death and effective communication with bereaved families. Further research should explore strategies to mitigate negative impacts and optimize positive outcomes related to this phenomenon.

Impact research of pain nursing combined with hospice care on quality of life for patients with advanced lung cancer.

This study aims to evaluate the impact of integrating pain nursing with hospice care on the quality of life among patients with advanced lung cancer. This study involving 60 advanced lung cancer patients admitted from January 2022 to January 2023. Participants were randomly assigned to 2 groups: the observation group received a combination of pain nursing and hospice care, while the control group received standard nursing care. The study assessed changes in the numeric rating scale for pain, self-rating anxiety scale (SAS), self-rating depression scale (SDS), cancer fatigue scale (CFS), death attitude, and various quality of life dimensions as measured by the Quality of Life Questionnaire-Core 30. Post-intervention, both groups exhibited reductions in numeric rating scale, SAS, SDS, and CFS scores compared to baseline, with more significant improvements observed in the observation group (P < .05). Additionally, post-intervention scores for death attitude and Quality of Life Questionnaire-Core 30 domains (physical, cognitive, social, role, and emotional functioning, as well as overall health) increased in both groups, with the observation group showing greater improvements than the control group (P < .05). The combination of pain nursing and hospice care significantly reduces pain, anxiety, and depression, decreases cancer-related fatigue, and improves the quality of life and death attitudes in patients with advanced lung cancer, highlighting the benefits of this integrative approach in palliative care settings.

What do suicide loss survivors think of physician-assisted suicide: a comparative analysis of suicide loss survivors and the general population in Germany.

BACKGROUND: Physician-assisted suicide (PAS) and voluntary euthanasia remain highly debated topics in society, drawing attention due to their ethical, legal, and emotional complexities. Within this debate, the loss of a loved one through suicide may shape the attitudes of survivors, resulting in more or less favorable attitudes towards this topic. AIMS: This study aims to explore and compare the attitudes towards PAS and voluntary euthanasia in a population of suicide loss survivors and the general population, while also considering socio-demographic factors. METHODS: A total of 529 participants, 168 of whom were survivors of suicide loss, completed an online questionnaire on their attitudes (NOBAS) and opinions (open response format) towards PAS and voluntary euthanasia, as well as regarding their legalization in Germany. The analysis consisted of both quantitative and qualitative components. RESULTS: The entire sample showed positive attitudes towards PAS and voluntary euthanasia in terminally ill persons. Participants were more divided in their attitudes towards PAS in the case of a mental health disorder. Individuals without experienced suicide loss were more liberal regarding legalization in Germany and were more likely to understand the wish for PAS. Survivors of suicide loss were mainly concerned about the consequences for relatives. However, differences between both groups are small. DISCUSSION: The experience of a loss by suicide influences attitudes towards PAS and voluntary euthanasia. Both groups showed an accepting attitude towards PAS and voluntary euthanasia, but also expressed concerns and fears regarding easy accessibility and consequences for grieving relatives.

Differentiating between romantic and mature love: Revisiting the three caskets.

Freud's paper on the three caskets is revisited. His view that the lead casket represented death is supported by extracts from The Merchant of Venice, in particular the song, "Tell Me Where is Fancy Bred". It is argued that the acceptance of death is a necessary step in the transformation of romantic love to mature love. With experience of reality a disillusion of romantic idealisation becomes possible, but this means that losses have to be accepted and mourned. It is argued that this is made more bearable if an ironic stance enables an acceptance of the pleasures of romance without believing them to be literally true.

The Intimate Palliative Sphere: Affect, Gender, and the Good Death in Relational End-of-Life Narratives.

An increasing number of collaborative end-of-life narratives have been published after the death of the protagonist. Focusing on two examples of women's end-of-life memoirs in contemporary German popular culture, this essay examines how relationality, gender, and affectivity shape the philosophies, practices, and politics of palliative care and the associated concepts of the "good death." Ultimately, I argue that the memoirs foreground a still-marginal narrative and practice of dying at home within an intimate public sphere of palliation that transgresses traditional approaches to care for the dying in contemporary health care. They also contribute to gendered and sentimental notions of family care and of the self-determined and autonomous body and death.

Last Narratives: Life Writing Palliative Praxis.

