Some Personal Reflections on the History and Current Status of Textbooks in the Field of Death, Dying, and Bereavement

This article is a contribution to recording one dimension of the history of education in the field of death, dying, and bereavement. It offers some personal reflections on the history and current status of textbooks in our field that have been or are currently published in North America. The scope of this reflection looks back on the earliest textbooks in this field published in the 1960s and 1970s and extends to textbooks published in the early 2020s. Critical comments are offered on general trends or on textbooks that are no longer in print, but not on individual titles that are currently available for adoption and instructional use. Because I am the lead author of one such textbook, I do not choose to engage in invidious comparisons. Instead, this article includes descriptions of contemporary textbooks taken from the Amazon website.

The Meaning of Hope for Polish Male Patients Dying from Cancer Depending on Their Age: An Interdisciplinary Study with the Use of Osgood's Semantic Differential Method

Background/Objectives: The subject of this article is the reflection on hope-one of the most important predictors and motivators of human actions. Hope is our response to a threat, and it is also the emotion that allows us to overcome hopelessness and to reduce suffering. Hoping is a human capacity with varying cognitive, emotional, and functional dimensions. Psychological, pedagogical (particularly in the framework of special-needs pedagogy and thanatological pedagogy), and theological reflection on hope can be helpful for dying people. The objective of this study was to characterize hope in the semantic space of individuals in the terminal stage of cancer and to verify whether age is a variable that determines this hope. Methods: To complete the study, the Osgood semantic differential method was applied, as modified by Polish psychologist Dr. Boguslaw Block (the DSN-3 test). The research technique consisted of a therapeutic conversation. Results: Research results show that, in general, those in the terminal stage have positive associations with hope. In all three aspects of the used test, namely the cognitive, emotional, and functional aspects, the highest scores assigned to the perception of hope were obtained from men up to 35 years of age. Depending on the ages of patients, one could observe certain semantic shifts, but they did not prove to be statistically significant. Conclusions: Polish males surveyed at the end of life due to cancer generally perceived hope as a supportive force. Therefore, hope can provide emotional support to patients in the terminal stage of cancer and improve their quality of life.

Some Reflections On The History And Current Status of Education in the Field of Death, Dying, and Bereavement at the College and University Level In North America

This article is a contribution to recording one dimension of the field of death, dying, and bereavement. It offers some personal reflections on the history and current status of formal education in this field at the college and university level in North America. The scope of this reflection looks back on the earliest known examples of formal education in this field that took place in the 1960s and 1970s, provides examples of some of the early pedagogical resources that were created to support and foster those initiatives, and sketches more recent developments as regards introductory or undergraduate survey courses in this field, other death-related courses, programs in thanatology, and efforts to offer certificates or certification for educators and other professionals in this field. The article concludes with some thoughts about what we have learned from and about education in the field of death, dying, and bereavement.

Death education interventions for people with advanced diseases and/or their family caregivers: A scoping review

BACKGROUND

People with life-threatening diseases and their family caregivers confront psychosocial and spiritual issues caused by the persons' impending death. Reviews of death education interventions in the context of life-threatening diseases are scarce and limited to certain intervention types.

AIMS

This study aims to ascertain existing evidence on death education interventions for the population of adults with advanced diseases and/or their family caregivers and identify gaps for future research.

DESIGN

A scoping review guided by Arksey and O'Malley's framework.

DATA SOURCES

Thirteen electronic databases were searched for experimental and qualitative studies on death education interventions for the advanced disease population and/or their family caregivers between 1 January 1960 and 25 October 2023.

RESULTS

Nine types of interventions were identified in 47 studies, which included 5 qualitative and 42 experimental designs, half of which were pilot and feasibility trials. Most of the studies focused on people with advanced cancer, and only seven investigated caregivers or families/couples. Death-related outcomes were less likely to be assessed relative to psychological outcomes, spiritual well-being, and quality of life. Life review interventions, cognitive-behavior therapy, narrative therapy, and general psychosocial interventions decreased depression and anxiety, but evidence was limited. Factors contributing to the interventions' success included intervention content, which enabled the disclosure of personal experience and death concerns comfortably, trained professionals, and connection to family caregivers.

CONCLUSIONS

This work identified a few potentially effective death education interventions for psychological outcomes for people with advanced cancer or their caregivers. Additional trials are needed to confirm the effectiveness of these interventions.

Death in the Scottish curriculum: Denying or confronting?

The important role of schools in supporting children experiencing bereavement is established, yet less is known about how school curricula include death as part of life and this limits our understanding of the systemic structures that shape children's knowledge and experience of death. To address this gap, this paper discusses an analysis of the Scottish curriculum to explore the extent to which death features in compulsory education for children aged 3 to 15 years. The findings show that whilst death is present across the curricula, certain types of 'knowing' death are promoted, largely situated across religious teaching, which may limit children's engagement with the multiple and complex ways in which death features across individual, social, physical, and relational domains. By integrating the concepts of death systems and death ambivalence, the paper develops new knowledge on the interplay between curricula and sense making around death in children's lives that has practical utility.

Death education for Palliative care: a european project for University students

BACKGROUND

The need to spread the culture of palliative care and to train health care professionals from undergraduate courses is recognised internationally. The article presents the outcomes of a project devoted to palliative care training in university courses in four countries.

