Relationships between Death Anxiety and Quality of Life in Iranian Patients with Cancer

The mediating role of meaning in life between experiential avoidance and death anxiety among cancer patients: a cross-sectional study

BACKGROUND

Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables.

METHODS

A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer's Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety.

RESULTS

A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = - 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = - 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (β = 0.464) and presence of meaning (β = -0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect.

CONCLUSION

Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management.

A Systematic Review and Meta-analysis of Death Anxiety Among Iranian Patients With Cancer

Death anxiety in cancer patients can cause and exacerbate mental disorders and affect the healing process and survival. In this study, percentage score of death anxiety among Iranian cancer patients was reported. The databases of Scopus, PubMed, ISI, MagIran, and Scientific Information Database were searched and 396 articles were retrieved. Twenty-three eligible studies were included in the analysis considering the inclusion criteria. Heterogeneity among selected studies was assessed through the Cochrane Q test and I2 test. The percentage of death anxiety scores in Iranian patients with cancer was 59.91% (95% confidence interval: 51.57-62.24). The results of subgroup analysis showed that the percentage of death anxiety scores in patients with breast cancer was 67.55% (95% CI: 56.50-78.60) and in patients with other malignancies was 53.78% (95% CI: 50.20-57.36). Death anxiety is high among Iranian patients with cancer and counseling sessions to control and manage this challenge seems necessary.

The effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer

OBJECTIVES

This study was conducted to determine the effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer.

METHODS

This cross-sectional and correlational study was conducted with 125 patients with cancer who were admitted to the oncology clinic of a university hospital in the Central Anatolian Region of Turkey between March and December 2022 and who met the research criteria and accepted to participate in the study. The data were collected with "Patient descriptive information form," "Brief Illness Perception Questionnaire (BIPQ)," "Scale of Death Anxiety (SDA)," and "Satisfaction with Life Scale (SWLS)."

RESULTS

It was found that mean BIPQ score of the patients was 39.54 ± 12.82, the mean SDA score was 8.02 ± 3.16, and the mean SWLS score was 14.74 ± 5.19. BIPQ total score was found to affect SDA total score positively (β = .751) and SWLS total score negatively (β = - .591). SDA total score was found to affect SWLS total score negatively (β = -.216) (p < .05).

SIGNIFICANCE OF RESULTS

It was found that patients with advanced gastrointestinal cancer had moderate level of illness perception and life satisfaction, and high death anxiety. It was found that as illness perception of the patients increased, their death anxiety increased and satisfaction with life decreased. In addition, it was found that as the death anxiety of patients increased, their satisfaction with life decreased.

The Relationship Between Spirituality and Religiosity with Death Anxiety Among Cancer Patients: A Systematic Review

This systematic review aimed to summarize the evidence regarding the relationship between spirituality and religiosity with death anxiety (DA) among cancer patients. This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist. An extensive search was conducted on electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) via keywords extracted from Medical Subject Headings from the earliest to February 9, 2022. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Fifteen studies were selected for inclusion in this systematic review. Nine and six studies assessed the relationship between spirituality and religiosity with DA in cancer patients, respectively. Most studies had a negative relationship between spirituality (n = 8) and religiosity (n = 4) with DA. In sum, most studies showed that religion and spirituality are negatively related to DA in patients with cancer.

Predictors of death anxiety among Iranian cancer patients: Contribution of sense of Coherence

BACKGROUND

Death anxiety is a negative consequence of cancer that influences the quality of life of many patients. This study determined the predictors of death anxiety and the contribution of the sense of coherence to this disorder among Iranians with cancer.

METHODS

The present research was a descriptive-analytical study that examined cancer patients referring to one of the educational hospitals in Tehran, Iran. Two hundred eligible patients selected by purposeful sampling filled out a clinical and demographic questionnaire. The data were analyzed by the SPSS 20 software.

RESULTS

The correlational results revealed a negative and significant relationship between death anxiety and a sense of coherence (r = -0.610). Likewise, age, gender, marital status, occupational and economic circumstances, and cancer type were among the variables that correlated with death anxiety and predicted 85% of this psychological state.

CONCLUSION

The researchers recommend mental assessment in oncological care to identify psychological challenges to realize the ultimate goal of palliative care, i.e. improving patients' quality of life.