Research on palliative care emphasizes the crucial role of narratives in the encounter with suffering and dying patients because we need to learn from the dying in order to improve care for them. Autobiographical narratives by terminally ill writers contribute to a more encompassing understanding of what it means to be dying as they often thematize dying and death, besides theorizing all kinds of implications of terminal illness. Among such autothanatographers are well-known writers such as Gillian Rose, Jenny Diski, and Tom Lubbock. The process of writing about the last stage of their lives is palliative narrative praxis because the narrative act alleviates suffering. Exploring dying and death in philosophical, literary, and often highly poetic terms needs to be read and interpreted within a more complex web of meaning-making.

Palliative Images in Marion Coutts's The Iceberg and Marco Peano's L'invenzione della madre.

This article explores the representation of terminal brain cancer in Marion Coutts's memoir The Iceberg (2014), on her husband's illness and death, and Marco Peano's autofiction L'invenzione della madre (The invention of the mother; 2015), about a son who cares for his mother during her final days. While addressing the medicalization of dying and the efficacy of palliative care, both texts engage pervasively with visual culture. This emphasis on the visual arts and cinema provides a thought-provoking commentary on the protagonists' experience of witnessing the gradual erosion of verbal expression in their dying loved ones. This essay will thus explore both the use of visual culture as palliative praxis and the authors' implicit considerations on the role of narrativity in dying.

Love, Death, and-No Hospital!: Assisted Dying, "Liebestod," and Existential Suffering.

Contemporary literature about assisted dying in Germany, Switzerland, and France repeatedly explores the impact of illness on romantic relationships. Faced with the imminent or experienced death of their loved one, the healthy partner is affected by existential suffering and refuses to outlive the other. This dynamic leads to (joint) suicide, echoing the literary tradition of the Liebestod, where lovers prefer death over separation. This paper examines three contemporary texts on this theme. It illustrates that while the Liebestod is depicted as a romantic death, it inherently rejects a medicalized end of life. Despite overlaps between palliative care and the notion of a "good death," palliative care is absent, as the focus is on avoiding the existential suffering from losing a beloved partner, making suicide the only viable option.

The impact of death priming on climate change denial: a preliminary investigation.

Background: Climate change denial (CCD) has been found to be more pronounced among individuals with a conservative political orientation. Terror Management Theory posits that an individual's worldview serves as a primary defense mechanism in coping with existential threats, such as the reality of climate change. Drawing on these premises, we conducted preliminary research investigating the impact of death priming on CCD from the Terror management theory perspective. Methods and results: We administered a death priming task and measured CCD in its immediate wake or following a delay task. We confirmed among 219 Amazon's MTurk participants that immediately following death priming, CCD was reduced among all participants. In the delayed death priming condition, we acquired preliminary evidence that CCD was heightened among Republican participants. Conclusions: These findings demonstrate the relevance of death priming to CCD tendencies and potentially spawn future research regarding CCD as a particular form of coping with existential threats.

[Dying during the pandemic: Experiences of relatives of patients who died during the COVID-19 pandemic in Chile]. / Morir en pandemia: Experiencias de familiares de pacientes fallecidos durante la pandemia COVID-19 en Chile.

INTRODUCTION: The COVID-19 pandemic marked a milestone in the history of medicine worldwide. Together with the humanitarian drama it represented, the problems that arose are promoting lines of research in multiple fields. One of these fields is the aspects related to medical communication and end-of-life care. This paper reports the experiences and perceptions of relatives of patients who died during the pandemic with a psychospiritual support intervention in a public hospital in the Metropolitan Region, Chile, called "farewell". METHODS: A qualitative study was conducted with a phenomenological approach based on in-depth interviews. From this, categories were derived that allowed a systematization of the observation of the experiences. RESULTS: Among the results, the impact of the circumstances and the communication provided by the medical team on grief should be highlighted. The use of the word "farewell" emerges as a useful, albeit ambiguous, communicative tool when it comes to adequately framing an end-of-life process. CONCLUSIONS: It is argued that the end of life is an area that requires physical and psychospiritual spaces, and adequate training at all levels to do justice to a highly relevant moment in the care of people.

The effect of sleep quality on attitudes toward death in breast cancer survivors.