AIMS

This article considered the outcomes of a course designed for university students who had the potential to work in a palliative care team. The main aim was to check the efficacy of the course and the motivation to work in palliative care settings, considering the impact of fear and representations of death.

METHODS

The project presented the essential contents related to palliative care, using psychodramatic and photo-voice techniques. Longitudinal measurements were taken using a quantitative method design to detect changes among the students involved. The project involved 341 students at the first administration of the survey consisted of a protocol composed of standardized questionnaires in five countries (Austria, Israel, Italy, Poland and Romania), of whom 276 completed the pre- and post-surveys-165 of them in the experimental group and 111, in the control group.

RESULTS

The experience showed that it is possible to address death-related issues seriously and competently without necessarily causing discomfort and despondency in students. The results of the changes over time in the experimental and control groups highlight how the view of death as annihilation is correlated with the fear of death and the need for avoidance of thoughts concerning dying. The main result is that competence in palliative care facilitates familiarisation with issues of death and dying, as well as the ability to work in this area, thereby enhancing interpersonal skills.

CONCLUSION

The project showed that it is possible to implement death education on palliative care topics in undergraduate courses to increase motivation to work in this field.

Interest and Confidence in Death Education and Palliative Psychology in Italian and Indian University Students of Psychology: Similarities and Differences

Teaching death education and palliative psychology in universities has proven to be of great importance, especially in the health professions. The present study aims to evaluate the similarities and differences in interest and confidence in death education and palliative psychology between university psychology students from two culturally different countries: Italy and India. For this study, 63 Italian and 35 Indian psychology students were recruited to take part in a course on death education and palliative psychology. The results showed the positive impact of a death education and palliative psychology course on the training of professionals. In particular, this course was useful in helping students become familiar with and learn how to manage future professional situations related to death and dying. Specific differences between the two countries also emerged, particularly with regard to their approach to the end-of-life field, due to different cultural contexts. There is still much to be done by institutions to improve the dissemination and academic teaching of this area, which in turn can promote job opportunities for young people and encourage them to work in this field.

When residents die in Portuguese care facilities: The experiences and practices of care facility directors before and during the COVID-19 pandemic

This qualitative exploratory study aimed to describe the experiences and practices of care facility directors regarding residents dying in Portuguese residential care facilities (RCFs) before and during the COVID-19 pandemic. Data was obtained from 17 care director facilities who participated in focus groups. The data analysis followed the interpretative phenomenological approach. Participants stated that practices surrounding the death of the residents in Portuguese RCFs changed significantly from before to during the pandemic, regarding both those who died from COVID-19 infection and from other conditions. Four themes emerged that illustrated the situation during the peaks of the pandemic. During the pandemic, practices and experiences quite different from the usual ones have emerged. These results support the importance of a good death, and dying with dignity in RCFs, and the need for policies, practices, and training on the death of residents in RCFs in Portugal.

The Cognitive Aspect of Hope in the Semantic Space of Male Patients Dying of Cancer

The aim of this study is to characterize the cognitive aspect of the semantic space of hope in patients in the terminal stage of cancer. This was confirmed in the research on hope by C. R. Snyder and B. Schrank. Hope is of great importance in all the great world religions and belief systems, both as regards a personal God or impersonal deities. Hoping is a human capacity with varying affective, cognitive and behavioral dimensions. Psychological, pedagogical (particularly in the framework of special needs pedagogy and thanatological pedagogy) and theological reflection on hope can provide support for dying people. In order to conduct the research, the semantic differential research method was selected. The research technique employed was a therapeutic conversation, and the research tool was the B.L. Block's DSN-3 test. The DSN-3 test allows one to assess hope in the semantic space in three aspects: cognitive, emotional and functional. For the purposes of this study, only the cognitive aspect was taken into account. The study was begun on 1 April 2010 and ended in the last days of December 2020. It included 110 male patients in the terminal stage of cancer. The youngest respondent was 19 years old and the oldest was 94 years old. The surveyed men most often perceived hope in the semantic space in the cognitive aspect as more true, wise, meaningful and real than false, stupid, meaningless and deceptive. Their attitude to hope was, therefore, more affirmative than negative. The research did not reveal the importance of the age of the respondents on the degree of affirmation/negation of hope in the cognitive aspect in the semantic space; however, men in the period of late maturity and professional activity expressed the lowest level of the affirmation of hope. It is worthwhile to conduct further research concerning hope in other aspects (especially emotional and functional) in the semantic space in order to use the obtained results to consider what to take into account when providing patients in the terminal stage of cancer with better personalized holistic care than before.

The Central Role of Schools in Promoting Death Education Interventions

Avoidance of discussion about death is common in contemporary Western societies. Plenty of literature substantiates that (at the beginning of the sentence), the actual tendency toward death denial can produce many negative effects such as the suppression of death-related thoughts and emotions. Death Education aims to strengthen the psychological anchors that allow us to recognize the profiles of anguish, prevent the decompensating factors of pathological mourning and process the experiences of loss at all ages. The article aims to support the usefulness and use of Death Education interventions in schools and their central role in promoting these interventions.

Perceptions of Death Among Patients with Advanced Cancer Receiving Early Palliative Care and Their Caregivers: Results from a Mixed-Method Analysis

BACKGROUND

Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers.