Death Anxiety in Patients with a History of Coronary Artery Bypass Graft Surgery During the COVID-19 Pandemic: The Role of Spiritual Well-Being and Coping Strategies

Patients who have previously undergone coronary artery bypass surgery (CABG) were prone to death anxiety during the COVID-19 pandemic. It appears that spiritual well-being and appropriate coping strategies may mitigate the harmful effects of death anxiety. Therefore, this study aimed to determine the level of death anxiety in patients with CABG during the COVID-19 pandemic and investigate the relationship between spiritual well-being, coping strategies and death anxiety.This cross-sectional study was conducted on 100 patients with CABG history in Tehran from June 2021 to February 2022. The face-to-face questionnaire, containing questions on demographics, Templer's death anxiety scale, the spiritual well-being questionnaire, and the ways of coping questionnaire was administered to collect data. Statistical analysis was performed using descriptive-analytical statistics, correlation tests, and logistic regression models.Participants' mean age was 55.59 ± 12.78 years. The mean death anxiety score was 10.00 ± 2.16, with 87% of participants reporting high levels and 13% reporting low levels of death anxiety. Based on the results, there was a significant negative correlation between death anxiety and coping strategies, as well as subscales of distancing, seeking social support, accepting responsibility, and planful problem-solving. Logistic regression showed that with the increase in the score of spiritual well-being, the odds of having high levels of death anxiety decreased (p < 0.05). Furthermore, increasing the total score of coping strategies, and the score of self-controlling, seeking social support, accepting responsibility, and planful problem-solving, significantly reduced the odds of high levels of death anxiety (p < 0.05).The study showed that patients with a CABG history experienced high death anxiety during the COVID-19 pandemic. According to the findings, spiritual well-being and coping strategies, especially self-controlling, seeking social support, accepting responsibility, and planful problem-solving, may reduce the odds of severe death anxiety. These should be considered as effective targets for psychological intervention in these patients.

Development and validation of the Earthquake Obsession Scale

Earthquakes are natural disasters that are very destructive and whose timing is unknown. These disasters can have a very negative effect on people's mental health, and their effects can last for many years. This study examined the psychometric properties of a scale to measure earthquake obsession. Data were collected from adults living in different provinces of Türkiye (N = 732), who completed the new scale, Doomscrolling Scale, Death Distress Scale, and Mental Well-Being Scale. The Earthquake Obsession Scale (EOS) had a two-factor structure, good internal consistency reliability, and convergent and discriminant validity. Correlational analysis revealed that earthquake obsession was positively associated with doomscrolling and death anxiety, and negatively associated with well-being. Mediation analysis indicated that doomscrolling and death distress mediated the relationship between earthquake obsession and well-being. The results emphasized the potential of earthquake obsession to affect daily life negatively and revealed its relationship with psychological variables.

Spiritual-Cultural Needs as the Main Causative Factor of Death Anxiety in Iranian COVID-19 Patients: A Qualitative Study

COVID-19 patients have been reported to more than likely experience a variety of difficult physical and psychological problems. This qualitative study aims to perceive psychological experiences in COVID-19 patients in Iran. The study method is qualitative, with a conventional content analysis approach adopted. Purposive sampling was applied to 20 COVID-19 patients admitted to medical wards at hospitals in Tehran, Iran. Additionally, data were collected using semi-structured interviews. All data were analyzed based on the method proposed by Lindgren et al. (Int J Nurs Stud 108:103632, 2020). Data analysis identified the main theme to be "death fear and anxiety" with five main categories. These categories included the feelings of death panic and apprehension, uncertainty and ambiguity, fear of abandonment, fear of an unknown future for the family, and fear of unmet spiritual-cultural needs. Accordingly, the patients' experiences of COVID-19 contraction were unique. Against this backdrop, understanding COVID-19 patients' complexities, experiences, beliefs, and attitudes about anxiety and death, can lead to an  improved awareness and understanding of the psychological consequences of COVID-19 by executive decision-makers, healthcare personnel and mental health professionals.

Death Anxiety in Caregivers of Chronic Patients

This study aimed to determine the extent to which caregivers of patients with chronic illnesses experience death anxiety, and which variables from caregivers and patients might potentially be related to their death anxiety. It also aimed to compare the levels of death anxiety between patients and caregivers. Web of Science, Scopus, PubMed, Psychology Database, Cochrane, and Google Scholar were searched for original studies available until December 2022 that quantitatively addressed death anxiety in family and informal caregivers of individuals with chronic illnesses. The methodological quality of the included studies was assessed, and a meta-analysis was conducted using Hedges' g as the effect size index and the DerSimonian-Laird method to analyze differences between patients and caregivers in death anxiety. The results of the 11 included studies showed moderate levels of death anxiety in caregivers, and the meta-analysis (k = 7; 614 patients and 586 caregivers) revealed non-significant differences between the death anxiety experienced by patients and caregivers (pooled Hedges' g = -0.03, 95% CI = -0.29 to 0.25, p = 0.802). Some sociodemographic and psychological factors (e.g., gender, depression, and anxiety) might be related to the death anxiety experienced, but additional research is necessary to validate these findings.