PURPOSE: The aim of this study was to determine the levels of sleep quality and attitudes toward death among breast cancer survivors and to examine the impact of sleep quality on attitudes toward death. METHODS: This descriptive and correlational study was conducted with 117 patients who had been treated for breast cancer in radiation oncology. Data were collected using a Demographic Information Form, the Pittsburgh Sleep Quality Index, and the Death Attitude Profile-Revised Scale. RESULTS: The mean score for sleep quality among breast cancer survivors was 15.17 ± 3.96, while the mean score for the Death Attitude Profile-Revised was 137.65 ± 30.74. Sleep quality was associated with marital status, place of residence, perception of economic status, presence of social support, time since diagnosis, body mass index, and other factors (p < 0.05). Attitudes toward death were associated with age, educational level, occupation, place of residence, perception of economic status, comorbidity, histopathological stage, chemotherapy status, type of breast surgery, and other factors (p < 0.05). Additionally, a moderately positive correlation was found between sleep quality and attitudes toward death among women undergoing breast cancer treatment (r = 0.368, p < 0.001). It was determined that patients' sleep quality, education status, and comorbidity had a significant effect on attitudes toward death and the variables explained 29.4% of the variance (R2 = 0.294) (p < 0.001). CONCLUSION: This study shows that there is a significant relationship between sleep quality and attitudes toward death in cancer patients and that sleep quality affects attitudes toward death. In addition, when evaluating the sleep quality and attitudes toward death of women treated for breast cancer, taking into account their sociodemographic characteristics and treatment characteristics may contribute positively to the recovery process and quality of life.

Predicting place of death of patients with advanced cancer receiving home-based palliative care services in Iran.

BACKGROUND: While home is frequently expressed as the favorite place of death (PoD) among terminally ill cancer patients, various factors affect the fulfillment of this wish. The determinants of the PoD of cancer patients in countries without healthcare system-integrated palliative and supportive care have not been studied before. This study aimed at identifying the predictors of the PoD of patients who suffer from advanced cancer by developing a reliable predictive model among who received home-based palliative care in Iran as a representative of the countries with isolated provision of palliative care services. METHODS: In a cross-sectional study, electronic records of 4083 advanced cancer patients enrolled in the Iranian Cancer Control Center (MACSA) palliative homecare program, who died between February 2018 and February 2020 were retrieved. Multivariable binary logistic regression analysis as well as subgroup analyses (location, sex, marital status, and tumor topography) was performed to identify the predictors of PoD. RESULTS: Of the 2398 cases included (mean age (SD) = 64.17 (14.45) year, 1269 (%52.9) male), 1216 (50.7%) patients died at home. Older age, presence and intensity of medical homecare in the last two weeks and registration in the Tehran site of the program were associated with dying at home (P < 0.05). Gynecological or hematological cancers, presence and intensity of the calls received from the remote palliative care unit in the last two weeks were predictors of death at the hospital (p < 0.05). The model was internally and externally validated (AUC = 0.723 (95% CI = 0.702-0.745; P < 0.001) and AUC = 0.697 (95% CI = 0.631-0.763; P < 0.001) respectively). CONCLUSION: Our model highlights the demographic, illness-related and environmental determinants of the PoD in communities with patchy provision of palliative care. It also urges policymakers and service providers to identify and take the local determinant of the place of death into account to match the goals of palliative and supportive services with the patient preferences.

[Loneliness at the end of life]. / Einsamkeit am Lebensende.

Advanced incurable diseases are often accompanied by numerous losses and burdens as the disease progresses, leading to a loss of autonomy, self-determination, and dignity for those affected, all of which can subsequently promote feelings of loneliness at the end of life. Declining health, increasing symptom burden, loss of social roles, and the fear of death and dying are among the key risk factors for loneliness towards the end of life. In this article, we provide an overview of the different dimensions of loneliness experienced at the end of life. We discuss existential loneliness alongside emotional and social loneliness, explore causes and health implications of loneliness at the end of life, suggest diagnostic tools for assessing loneliness, and finally provide recommendations for addressing emotional, social, and existential loneliness at the end of life. The loneliness of caregivers is also discussed. We suggest that addressing social and emotional loneliness early in the course of a terminal illness is crucial. Palliative, psychological, and spiritual support can strengthen interpersonal relationships, foster a sense of meaning and purpose, and alleviate the adverse effects of loneliness on mental and physical health as well as quality of life. In contrast, existential loneliness is considered an expression of profound emotional maturity and can offer opportunities for inner growth, contributing to a more refined sense of self while reinforcing identity, dignity, and transcendence at the end of life.

Bittersweet Prognostication.

In this narrative medicine essay, a pediatric critical care physician explores the right moment to speak with parents about their child's life or death outcome, relying on the various elements involved in predicting an iffy endeavor.