MATERIAL AND METHODS

Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers.

RESULTS

Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, Ps < .0001; adjectives, Ps < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group.

CONCLUSIONS

EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers.

The Co-Construction of an Elegant Ending-Polyphonic Musical Intervention in Palliative Care: A Case Study

The complexity of creative processes, within which human nature pines and finds itself, reflects a state of relational emergency. The weak structure of our multicultural system gives us a series of behavioral flaws, denouncing our inability to welcome diversity and treasure it. In the search for the way out, using the metaphor of polyphony is increasingly frequent. However, since the term Polyphony is borrowed from musical language, it would be necessary to experience it concretely, and this usually does not happen. Those musicians who aspire to be artists in helping relationships should constantly train themselves in this sense and force themselves to make their ability understood externally, helping those who for reasons of life find themselves experiencing the limit. The field of palliative care is probably the most suitable socio-cultural setting for getting in touch with the personal (mis)interpretations, idiosyncrasies, and pain of those who feel close to the end. To their aid, the aesthetic criterion advances. Making sacred the unifying experience of loss and finiteness turns into an educational process moreover therapeutic, in the co-construction of an elegant "finale" able to reach the heart and intelligence of those who remain.

The Interactive Factors Contributing to Fear of Death

Despite the importance of the topic of death, a limited comprehensive statistical analysis conducted highlighting the complex association between fear of death and various variables. Thus, this study is conducted to account for the possible complexity by considering all interaction terms after reducing the dimensionality of a dataset by means of recursive feature elimination, followed by the removal of the multi-collinear variables. The results highlighted, for instance, although being married, older and female offset the negative associations of fear of death, their impacts are multiplicative. Also, those who think cryonics is desirable are associated with higher fear of death. For instance, while belief in cryonics is positively associated with fear of death, its association varies depending on the trouble that individuals experience that someday they would not be alive and their marital status.

Acknowledging bereavement, strengthening communities: Introducing an online compassionate community initiative for the recognition of pandemic grief

Despite public health measures and collective efforts, millions of individuals have unfortunately died from COVID-19 complications worldwide, leaving several million family members at risk of developing bereavement complications. In the Canadian province of Quebec, where substantial deaths were associated with COVID-19, we established an online support community for bereaved caregivers who lost a loved one during the pandemic. We explain how we created a community that recognized pandemic grief and advocated for its wider acknowledgment. We discuss "compassionate communities," the theoretical underpinning of our initiative, as a means to foster solidarity, normalize finitude, create and maintain a safe social space through group sharing, and challenging capitalist principles. We then describe the eight areas of activities inspired by the Charter of Pallium Canada: education and training, hospices and nursing homes, media and social media, commemoration, celebrations, artistic practices and storytelling, marginalized populations, and review and evaluate. We propose that online communities constitute a powerful space for community members to gather and advocate for greater awareness of the inequities found in end-of-life care and bereavement services, to denounce abusive situations experienced by many individuals who died from COVID-19 complications, and to fight against the lack of recognition experienced by numerous caregivers.

Construction of life-and-death education contents for the elderly: a Delphi study

BACKGROUND

Life-and-death education is intimately related to palliative-and-hospice care. It should be implemented among groups of all ages, especially for the elderly. This study aims to establish expert consensus on a set of scientific and systematic life-and-death education contents for the elderly and provide reference for the practice on the elderly.

METHODS

This study designed three rounds of expert consultation by using a Delphi method. A panel of 22 experts from the fields of palliative-and-hospice care, life-and-death education, geriatric nursing, humanities and ethics, and geriatric psychology participated in the study.

RESULTS

This study finally reached expert consensus on the contents of life-and-death education for the elderly, containing 4 first-level items, Life-and-death literacy promotion in the elderly; Life-and-death concept establishment of the elderly; Life-and-death planning of the elderly; Life-and-death thoughts of the elderly with affiliated 9 second-level items, and corresponding 23 detailed third-level items.

CONCLUSIONS

The life-and-death education contents for the elderly offer a basis for publicity for health professionals, promote dialogues on death, preparation, and planning for death and dying. The life-and-death education contents system was clear in coherence containing definite and comprehensive contents, which enriched life-and-death education resources globally. The results could assist in the planning of palliative-and-hospice care services to improve quality of death of the elderly.

Community-based death preparation and education: A scoping review

The COVID-19 pandemic revealed a need for people and communities for death preparation. Few studies have examined community-level interventions for death preparation and education. This scoping review scrutinized the relevant literature following PRISMA 2018 guidelines. Six databases were searched for articles published between 2010 and 2020. We found that cultural, socioeconomic, and individual values affected death preparation and that online courses and life-death education were effective preparation methods. Additional research is needed to identify the population-specific effectiveness of interventions. To fully investigate death preparation and education at the community level, theory-based studies employing quantitative and qualitative methods are also needed.

