Fear of death and dying among medical students

Fear of Death and Examination Performance in a Medical Gross Anatomy Course with Cadaveric Dissection

Cadaveric dissection offers an important opportunity for students to develop their ideas about death and dying. However, it remains largely unknown how this experience impacts medical students' fear of death. The current study aimed to address this gap by describing how fear of death changed during a medical gross anatomy dissection course and how fear of death was associated with examination performance. Fear of death was surveyed at the beginning of the course and at each of the four block examinations using three of the eight subscales from the Multidimensional Fear of Death Scale: Fear of the Dead, Fear of Being Destroyed, and Fear for the Body After Death. One hundred forty-three of 165 medical students (86.7%) completed the initial survey. Repeated measures ANOVA showed no significant changes in Fear of the Dead (F (4, 108) = 1.45, P = 0.222) or Fear for the Body After Death (F (4, 108) = 1.83, P = 0.129). There was a significant increase in students' Fear of Being Destroyed (F (4, 108) = 6.86, P < 0.0005) after beginning dissection. This increase was primarily related to students' decreased willingness to donate their body. Concerning performance, there was one significant correlation between Fear for the Body After Death and the laboratory examination score at examination 1. Students with higher fears may be able to structure their experience in a way that does not negatively impact their performance, but educators should still seek ways to support these students and encourage body donation.

A Multifactorial Approach to Predicting Death Anxiety: Assessing the Role of Religiosity, Susceptibility to Mortality Cues, and Individual Differences

Death anxiety is not only experienced by individuals receiving end-of-life care, but also by family members, social workers, and other service providers who support these individuals. Thus, identifying predictors of individual differences in experienced death anxiety levels may have both theoretical and clinical ramifications. The present study assessed the relative influence of religiosity, susceptibility to mortality cues, state and trait anxiety, and demographic factors in the experience of death anxiety through an online survey distributed to members of two online communities related to end-of-life care. Results indicated that cognitive and emotional susceptibility to mortality cues, as well as gender, predicted differences in death anxiety. Conversely, religiosity and age did not increase the predictive power of the model. Thus, death anxiety may be a function of emotional, cognitive, and sociocultural factors that interact in complex, but predictable, ways to modulate the response to mortality cues that occur in one's life.

Thanatologists View Death: A 15-Year Perspective

This study examined the death attitudes of a number of prominent thanatologists over a 15-year span. In 1973, 40 (30 men, 10 women) invited participants at a conference on death and dying were surveyed concerning their attitudes toward dying and death using Feifel's Death Attitudes Questionnaire, a Death Semantic Differential Test, and a Death Metaphors Test. Fifteen years later, 25 (62.5 percent) of these individuals again gave their responses to the three measures. Analyses were limited to basic group comparisons because the original raw data were unavailable. Respondents were primarily behavioral scientists (64 percent), but sizeable minorities were from medicine/nursing (24 percent) and religion/philosophy (12 percent). They were about equally divided in the religious (45 percent) versus non-religious (55 percent) categories, and rated themselves as being fairly satisfied with themselves and life in general. Almost two-thirds reported some fear of death (64 percent at both time points), and only 20 percent indicated that the idea of their own death was “easy to accept.” Most (60–64 percent) reported a fear of the personal consequences of death, including pain and an inability to have experiences or complete projects, with the next most pervasive fear (36–40 percent) being the consequences to loved ones, including pain, loss, and financial difficulties. Concerning what occurs after death, about half of the respondents (48–52 percent) indicated that death is the end of existence, another 24–30 percent were uncertain and 16–17 percent believed in the continued existence of a soul. Death attitudes were remarkably stable over the 15-year interval. The major difference found was a lessening of death fear from 1973 to 1988 ( p < .002), that subjects attributed primarily to their ongoing conversations about death and dying (56 percent), and the deaths of family and friends (32 percent).

Fear of Death in Widows: Effects of Age at Widowhood and Suddenness of Death

This study investigated how widows' fears of death are affected by their age at widowhood and suddenness of death. Researchers administered the Collett-Lester Fear of Death Scale to 423 participants, categorized according to age (50 and 51) and suddenness of death (expected, unexpected, and non-widowed). No significant differences in fears of the dying process were found among groups. Fears of death of others and death of self were influenced by a significant effect of age: younger women expressed greater fears than older women. A significant interaction between age and suddenness of death was found regarding fear of death of others. Results are discussed and implications for research and practice are suggested.

Medical Students' Death Anxiety: Severity and Association With Psychological Health and Attitudes Toward Palliative Care

CONTEXT

Death anxiety (DA) is related to awareness of the reality of dying and death and can be negatively related to a person's psychological health. Physicians' DA also may influence their care for patients approaching death. Doctors face death in a professional context for the first time at medical school, but knowledge about DA among medical students is limited.

