Validation of the Collett-Lester fear of death scale in occupational therapy students: psychometric testing and implications for palliative care education.

BACKGROUND: The fear of death is a common experience among healthcare students and professionals that may impact the quality of care provided to patients, particularly those receiving palliative care. The Collett-Lester Fear of Death Scale is a widely used instrument to assess this fear, although its psychometric properties have not been extensively studied in Occupational Therapy students. The present study aimed to validate the Collett-Lester Fear of Death Scale (CL-FODS) in a sample of Occupational Therapy students and to explore its implications for palliative care education. METHOD: A cross-sectional study was conducted to perform psychometric testing of the CL-FODS in Occupational Therapy undergraduate students. Structural validity, internal consistency, and test-retest reliability were analysed. A total of 195 Occupational Therapy students were included in this study. Additionally, the participants completed a brief survey on their experiences and attitudes towards palliative care. RESULTS: The internal consistency was satisfactory (α = 0.888). The exploratory factor analysis to evaluate the internal structure yielded four factors. The model fit indices were: comparative fit index = 0.89, and root mean square error of approximation = 0.06). The test-retest reliability was satisfactory and demonstrated an intraclass correlation coefficient of 0.939. CONCLUSION: The Spanish version of the CL-FODS showed satisfactory psychometric properties; therefore, assessing fear of death in Occupational Therapy students is helpful. This study highlights the importance of addressing fear of death and palliative care education in Occupational Therapy undergraduates to improve future professional attitudes and, consequently, the quality of patient care at the end of life.

How do ageism, death anxiety and ageing anxiety among medical students and residents affect their attitude towards medical care for older patients: a systematic review.

BACKGROUND: Although the number of older patients requiring medical care is increasing, caring for older patients is often seen as unattractive by medical trainees (i.e., medical students, residents, interns, and fellows). Terror Management Theory states that people have a negative attitude towards older people, because they remind people of their own mortality. We hypothesize that ageism, death anxiety, and ageing anxiety among medical trainees negatively affect their attitude towards medical care for older patients. This review aimed to examine and generate an overview of available literature on the relationship between ageism, death anxiety, and ageing anxiety among medical trainees and their attitude towards medical care for older patients. METHODS: A systematic review was performed with a review protocol based on the PRISMA Statement. PubMed, Ebsco/PsycInfo, Ebsco/ERIC and Embase were searched from inception to August 2022, using the following search terms, including their synonyms and closely related words: "medical trainees" AND "ageism" OR "death anxiety" OR "ageing anxiety" AND "(attitude AND older patient)". RESULTS: The search yielded 4072 different studies; 12 eligible studies (10 quantitative and 2 qualitative) were identified and synthesized using narrative synthesis. Findings suggest that a positive attitude towards older people was related to a positive attitude towards medical care for older patients among medical students. The available literature on the relationship between death anxiety and/or ageing anxiety and attitude towards medical care for older patients among medical trainees was limited and had a heterogeneity in focus, which hindered comparison of results. CONCLUSION: Our findings suggest that a positive attitude towards older people in general is related to a positive attitude towards medical care for older patients among medical students. Future research should focus on further exploring underlying mechanisms affecting the attitude towards medical care for older patients among medical trainees.

Death anxiety among the oldest old in Germany. Evidence from the nationally representative 'Old Age in Germany (D80+)'.

BACKGROUND: There is a lack of studies investigating death anxiety among the oldest old based on a large, nationally representative sample during the pandemic. Thus, our aim was to investigate the prevalence and determinants of death anxiety among the oldest old in Germany during the Covid-19 pandemic. METHODS: Cross-sectional data were taken from the 'Old Age in Germany' (D80+) study. This is a large, nationwide representative study including individuals 80 years and over living at home and individuals in institutionalised settings (N = 9542 individuals in the analytic sample). RESULTS: Overall, 30% of the respondents reported the absence of death anxiety, 45.5% reported a rather not strong death anxiety, 20.2% reported a rather strong death anxiety, and 4.3% reported a very strong death anxiety. Linear regressions revealed that higher death anxiety was significantly associated with being female (ß = 0.21, P < 0.01), younger age (ß = -0.02, P < 0.001), being married (ß = 0.09, P < 0.001), high education (compared to low education, ß = 0.07, P < 0.05), the presence of meaning in life (ß = 0.13, P < 0.001), higher loneliness levels (ß = 0.18, P < 0.001), the presence of multimorbidity (ß = 0.07, P < 0.05), and poorer self-rated health (ß = -0.07, P < 0.001). A further analysis showed that probable depression (ß = 0.31, P < 0.001) is also associated with higher death anxiety. CONCLUSION: About one in four individuals had a strong or very strong fear of death during the pandemic. Several sociodemographic, psychosocial, and health-related factors are associated with higher death anxiety. This better understanding of the determinants of death anxiety can be relevant for, among others, the affected individuals, informal and professional carers, as well as friends and relatives.