Suicide Prevention: University Students' Narratives on Their Reasons for Living and for Dying

Social isolation and loneliness are increasing in our contemporary western society and seem to correlate with suicide in adolescents and young adults. Social Workers are a potential resource to create such initiatives and projects that promote inclusion and cohesion within communities, a protective factor against suicide. Sixty-two Social Work BA students participated in a Death Education course based on education on suicide prevention. Participants carried out two activities. First, they were invited to complete two written semi-structured interviews on young people's reasons for living and dying. Second, they were invited to design suicide prevention interventions targeted at their peers and adolescents. Data were analyzed qualitatively within the Thematic Analysis framework. As regards the first activity, four main themes were identified: (1) Internet and social media; (2) social isolation and loneliness; (3) the importance of proximal relationships; and, (4) the importance of networking between proximal relationships, educational institutions and mental health services. Whereas, as for suicide prevention interventions, three main ideas were identified: (1) suicide prevention through community and networking between services; (2) academic institutions: high schools and universities; and, (3) suicide prevention through new technologies. To conclude, Death Education as education on suicide prevention can offer young people a space in which to voice their and their peers' reasons for living and dying and to reflect upon their contribution to suicide prevention as students and as future professionals.

The presence of death in Spanish education law (1812-2006)

The objective of this study is to determine whether death has been present, and if so in what way, in Spanish education law from 1812 to 2006. The presence of 25 terms semantically related to death was analyzed in laws and regulations on school curricula. Death is generally absent as a directly approachable phenomenon within the given period, except in scattered regulations which, as a rule, link death in education to religion. From the beginnings of the democratic period in Spain (1975), socially relevant subjects with indirect but significant relationships with death, such as biodiversity and the Holocaust, appear.

The COVID-19 pandemic has changed dying and grief: Will there be a surge of complicated grief?

Worldwide, more than 3 million people have died from COVID-19. Each decedent represents a person who was loved, will be missed, and whose death elicited grief. COVID-19 has changed the way we die and grieve. Many people have died without family members and friends present and many of the bereft have grieved and mourned alone. Individuals and communities have experienced multiple losses within a short time while suffering from concomitant stress, anxiety, and depression. More deaths and more grief will continue in the foreseeable future. Preventive education is needed to prepare for and manage the likely increase in complicated grief.

Life, death, and spirituality: A conceptual analysis for educational research development

Life education, also known as life and death education, is an important subject in Taiwan. Life education is more than just the study of a person's development throughout the lifespan (e.g., cognitive development). Within the learning and sociocultural contexts of Taiwan, interestingly, the study of life and death education is concerned with the premise of the promotion and fulfillment of life qualities (e.g., a person's state of contentment), and the meaningful understanding of the nature of death. To facilitate appreciation and deep, meaningful understanding of the subject, and to emphasize its uniqueness, educators have included in their teaching the importance of Eastern-derived philosophical beliefs and religious faiths (e.g., Buddhism). For example, relatively significant in its emphasis, the teaching of this subject involves detailed examination of theoretical accounts of spiritual cultivation and its positive effect on a person's interpretation and enlightenment of life wisdom.

The study of life education, or life and death education, we contend, is of significance as it provides life-related insights and theoretical understanding into the intricate nature of life and death. One notable aspect of the subject entails a person's acquired life wisdom, which in turn may shape his/her life practice on a daily basis (e.g., the proactive engagement in Buddhist meditation). Importantly, the study of life education may assist individuals with their coping of grief, and to approach death with a sense of peace, calmness, and dignity. In this analysis, coupled with Buddhist faith (or any other religious faith for that matter) and facilitated by spiritual cultivation (e.g., the belief in the notion of transcendence experience), a person may overcome grief by believing in the possibility that there is some form of post-death experience and the presence of a loved one's spiritual being. Given this emphasis, we consider an important focus for discussion in this article: to explore the significance of life and death education and to determine how its ‘positive nature’ could potentially yield two comparable implications for development: (i) to engage in appropriate pedagogical practices that would encourage and promote the study of life and death education, and (ii) to advance innovative research inquiries, theoretical, methodological, and/or empirical, which could highlight the significance of life education for life purposes (e.g., the significance of Chinese ideograms, such as 孝).

The hospice as a learning space: a death education intervention with a group of adolescents

Background

The denial of death in Western society deprives young people of the tools to derive meaning from experiences of death and dying. Literature shows that death education may allow them to become familiar with this topic without causing negative effects. This article describes the effects of a death education course with adolescents, wherein participants were given the opportunity to meet palliative doctors and palliative psychologists at school and in a hospice, where they were able to converse with the families of the dying.

Methods

This study used mixed methods and included an evaluation of a death education intervention with longitudinal follow-up of outcomes. The course involved 87 secondary school students (experimental group) aged between 16 and 20 years. We also recruited a control group of 76 similarly-aged students to observe differences. The variables we examined were: alexithymia, representation of death, value attributed to life and spirituality. These were measured with the following instruments: the Toronto Alexithymia Scale-20, the Testoni Death Representation Scale, the Personal Meaning Profile and the Spiritual Orientation Inventory, respectively. To better understand how the students perceived the experience, we asked the experimental group to answer some open-ended questions. Their answers were analysed through thematic analysis.

Results

The study showed that death education and the hospice experience did not produce negative effects, but rather allowed students to decrease alexithymia, improving their ability to recognise and express emotions. Thematic analysis revealed that all participants perceived the experience as very positive.

Conclusions

Our findings affirm that death education programs can be successfully implemented in high schools, and that they can usefully involve local hospices and palliative care professionals, especially physicians and psychologists.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00747-w.