OBJECTIVES

This study examined medical students' DA in relation to: 1) its severity, gender differences, and trajectory during medical education and 2) its associations with students' attitudes toward palliative care and their psychological health.

METHODS

Four cohorts of core science and four cohorts of clinical students at the University of Cambridge Medical School took part in a questionnaire survey with longitudinal follow-up. Students who provided data on the revised Collett-Lester Fear of Death Scale were included in the analysis (n = 790).

RESULTS

Medical students' DA was moderate, with no gender differences and remained very stable over time. High DA was associated with higher depression and anxiety levels and greater concerns about the personal impact of providing palliative care.

CONCLUSION

The associations between high DA and lower psychological health and negative attitudes toward palliative care are concerning. It is important to address DA during medical education to enhance student's psychological health and the quality of their future palliative care provision.

Psychological research on death attitudes: an overview and evaluation

One of the most substantial legacies of Herman Feifel was his pioneering research on attitudes toward death and dying in a variety of populations. The authors review the large and multifaceted literature on death anxiety, fear, threat and acceptance, focusing on the attitudes toward death and dying of relevant professional and patient groups, and the relationship of death concern to aging, physical and mental health, religiosity, and terror management strategies. We conclude with several recommendations for improving the conceptual and practical yield of future work in this area.

Health care providers and dying patients: critical issues in terminal care

Three major areas of concern can be identified in the relationship between health care providers and dying patients: a) the nature of the difficulties and stresses associated with terminal care, b) the education of providers for this kind of work, and c) the influence of organizational structure and institutionalized values on services for dying patients and their families. A review of the research literature indicates that obstacles to effective terminal care continue to exist at the personal, interpersonal, and social levels in the current American health care system. Particular attention is given to demonstrated differences among health care professionals in their sources of emotional support and to difficulties associated with innovations in terminal care. Recent developments such as the predetermined reimbursement for health care based on established diagnostic categories (DRGs) have the potential for generating further obstacles to the providers' efforts to function as one human being helping another.

The construction of the multidimensional orientation toward dying and death inventory (MODDI-F)

This article describes the development of a questionnaire for the multidimensional assessment of both the fear of dying and death and the acceptance of dying and death. The Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F) is based on a 2 x 4-dimensional a priori structure. It consists of a factor analytically constructed version with 47 items in 8 subscales. In a German sample (N = 944; 426 men, 513 women; 18-93 years, stratified by age and sex), the internal consistency of the subscales ranges from .82 to .92. With the exception of one subscale, test-retest reliability is satisfactory. Construct validity has been demonstrated. The influence of social desirability is small in women and moderate in men. The available data suggest that MODDI-F provides a comprehensive, differentiated, reliable, and valid measurement of various orientations toward dying and death.

Caring for terminally ill persons: comparative analysis of attitudes (thanatophobia) of practicing physicians, student nurses, and medical students

To investigate why some caregivers desire to avoid patients with terminal illnesses, a thanatophobia scale assessing caregivers' uncomfortable feelings and sense of helplessness was developed and evaluated among practicing physicians and student nurses and medical students. As a group, student nurses scored lower on the thanatophobia scale than practicing physicians and medical students. Higher scores on intolerance to clinical uncertainty were associated with higher thanatophobia scores in all groups. Scores for depressed mood, decreased sensitivity, and Machiavellianism were statistically significant predictors in some groups. Higher thanatophobia scores also predicted lower scores for ratings of self-esteem in caring for elderly patients. Among senior medical students, those with lower thanatophobia scores tended to enter primary care residencies. Health professional educators may find this scale helpful both in pinpointing sources of caregivers' angst and useful in counseling students in management of terminally ill persons.

Special not different: general practitioners' accounts of their care of dying people

In modern Britain the majority of terminal care occurs in people's own homes and many dying people and their carers would prefer the death itself to occur in the home. The quality of terminal care in the home and the possibility of a home death depend to a great extent upon the care provided by GPs and community nurses. This paper reports on GPs' experiences of caring for dying people and their attitudes towards such work. It is based on unstructured interviews with 25 GPs who graduated from the 1979 entry cohort to the University of Leicester medical school. The respondents were recruited via a questionnaire following up previous research with this cohort on 'fear of death'. Although self-selecting, interviewees were not significantly different from those who did not volunteer for interview in any of the statistical analyses of the questionnaire data. There were a number of similarities in their accounts of their care of dying people. Common themes were that the care of dying people was important, rewarding and satisfying; that the GPs saw themselves as part of a team of carers, frequently as team co-ordinators; good working relationships with district nurses but less satisfactory relationships with hospitals and social workers; that patient and family were both recipients of care; and honesty in communication with dying people, albeit tempered. Three issues of contemporary relevance were: tensions over the role of hospice and specialist terminal care services; care of people with chronic terminal illnesses other than cancer; and the role of GPs in the social construction of bereavement.