[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.

COVID-19, MEDIA DEPENDENCY AND FEAR OF DEATH: ANALYSIS OF PRE, DURING AND POST INFECTION AMONG AFFECTED PEOPLE.

Current research study aimed to know about media effects on individuals perception about death due to Covid-19 before, during and post disease among the people who suffered due to this disease. Media is main source of information and people depend upon media to know about any new issue. Study was interview based and ten individuals recovered from Covid-19 were interviewed. Interview was consisted on three parts i.e. before, during and after recover from Covid-19 Furthermore, researcher designed rating scale consisted on 0-6 numbers where 0 represented no fear of death due to media coverage about Covid-19 and 6 represented extremely high fear of death due to media coverage. The results found before infection media dependency was high and fear of death due to media information was moderate, while during isolation after being infected the fear of death was high and media dependency was moderate, whereas after recovery, both fear of death and media dependency found very low among individuals who suffered from Covid-19.

Relationship between COVID-19 anxiety and fear of death: the mediating role of intolerance of uncertainty among a Turkish sample.

The Coronavirus Disease 2019 (COVID-19) pandemic has increased the salience of death in our lives. The aim of this study is to uncover potential mechanisms underlying fear of death during the pandemic. A sample of 478 volunteers (312 females and 166 males) aged 18 years and older participated voluntarily in this study. Coronavirus Anxiety Scale, Multidimensional Mortality Awareness Measure, Intolerance of Uncertainty Scale, and Personal Information Form were used for data collection. The mediating role of intolerance of uncertainty in the relationship between COVID-19 anxiety and fear of death was determined using the bootstrapping method. COVID-19 anxiety was associated with increased intolerance of uncertainty, and fear of death. Intolerance of uncertainty was associated with increased fear of death. Furthermore, intolerance of uncertainty partially mediated the relationship between COVID-19 anxiety and fear of death. Results suggest that intolerance of uncertainty is a critical variable in the relationship between COVID-19 anxiety and fear of death. The current research adds to our knowledge of fear of death by investigating COVID-19 anxiety and intolerance of uncertainty. Additionally, this study underlies and contributes to the consideration of psychological health of individuals during the pandemic process. The results are discussed within the context of the COVID-19 pandemic.

Factors Moderating the Impact of After Death Communications on Beliefs and Spirituality.

After death communications(ADCs) are defined as perceived spontaneous contacts with living individuals by the deceased. This research presents on a subset of data from a recent large international survey of individuals who experienced ADCs and provided systematic information regarding these experiences. In our research we explore the impact of having an ADC on reported spirituality, religiosity, beliefs and attitudes about death and dying and also explore the moderating factors of this impact. We found that having an ADC was perceived as a positive life experience and that it was associated with a reduction in fear of death, belief in life after death and that the deceased could communicate with the living, and increased reported spirituality. Moderating factors include aspects of having or desiring physical contact with the deceased as well as perceiving some emotional reaction to the ADCs. Future directions for research exploration are also provided based on our findings.

Death Distress and Religiosity Among Spanish Patients Diagnosed With Depression and Anxiety.

Death is a common source of uncertainty and fear for humans. Religious beliefs are among the strategies that alleviate such discomfort. The aim of this study was to explore the correlation between Death Distress and religious practices while considering other associated variables (near-death experiences, death of loved ones, and psychiatric diagnoses). The Death Anxiety Scale, Death Depression Scale-Revised, and Death Obsession Scale were administered to 400 Spanish psychiatric outpatients. Anxiety was found to be crucial for the development of Death Distress across all associations. A relation between Death Distress and Catholicism was found, albeit significantly mediated by the frequency of practice.

Effect of Perceived Dyspnea on Attitude Toward Death From the Perspective of COPD Patients.

In this study, it was aimed to examine attitudes toward dyspnea and death from the perspective of Chronic Obstructive Pulmonary Disease (COPD) patients and to determine the relationship between them. This descriptive research was carried out in the chest diseases clinic of a public hospital and with the participation of COPD patients (n = 124). The data were obtained from the Personal Information Form, Death Attitude Profile-Revised, and Medical Research Council Scale. The neutral acceptance and approach acceptance subscale is explained as believing that death is an inevitable part of life and a transition to life after death. The escape acceptance subscale is explained as believing that life will save from physical or psychological harms. It was determined that the Neutral Acceptance and Approach Acceptance sub-dimension of the predictors of dyspnea, comorbid diseases, and COPD had a significant effect at a rate of 33% (p = 0.000). Dyspnea, Comorbid diseases, and the predictors of the severity of COPD affect the Escape Acceptance sub-dimension by 57% (p = 0.000). This research has shown that fear of death is high in COPD patients with high perceived dyspnea. The psychological support provided to patients with COPD should be considered to relieve the fear of death. New studies are needed in which these should be reevaluated in the same context.