Students' Confidence and Interest in Palliative and Bereavement Care: A European Study

As part of a European Erasmus Plus project entitled Death Education for Palliative Psychology, this study assessed the ways in which Master's Degree students in psychology and the creative arts therapies self-rated their confidence and interest in death education and palliative and bereavement care. In five countries (Austria, Israel, Italy, Poland, Romania), 344 students completed an online questionnaire, and 37 students were interviewed to better understand their views, interest, and confidence. The results revealed some significant differences between countries, and showed that older respondents with previous experience as formal caregivers for end-of-life clients showed greater interest in obtaining practical clinical competence in these fields. A mediation analysis indicated that students' previous care experiences and past loss experiences were related to students' current interest in death education and palliative and bereavement care through the mediation of their sense of confidence in this field. The qualitative findings identified five shared themes: life and death, learning about death, the psychological burden, personal experience and robust training, and four key training needs. Overall, students' interest in studying and working with terminal illness and death are rooted in internal resources, a preliminary sense of confidence, but also external requirements.

Mourning and Management of the COVID-19 Health Emergency in the Priestly Community: Qualitative Research in a Region of Northern Italy Severely Affected by the Pandemic

Background: The COVID-19 pandemic is causing major social changes to which significant psychological effects are linked. During the first phase of the pandemic wave in Italy, whilst there was insufficient information about the phenomenon and the strategies to safeguard the population against it, many categories of people, whose professions required constant contact with the public, were affected by the contagion.

Aims: The literature has shown how religiousness can support the management of stress due to diseases and health risks. In relation to this, the current study wanted to investigate how priests managed the early stages of the pandemic. This work, therefore, aimed to investigate the psychological experiences related to the contagion and the eventual death of colleagues as well as the resilience strategies activated by the priests during the process.

Participants: The research involved 12 Catholic priests, all male and aged between 42 and 63 years. They came from the same pastoral community in one of the regions in Northern Italy that were most affected during the first phase of the pandemic. Those ministers had been constantly in contact with the faithful of their parishes since the breakout of the virus.

Methodology: A qualitative research design was adopted, and in-depth interviews were conducted. The dialogues aimed at investigating the deep, personal and relational experiences of the priests, together with their concerns and the tools they adopted to manage anxiety. The texts obtained from the interviews were subjected to thematic analysis.

Results: The areas studied concerned the experiences of the participants during the lockdown, the implications of social distancing and lack of funeral rituality and, finally, the importance of prayer as a resilience factor.

Conclusions: In the current scenario dominated by the pandemic, it is significant and stimulating to understand and reflect on the functions and roles of the experiences of faith, particularly the act of elaborating the process of mourning due to COVID-19.

Words describing feelings about death: A comparison of sentiment for self and others and changes over time

Understanding public attitudes towards death is needed to inform health policies to foster community death awareness and preparedness. Linguistic sentiment analysis of how people describe their feelings about death can add to knowledge gained from traditional self-reports. This study provided the first description of emotive attitudes expressed towards death utilising textual sentiment analysis for the dimensions of valence, arousal and dominance. A linguistic lexicon of sentiment norms was applied to activities conducted in an online course for the general-public designed to generate discussion about death. We analysed the sentiment of words people chose to describe feelings about death, for themselves, for perceptions of the feelings of ‘others’, and for longitudinal changes over the time-period of exposure to a course about death (n = 1491). The results demonstrated that sadness pervades affective responses to death, and that inevitability, peace, and fear were also frequent reactions. However, words chosen to represent perceptions of others’ feelings towards death suggested that participants perceived others as feeling more negative about death than they do themselves. Analysis of valence, arousal and dominance dimensions of sentiment pre-to-post course participation demonstrated that participants chose significantly happier (more positive) valence words, less arousing (calmer) words, and more dominant (in-control) words to express their feelings about death by the course end. This suggests that the course may have been helpful in participants becoming more emotionally accepting in their feelings and attitude towards death. Furthermore, the change over time appeared greater for younger participants, who showed more increase in the dominance (power/control) and pleasantness (valence) in words chosen at course completion. Sentiment analysis of words to describe death usefully extended our understanding of community death attitudes and emotions. Future application of sentiment analysis to other related areas of health policy interest such as attitudes towards Advance Care Planning and palliative care may prove fruitful.

An Ethnography Study of a Viral YouTube Educational Video in Ecuador: Dealing With Death and Grief in Times of COVID-19

In Western societies, death is a social and educational taboo. Poor education about death and mourning processes and overprotective family and social attitudes move children away from death to avoid "unnecessary suffering." The COVID-19 outbreak highlighted these shortcomings and the difficult management of grief's complexity under sudden and unexpected scenarios. The need for immediate and constant updates related to COVID-19 benefited from social media coverage's immediacy. The use of YouTube as a digital platform to disseminate/search for knowledge exploded, raising the need to conduct ethnographic studies to describe this community's people and culture and improve the booming social media's educational capacity and quality. The present virtual ethnography studied 255,862 YouTube views/users and their behavior related to "Vuela Mariposa, Vuela," a children's story available online since 2009 (not monetized) about the cycle of life, death, and disenfranchised grief (not acknowledged by society) that went viral (+>999%) on May. To our knowledge, this case study is the first original research that explores the ethnography of (i) a viral video, (ii) on death and grief taboo topics, (iii) for prescholars, and (iv) before and during the COVID pandemic. The quantitative and qualitative analyses identified a change in the users' profiles, engagement, and feedback. During the previous 11 years, the users were 35-44 years old Mexican and Spanish women. Those in grief used narrative comments to explain their vital crisis and express their sorrow. In the pandemic, the analysis pointed to Ecuador as the virality geographical niche in a moment when the tragic scenarios in its streets were yet unknown. The timeline match with the official records confirmed the severity of their pandemic scenario. The viral video reached a broad population, with normal distribution for age, and including male gender. Engagement by non-subscribers, direct search (traffic sources), and mean visualization times suggested educational purposes as confirmed by the users' feedback with critical thinking referring to the cycle of life's meaning and societal mourning. For the youngest users, the video was part of academic assignments. The ethnography pointed at YouTube as a flexible education resource, immediately reaching diverse users, and being highly sensitive to critical events.