Spiritual Well-Being and Death Anxiety: A Cross-Sectional Study Among Iranian Patients With Acute Coronary Syndrome

Acute coronary syndrome (ACS) patients experience a tremendous psychological burden, typically in the form of death worry due to acute medical conditions and the possibility of mortality. The unfavourable conditions of ACS patients cause them to reconsider the meaning of life and their spiritual well-being. This study evaluated the association between death anxiety and spiritual well-being in a total of 241 ACS patients in Shahroud, northeast of Iran. The data were collected using the Templer Death Anxiety Scale, and the Spiritual Well-being Scale by convenience sampling method. All patients indicated a high degree of death anxiety, and roughly half reported a moderate level of spiritual well-being. There was a significant and direct correlation between death anxiety and spiritual well-being levels. Older age, single status, and non-smoking were other predictors of good spiritual well-being. A multidisciplinary health team should identify and implement approaches to promote spiritual well-being and reduce mental suffering.

Factors influencing death anxiety among Chinese patients with cancer: a cross-sectional study

OBJECTIVE

The purpose of this study was to investigate death anxiety status among Chinese patients with cancer and identify factors that affect death anxiety.

DESIGN

Cross-sectional study.

SETTING

Changsha, Hunan Province, China.

PARTICIPANTS

A total of 286 inpatients diagnosed with cancer were randomly recruited from a tertiary cancer centre and completed the questionnaires between January and June 2021.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the status of death anxiety. The secondary outcomes were the factors that affect death anxiety among Chinese patients with cancer.

METHODS

A total of 286 Chinese patients with cancer were recruited from a tertiary cancer hospital to complete the demographic and clinical characteristics questionnaire, Templer's Death Anxiety Scale, Acceptance and Action Questionnaire-second edition, and Meaning in Life Questionnaire from January to June 2021. Data were analysed using t-test, analysis of variance, Kruskal-Wallis H test, Pearson correlation analysis and multiple linear regression analysis.

RESULTS

On average, patients with cancer scored 7.72±4.17 for death anxiety, 25.71±9.69 for experiential avoidance and 45.19±8.22 for meaning in life. Ultimately, the statistically significant factors influencing death anxiety were education levels, insurance, pain scores, experiential avoidance and meaning in life. These factors explained 40.6% of the difference in death anxiety.

CONCLUSIONS

Patients with cancer in China experienced a high level of death anxiety. This study showed that experiential avoidance and meaning in life were important factors that affected death anxiety in patients with cancer. Further studies should be conducted to explore effective interventions to prevent experiential avoidance and increase meaning in life for patients with cancer. Attention should be paid to patients without insurance but with lower education levels and higher pain scores to ultimately relieve death anxiety and improve their quality of life.

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

OBJECTIVE

This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety.

METHODS

Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety.

RESULTS

Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety (R ² ​= ​0.335, F ​= ​20.072, P ​< ​0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F ​= ​5.892, P ​= ​0.003). Multivariate analysis revealed no significant association between family function and death anxiety.

CONCLUSIONS

Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.

Does Spiritual Well-Being Affect Death Anxiety and Psychological Resilience in Cancer Patients?

This study was conducted to research the effects of spiritual well-being on death anxiety and psychological resilience in cancer patients. This cross-sectional, descriptive and correlational study was carried out with 260 cancer patients who were admitted to oncology and haematology outpatient clinic of a university hospital in east of Turkey between October 2021 and April 2022. The data were collected by using "Personal Information Form", "Spiritual Well-being Scale (FACIT-sp), Death Anxiety Scale (DAS) and The Brief Resilience Scale (BRS). It was found that mean DAS total score of cancer patients was 12.51 ± 3.39, while their mean FACIT-sp total score was 26.10 ± 6.93 and their mean BRS total score was 16.1 ± 7.05. It was found that FACIT-sp total score affected DAS and BRS total score positively, while DAS total score affected BRS total score negatively (p < .001). It was found that cancer patients had moderate level of spiritual well-being and psychological resilience and high level of death anxiety. It was also found that death anxiety and psychological resilience of cancer patients increased as their spiritual well-being levels increased. Psychological resilience was found to decrease as death anxiety increased.