The Effect of Emergency Nurses' Psychological Resilience on Their Thanatophobic Behaviors: A Cross-Sectional Study.

PURPOSE: This study analyzed the effect of emergency nurses' psychological resilience on their thanatophobic behaviors. METHODS: The research was conducted with 156 emergency nurses. In the data collection process, the Socio-Demographic Information Form, the Brief Resilience Scale, and the Thanatophobia Scale were used. RESULTS: It was found that emergency nurses had medium-level psychological resilience and high-level thanatophobia. Besides, it was discerned that there was a moderate negative relationship between psychological resilience and thanatophobia (r:-.643, p: 0.000). Lastly, as per the simple linear regression analysis, it was identified that the predictor variable of psychological resilience accounted for 40.9% of the variance in the predicted variable of thanatophobia (R2:.409, p: 0.000). PRACTICE IMPLICATIONS: Emergency nurses, who are faced with many negative situations, need to have a high level of psychological resilience in order to get out of the mental state brought by negative conditions as soon as possible, and it is recommended to carry out applications to increase psychological resilience.

The Validity and Reliability of the Thanatophobia Scale-Turkish Form: A Psychometric Study Among Nurses.

Purpose: To examine the validity and reliability of the Thanatophobia Scale-Turkish Form among nurses. Design and methods: This methodological study included 154 nurses. Content and construct validity, item analysis, confirmatory factor analysis, and internal consistency were used to evaluate the data. Findings: The content validity index of the scale was 0.91. Item-total score correlation values varied between 0.453 and 0.718. As a result of the confirmatory factor analyses, one factor was confirmed. Cronbach's alpha internal consistency coefficient was 0.854. Practice Implications: Thanatophobia Scale-Turkish Form is a valid and reliable tool used to evaluate the fear of death among nurses.

Testing the High-Risk Behavior Model Among the Students Based on Religious Orientation With the Mediation of Fear of Death.

Adolescents are at high-risk for adverse health outcomes associated with high-risk behavior. The present study aimed to test the high-risk behavior model among the students based on religious orientation with the mediation of fear of death. This descriptive correlational study utilized structural equation modeling. The statistical population comprised all senior high school female students in Mashhad. 200 students were selected using cluster random sampling method. Data collection tools included the Iranian Adolescents Risk-taking Scale, Templer Death Anxiety Scale, and Allport and Ross Religious Orientation Scale. The result of a structural equation model suggested that the relationship between religious orientation and high-risk behavior was mediated through fear of death. Furthermore intrinsic religiosity has a negative direct relation with fear of death and high-risk behavior, and extrinsic religious orientation have a positive direct relation with fear of death and high-risk behavior. On this basis, it was concluded that religious orientation influences high-risk behavior indirectly through fear of death.

An Exploration of Death Anxiety of Family Members of Silent Mentor Body Donation Program.

Background: This study assesses the level of death anxiety among the family members of the Silent Mentor Programme (SMP) and determines whether their participation in various ceremonies during the training session impacted their death anxiety. Methods: The revised Collett-Lester Fear of Death Scale (CL-FODS) was administered to the study participants before the opening ceremony and after the sending-off ceremony of the programme. Results: All the four subscales that measure fear of one's own death, fear of the process of one's own dying, fear of the death of others and fear of the process of others dying in the CL-FODS showed significant reduction after the sending-off ceremony compared with before the opening ceremony. Younger family members reported significantly higher mean total death anxiety scores compared to the older members. Conclusion: The SMP not only nurtures doctors with humanity but also helps the family members to cope with grief and loss.

Cancer-Related Stigmatization, Quality of Life, and Fear of Death Among Newly Diagnosed Cancer Patients.

The purpose of the study is to investigate the gender differences among newly diagnosed cancer patients from the cultural perspective of Pakistan. The data comprised two equal groups: men (50%) and women (50%). Most participants were 31-45 years old, and the duration of the cancer diagnosis was less than 6 months (74.6%). The data was collected on the following scales: the discrimination and stigma scale, the internalized stigma scale, the WHO-quality of life scale, and the fear of death scale. Data was analyzed using SPSS v.25; descriptive statistics, an independent sample t-test, and simple linear regression were applied to the data. The results revealed that men and women are both experiencing cancer-related stigmatization in Pakistan. However, women face a higher level of stigmatization, lower quality of life, and higher fear of death than men. Furthermore, the regression analysis result confirms that the cancer-related stigma faced by the diagnosed patients decreases the patient's quality of life and induces the fear of death.