Introducing the Study of Life and Death Education to Support the Importance of Positive Psychology: An Integrated Model of Philosophical Beliefs, Religious Faith, and Spirituality

Life education, also known as life and death education, is an important subject in Taiwan with institutions (e.g., high school) offering degree programs and courses that focus on quality learning and implementation of life education. What is interesting from the perspective of Taiwanese education is that the teaching of life education also incorporates a number of Eastern-derived and conceptualized tenets, for example, Buddhist teaching and the importance of spiritual wisdom. This premise contends then that life education in Taiwan, in general, is concerned with the promotion, fulfillment, and cherishing of quality life experiences (e.g., personal contentment, happiness). One example of life education, which resonates with other spiritual beliefs and religious faiths (e.g., Hinduism), is related to spiritual cultivation and the enlightenment of life wisdom. Our own teaching of the subject, likewise, places emphasis on the goal of teaching students to seek meaningful understanding of and appreciation for three major, interrelated components of life education: life wisdom, life practice, and life care. It has been acknowledged, to a certain degree, that life education has made meaningful contributions, such as the creation and facilitation of a civil, vibrant society, and that many Taiwanese individuals show dignity, respect for elders, and reverence for spiritual and religious faiths. For example, aside from high-quality hospice care, many Taiwanese engage in different types of benevolent acts (e.g., providing spiritual advice to someone who is dying), where possible. Life education is a beneficial subject for teaching and learning as its theoretical understanding may help individuals cope with pathologies and negative conditions and life experiences. One negative life experience, in this case, is the ultimate fate of humankind: death. Approaching death and/or the onset of grief is something that we all have to experience. How does one approach death? It is not easy feat, and of course, grief for a loved one is personal, and some of us struggle with this. We contend that spiritual cultivation and enlightenment, arising from life education, may assist us with the topic of death (e.g., the possibility of transcendence beyond the realm of life). More importantly however, from our own teaching experiences and research development, we strongly believe and rationalize that the subject of life education could, indeed, coincide with and support the paradigm of positive psychology (Seligman, 1999, 2010; Seligman and Csíkszentmihályi, 2000). Forming the premise of the present conceptual analysis article, we propose that a person's "spiritual and enlightened self," reflecting the convergence of three major aspects of life education (i.e., philosophical reflection, enrichment of personal well-being, and spiritual cultivation), would result in the initiation and creation of a number of virtues and positive characteristics, for example, having a positive outlook in life, having a perceived sense of spirituality, showing compassion, forgiveness, etc. These virtues and quality characteristics, from our philosophical reasoning, are equivalent to those qualities that the paradigm of positive psychology advocates for. In summary, we conceptualize that the subject of life education, from the perspective of Taiwanese education, may intertwine with the paradigm of positive psychology. A person's spiritual and enlightened self, or his/her "holistic self," from our rationalization, is the ultimate optimal life experience that he/she may have, enabling him/her to address the gamut of life conditions and experiences. The distinctive nature of life education in this case, as a point of summary, is that it incorporates spiritual beliefs and religious faiths (e.g., Buddhist faith), encouraging a person to seek nature and divine-human relationships, as well as to contemplate and to explore the complex nature of his/her inner self. The notion of Buddhist samsâra, for example, as "evidence" of spirituality, entailing the endless cycle of birth, rebirth, and redeath, may provide a person with hope into the afterlife. Such esoteric discourse, we contend, is positive and optimistic, allowing individuals to discard the dividing line between life and death.

COVID-19 brings a new urgency for advance care planning: Implications of death education

The U.S. has the highest number of coronavirus disease (COVID-19) cases and deaths of any nation. Deaths due to COVID-19, especially among older adults and people of color, have created an urgency for advanced care planning (ACP). Despite benefits of ACP, only one-third of U.S. adults have completed advance directives, in part due to a lack of death education. We recommend four actions to increase death education and ACP completion: (1) integrate death education into teacher preparation programs, (2) incorporate death education in undergraduate curricula, (3) provide better education in death and dying to future health professionals, and (4) educate the public.