The development of a training model to improve health professionals' skills, self-efficacy and outcome expectancies when communicating with cancer patients

Health professionals such as doctors and nurses are in a key position to help reduce the high prevalence of affective disorders and psychological problems experienced by cancer patients. This role, however, is inhibited by ineffective communication practices which include the use of distancing strategies and avoidance by the health professional. A number of contributory factors such as skill deficits and anxiety about negative consequences for the patient and the health professional have been identified in previous research and brief problem-focused training workshops developed to address these factors with only limited success. Researchers in applied psychology have recommended that the development of training programmes and their evaluation are based upon approaches which take into account cognitive and affective factors as well as change in skills. The aim of this paper is to develop a conceptual model of communication behaviour in the cancer setting. The model aims to take account of the role that knowledge and skill deficits, self-efficacy and outcome expectancy beliefs and perceived support plays in the ability and willingness of health professionals to assess their patients' concerns. It has been applied to guide the development of a revised approach to brief, problem-focused workshops for health professionals. It also allows a systematic and multi-dimensional evaluation of training outcomes. Preliminary results indicate this is a promising area of communications research.

Relationships among death anxiety, communication apprehension with the dying, and empathy in those seeking occupations as nurses and physicians

In light of the modern phenomenon of increased institutionalized deaths occurring in hospitals and in nursing homes, much of recent death attitude research has focused on health professionals. The present study explored possible relationships among measures of death anxiety, communication apprehension with the dying, and empathy in undergraduate nursing, premedical, and control subjects. Main effects for year in school indicated that seniors scored lower than freshmen on communication apprehension with the dying. The multivariate effects for field of study were also significant, with univariate results indicating that nursing students scored lower than controls on communication apprehension with the dying.

Death Anxiety and Personality: Are they Truly Related?

The purpose of the present study was to investigate a multidimensional conceptualization of death, as opposed to the traditional unidimensional approach, by utilizing a randomly-ordered questionnaire composed of selected personality variables and two measures of death anxiety (Templer's 1970 Death Anxiety Scale and Sarnoff and Corwin's 1959 Fear of Death Scale). Personality variables measured were extraversion-introversion, neuroticism, Type AB behaviors, and major life stressors. The questionnaire was completed by 161 undergraduates attending a Southwestern college. Results of Pearson correlation analyses demonstrated that both death anxiety scales were significantly related to neuroticism and to Type A behavior patterns, such that high death anxiety was correlated with greater emotionality and more aggressiveness. Correlational measures with extraversion and life stressors did not reach significance. Stepwise multiple regression analyses indicated that neuroticism, Type A behaviors, extraversion, and anticipated life stressors accounted for a significant amount of variability in death anxiety. Suggestions made for future researchers include measuring different populations and further developing a multidimensional conceptualization of death.

Fear of Personal Death and the Mmpi Profile of Middle-Age Men: The Moderating Impact of Personal Losses

The present study examines the association of fear of personal death and aspects of psychological maladjustment and the moderating impact of personal losses. Ninety-seven middle-aged Israeli males completed the MMPI, a brief scale on personal loss experiences, and the Fear of Personal Death Scale. Results revealed that the MMPI profile was significantly related to the pattern of fear of personal death. This association, however, only reached significance among the middle-aged men who had not experienced personal losses. In addition, respondents who had experienced personal losses reported higher levels of fear of personal death than respondents who had not experienced any personal loss. Results were discussed from a multidimensional perspective of fear of death.

Educating psychiatry residents about death and dying. A national survey

A national survey was conducted to assess the prevalence of teaching about death and dying issues in psychiatric training programs. Responses from 142 program directors indicated that 56% of responding programs offer specific lectures or didactics on this topic. Of residents surveyed (N = 286), 25.8% reported such lectures. Residents' feelings and experiences regarding death and dying are also explored. Psychiatric residency training programs are challenged to enhance their educational efforts on this topic in view of the demand for this knowledge resulting from many factors, which include the AIDS epidemic, issues of assisted suicide, and expectations from medical colleagues.

Formal instruction in United Kingdom medical schools about death and dying

The paper reports the findings of a short questionnaire survey of medical schools conducted in June 1983. All U.K. schools replied. Only four schools do not provide formal instruction about death and dying for all their students.

'We didn't want him to die on his own' ? nurses' accounts of nursing dying patients

This paper is based on nurses' accounts of their experiences of nursing dying patients, and the attitudes towards such work which they expressed. Nurses reported high levels of emotional involvement with their dying patients and expressed a preference for being honest with them about their condition. They preferred to nurse patients who were aware of their death rather than those who were not. Structural aspects of the ward organization which facilitate such action and attitudes are identified.