Fear of Death and Death Acceptance Among Bereaved Adults: Associations With Prolonged Grief.

This study aimed to analyze fear of death and neutral acceptance of death after a significant loss and their associations with prolonged grief. The sample of the study included 239 bereaved participants. Time since the loss ranged from 6 to 72 months. We found that neutral acceptance of death was associated with older age, a natural cause of death, and the ability to find meaning in the death of a close one. Fear of death was negatively associated with the frequency of practicing religion. We found that fear of death but not neutral acceptance was significantly associated with prolonged grief symptoms.

Attitude Toward Death From the Perspective of Erik Erikson's Theory of Psychosocial Ego Development: An Unused Potential.

The aim of the article is to design a conceptual framework within the theory of psychosocial ego development that will allow for a better understanding and explanation of attitude toward death in the life cycle. The main weaknesses of previous studies on death attitude were examined; Erikson's concept may help exceed these limitations. The use of the model of hierarchy of defense mechanisms to study death attitude within Erikson's theory was proposed. The concept of the death complex was mentioned to better conceptualize the problem of attitude toward death as a part of the psychosocial theory. Finally, the evolution of attitude toward death in the consecutive phases of psychosocial development was discussed in the light of the concept of syntonic and dystonic ego features, as well as death complex, defense mechanisms, and psychosexual modes.

Does Psychosocial Ego Development Partially Mediate the Association Between Defense Mechanisms and Death Attitude?

Some authors suggest the existence of links between the mechanisms of defense and attitude toward death, however, mechanisms underlying these relationships are not well understood. The objective of the present research was to investigate whether psychosocial ego development is a partial mediator in the association between mechanisms of defense and death attitude. The study included participants (N = 382) aged 19-85 (M = 47.02, SD = 16.19). Three measures were used: Defense Style Questionnaire-40, Psychosocial Inventory of Ego Strengths, and Death Attitude Profile-Revised. Findings partly confirmed the hypotheses. Psychosocial ego development is a partial mediator in positive relationships between maladaptive defenses and fear of death, death avoidance, and escape acceptance. Psychosocial ego development is also a partial mediator in the positive association between more adaptive defenses and approach acceptance. The study provides novel information on the mechanisms underlying the association between defense mechanisms and multidimensional death attitude.

Attitudes of Palestinian and Polish Medical Students Towards Death.

Attitudes of students of health-related subjects towards the death are an important issue showing the behaviour and values ​​that guide young people in everyday interactions. The study was conducted using the Questionnaire About Attitudes Against Death (DAP-R-PL) among 309 students, including 150 Palestinian from the Faculty of Nursing and Health Sciences and 159 Polish from the Faculty of Health Sciences. It was noticed that the attitude of Death Avoidance is higher in Palestinians than in Poles. The biggest difference between correlation indicators is for the factors fear of death and death avoidance (FD and DA). This value is positive for Palestinian respondents and negative for Polish respondents. The study confirms that the attitudes of students towards death from both universities in the perspective of 5 factors are positive and in future contacts with dying patients they will cope with this challenge.

Oxytocin intensifies the mortality salience effect: Novel evidence for the social salience model of oxytocin.

Oxytocin plays an important role in human responses to threat processing. Few studies have directly examined the effects of oxytocin on our response to death-related stimuli. In the current study, 63 participants intranasally received either 32 IU of oxytocin or a placebo and thereafter completed a visual dot-probe task consisting of death-related and non-death related images. The results indicated that oxytocin enhanced participants' vigilance toward death-related images as well as increased their anxiety about and fear of death. Overall, oxytocin amplifies the defensive responses to a mortality threat, supporting the social salience model of oxytocin.

Does talking about end of life with adults with intellectual disability cause emotional discomfort or psychological harm?

BACKGROUND: Caregivers often avoid involving people with intellectual disability in end-of-life discussions and activities. One reason is fear that the person may become upset or psychologically harmed. METHODS: Pre and post a 6-month intervention about end of life, we assessed depression, anxiety, and fear of death among intervention (n = 24) and comparison (n = 20) participants with intellectual disability. End-of-life 'encounters' (conversations/activities about end of life) were monitored, including comfort ratings. RESULTS: Overall, 79% of encounters were rated very comfortable/somewhat comfortable. Participants initiated 69% of encounters. There was no significant pre-post change in depression or fear of death. Anxiety improved significantly. CONCLUSIONS: This is the first controlled, longitudinal study providing robust evidence about whether discussing end of life leads to emotional discomfort or psychological harm. Data showed adults with intellectual disability can safely engage in conversations/activities about end of life. The high percentage of participant-initiated encounters showed participants wanted to talk about end of life.