A Place to Live and to Die: A Qualitative Exploration of the Social Practices and Rituals of Death in Residential Aged Care

In many countries, an increasing proportion of deaths occur in residential aged care (RAC) (nursing homes) meaning that these have become both a place to live - a home- and a place to die. This paper reports on death practices and rituals in 49 RAC facilities in Aotearoa/New Zealand narrated in semi-structured interviews with staff. Themes coalesced around 'good death'. Dying alone was not seen as a good death and the demands of trying to prevent this caused tension for staff. Meeting family wishes, post death decision-making, after death practices and rituals, including communicating and remembrance of the death, were explored as part of good death. Overall, death rituals in RAC were limited. Balancing the needs of the living, the dying and the dead created tension. The rituals and practices facilities are currently enacting in death/post-death require attention, since more people will die in RAC with increasingly diverse needs.

A call for epidemiology and thanatology to address the dying, death, and grief pipeline among Blacks in the United States

Dying, death, and grief are significant events that impact individuals, families, and communities. In the United States, Blacks historically have higher morbidity and mortality rates than other racial-ethnic groups. While death is a normal and natural phase of the life-course process, high incidents of infant mortality, premature death, and preventable death are not. The disproportionate burden of dying, death and grief among Blacks have detrimental consequences which demand interdisciplinary interventions from public health and death study researchers. This manuscript explores dying, death and grief from three distinct fields of study: (1) epidemiology of death, (2) social epidemiology of death, and (3) thanatology.

Death education from an Hegelian perspective

This paper discusses death education from an Hegelian perspective, with the aim to generate insights to complement existing literature on death education. Three Hegelian elements are identified. The first is the natural view, that is, death is a natural phenomenon. The second is the moral view, that is, death is significant in contributing to the ethical life and no individuals have the right to end their own life. The third is the ontological view, that is, the life-and-death struggles for recognition raises individuals' consciousness, and death transforms the divine into universal and enables the ultimate realization of the spirit to Absolute Knowing.

The effect of death education on fear of death amongst Italian adolescents: A nonrandomized controlled study

This study describes the psychological effects of death education in reducing the fear of death in a large cohort of Italian adolescents. Following the constructs of "distal defenses" and "mortality salience" of Terror Management Theory, this research intervention also evaluated the proposition that spirituality and belief in an afterlife could provide an effective buffer against fear of death. Five hundred thirty-four Italian high school students participated in a school-based death education program with an experimental group and a nonrandomized control condition. Using a pre/post-course design, we assessed fear of death, alexithymia, and representations of death and spirituality for both groups. Results confirmed that the course reduced death fears and the representation of death as annihilation while also enhancing spirituality. In particular, the older participants in the death education course increased their spirituality and decreased their fear of death, whereas females reduced their conviction that death was an absolute annihilation. Finally, the structural model suggested that alexithymia mediates the relationships among fear of death and spirituality; in particular, fear of death predicted more alexithymia and more alexithymia predicted lower spirituality.

Dealing with death in cancer care: should the oncologist be an amicus mortis?

The way death is (not) dealt with is one of the main determinants of the current crisis of cancer care. The tendency to avoid discussions about terminal prognoses and to create unrealistic expectations of fighting death is seriously harming patients, families and healthcare professionals, and the delivery of high-quality and equitable care. Drawing on different literature sources, we explore key dimensions of the taboo of death: medical, policy, cultural. We suggest that the oncologist, from a certain moment, could take on the role of amicus mortis, a classical figure in the past times, and thus accompanying patients towards the end of their life through palliation and linking them to psychosocial and ethical/existential resources. This presupposes the implementation of Supportive Care in Cancer and the ethical idea of relational autonomy based on understanding patients' needs considering their sociocultural contexts. It is also key to encourage public conversations beyond the area of medicine to re-integrate death into life.

Passing on death: An audit of the terminology utilized in discharge summaries for deceased patients

A retrospective audit of terminology utilized in discharge summaries to convey the death of inpatients in an Australian tertiary hospital was undertaken. Completion rates of summaries for this patient cohort were also assessed. Less than 60% had a summary finalized, and for those that did, euphemisms were utilized most commonly; passed away was employed in >70% of cases. There is no difference in terminology choice between doctors at the beginning, compared to the end, of their first year as a doctor, nor between first year or more experienced doctors. Irrespective of clinician level, doctors use euphemisms to convey a death.

Let's Start With the End: Bibliodrama in an Italian Death Education Course on Managing Fear of Death, Fantasy-Proneness, and Alexithymia With a Mixed-Method Analysis

This article presents the results of an experience of death education (DE) course with bibliodrama in Italian high schools, which focused on emotions and existential themes. The research analyzed the inability to recognize or describe one's own emotions (alexithymia), fantasy-proneness, and attitudes toward death in two different groups of students: one who took a course on DE (with 113 students) and another who did not participate in it (with 114 students). The use of a mixed method allowed this study to explore the quantitative results that the students indicated in the questionnaire and the qualitative open answers to the final question about how they had profited from this DE course. The results showed that the course had a positive effect, as the DE group significantly decreased alexithymia and negative attitudes toward death, particularly in fear and avoidance of death, making their representation of death less traumatic.

"Before I die I want to …": An experience of death education among university students of social service and psychology

The censorship of death and dying has removed the "memento mori" practices, and in order to reintroduce this practice, some "Before I die" projects have been increasingly implemented. Running in parallel, in the syllabi of social service and psychology students, some experiences of death education has commenced. This study illustrates the results of a qualitative research conducted on the "Before I die I want to …" Polaroid^® Project (BIDIWT), which is divided into two phases. The first phase entails an analysis of the wishes collected from the United States, Japan, India, and Italy. The second phase refers to the analysis of the captions of the BIDIWT realized from two groups of undergraduates, with regard to the effect of such experience on their religiosity, representation of death, and fear of death.

Psychodrama and Moviemaking in a Death Education Course to Work Through a Case of Suicide Among High School Students in Italy

This study describes the psychological effects of an experience of death education (DE) used to explore a case of suicide in an Italian high school. DE activities included philosophical and religious perspectives of the relationships between death and the meaning of life, a visit to a local hospice, and psychodrama activities, which culminated in the production of short movies. The intervention involved 268 high school students (138 in the experimental group). Pre-test and post-test measures assessed ontological representations of death, death anxiety, alexithymia, and meaning in life. Results confirmed that, in the experimental group, death anxiety was significantly reduced as much as the representation of death as annihilation and alexithymia, while a sense of spirituality and the meaning of life were more enhanced, compared to the No DE group. These improvements in the positive meaning of life and the reduction of anxiety confirmed that it is possible to manage trauma and grief at school with death education interventions that include religious discussion, psychodrama and movie making activities.

Change in death metaphors among university students in Hong Kong from 2004 to 2016

Death metaphors are a meaningful way to understand personal perceptions of death, an important construct affecting how people live. This study collected death metaphor data among 100 university students in Hong Kong in 2016 and compared the findings with another study reported in 2004. Interpersonally oriented death metaphors were still popular among students a decade later. There was a general decrease in positive perception of death and an increase in negative perception of death from 2004 to 2016. Death metaphors are useful tools in death education programs, especially in cultures where death is a taboo topic.

Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course

A Massive Open Online Course, Dying2Learn, was designed to foster community death conversations and strengthen community awareness of palliative care and death as a normal process. This exploratory study used a pre–post prospective design to determine if participation in Dying2Learn and exposure to online conversations about death and dying resulted in any significant influence on death competence in 134 participants who completed the Coping-with-Death-Scale both at the beginning and end of the course in 2016. Death competence refers to a range of attitudes and capabilities people have for dealing with death. Results at the end of the course indicated that engagement in Dying2Learn led to significant improvements in death competence scores over time (medium-to-large effect size). The positive impact was greater for those who completed more of the course, and effectiveness did not depend on sociodemographic characteristics. In conclusion, this study found that an online learning platform in the form of a Massive Open Online Course could engage community members in meaningful social discussion about death and dying, and that exposure to these conversations was beneficial for all participants regardless of previous exposure to death. Further exploration is required to determine whether this change in death competence will have an impact on participant’s behavior in the community regarding death conversations and preparedness.

The body of knowledge in thanatology: An outline

The Association for Death Education and Counseling has updated its articulation of the body of knowledge in the field of thanatology. In doing so it has relinquished the use of a matrix format in favor of a more serviceable outline containing three major sections: Arenas of Thanatology, Practice Considerations for Professionals in the Field, and Contextual and Theoretical Considerations. Accompanying the outline is a new commentary on the state of the field itself, along with an annotated bibliography of recent relevant publications.

Psychological Features of Hypnotizability: A First Step Towards Its Empirical Definition

This study examined the relationship between the Hypnotic Induction Profile (HIP) and several psychological tests: Tellegen Absorption Scale (TAS), Spontaneity Assessment Inventory-Revised (SAI-R), Dissociative Experiences Scale (DES), Short-Form Boundary Questionnaire (SFBQ), Mini Locus of Control (MLOC), Testoni Death Representation Scale (TDRS), and the Interpersonal Reactivity Index (IRI). Two hundred and forty volunteers were administered the above tests; 78 of them were also administered the HIP, and its scores were compared to those on the other tests. A significant correlation was found among the TAS, DES, SFBQ, and IRI. The HIP was significantly correlated to the DES (r = .19 p_1tail = .045), and the IRI-ec subscale (r = .19 p_1tail = .044); 14 test items from DES, IRI, TAS, SAIR, and SFBQ were also significantly related to the HIP. The findings suggest that hypnotizability may relate to stronger perception of the inner world, decreased aptitude for managing memory processing, and increased sensitivity and empathy.

Publication Trends in Thanatology: An Analysis of Leading Journals

To identify important trends in thanatology as a discipline, the authors analyzed over 1,500 articles that appeared in Death Studies and Omega over a 20-year period, coding the category of articles (e.g., theory, application, empirical research), their content focus (e.g., bereavement, death attitudes, end-of-life), and for empirical studies, their methodology (e.g., quantitative, qualitative). In general, empirical research predominates in both journals, with quantitative methods outnumbering qualitative procedures 2 to 1 across the period studied, despite an uptick in the latter methods in recent years. Purely theoretical articles, in contrast, decline in frequency. Research on grief and bereavement is the most commonly occurring (and increasing) content focus of this work, with a declining but still substantial body of basic research addressing death attitudes. Suicidology is also well represented in the corpus of articles analyzed. In contrast, publications on topics such as death education, medical ethics, and end-of-life issues occur with lower frequency, in the latter instances likely due to the submission of such work to more specialized medical journals. Differences in emphasis of Death Studies and Omega are noted, and the analysis of publication patterns is interpreted with respect to overall trends in the discipline and the culture, yielding a broad depiction of the field and some predictions regarding its possible future.