The prevalence and risk factors of death anxiety and fear of COVID‐19 in an Iranian community: A cross‐sectional study

Background and Aims

Methods

Results

Conclusions

The Relationship Between Religious Orientation and Death Anxiety in Iranian Muslim Patients with Cancer: The Mediating Role of Hope

Cancers are globally prevalent often life-threatening diseases that carry an immense psychological burden such as death anxiety. Thus, identifying protective psychological factors affecting death anxiety in individuals with cancer is of strong relevance. This study investigated the potential mediating role of hope in the relationship between religious orientation and death anxiety in Iranian patients with cancer. A cross-sectional design was used to evaluate death anxiety, hope, and religious orientation in a convenience sample of 320 patients (age range 18-89 years) with cancer. Measures included demographic factors, health characteristics, and validated instruments of the study constructs. Path analysis was used to evaluate mediation models. The findings indicated a direct path from intrinsic religious orientation (β = - 0.122, p < 0.001) to death anxiety and a direct path from hope (β = - 0.258, p < 0.001) to death anxiety. However, when hope was introduced as a mediating variable, the relationship between intrinsic religious orientation and death anxiety became non-significant (β = 0.001, p = 0.983). In this study, hope largely explained the relationship between intrinsic religiosity and death anxiety. In countries such as Iran where religiosity is an important psychological construct, greater hope among the more intrinsically religious may help to explain why more deeply religious persons experience less anxiety.

High death anxiety and ambiguous loss: Lessons learned from teaching through the COVID-19 pandemic

For gerontological educators, topics such as mortality, loss, and end-of-life issues often emerge or are central in their courses. However, teaching in the era, and aftermath, of the COVID-19 pandemic has heightened the salience of death and loss, raising questions about best practices and teaching pedagogies to support student learning amidst a global crisis. This qualitative study utilized written narratives collected during the pandemic from students enrolled in an undergraduate thanatology course. Content analysis of written narratives (n = 44) revealed three themes that can help inform strategies to best support student learning during challenging times. Participants desired more flexibility; compassion and understanding; and more targeted resources and socioemotional support. Results have immediate implications for educators teaching during the pandemic and for years to come. We provide recommendations for teaching and learning support, as well as advocate for more university and community-based thanatology and gerontology education offerings.

Fear of Recurrence of Atrial Fibrillation: Translating a Cancer Fear Model to the Atrial Fibrillation Patient Experience

BACKGROUND

Atrial fibrillation occurs when rapid and disorganized electrical signals cause the atria in the heart to beat irregularly and is associated with an increased risk for stroke. Despite medical advancements, first and second line atrial fibrillation treatments exhibit significant recurrence rates. Because of this, atrial fibrillation patients often experience disease-specific fears that are not routinely assessed and targeted in clinical management. Fear of recurrence models in cancer research and other cardiac-specific fears have paved the way for a patient-centric approach to disease intervention.

PURPOSE

Clinical assessment focused solely on the taxonomy of anxiety disorders may miss key components unique to the atrial fibrillation patient experience. An anxiety disorder diagnosis in the presence of an arrhythmia could be misleading and ultimately fail to address patient needs. Modeled from the cancer literature, providers may benefit from a broader disease specific conceptualization for AF patients that differs from a general DSM-5 diagnosis.

AIMS

The objectives of this paper are: (1) to review the medical aspects of atrial fibrillation, (2) to examine the comparability of fear of recurrence concept from cancer literature to the atrial fibrillation patient, and (3) to suggest considerations of these novel concepts in patient care.

FUTURE DIRECTIONS

Increased understanding of fear of recurrence among atrial fibrillation patients aims to define and assess fear of recurrence components, determine treatment targets, and ultimately improve patient outcomes.

Predictors of Quality of Life in Patients with Heart Disease

Individuals with heart disease have been found to have more negative psychological and physical effects that impact their quality of life (QoL) than the general population. Spiritual well-being is considered a protective factor associated with QoL in people with heart disease. Therefore, the current research seeks to evaluate whether sociodemographic factors and spiritual well-being predict QoL among patients with heart disease. A total of 500 patients who were selected through a convenient sampling method from an Iranian hospital participated in this descriptive-correlational study. Data were collected using the McGill QoL Questionnaire, the Spiritual Well-being Scale, and demographic variables. The data analysis included descriptive and inferential statistics powered by SPSS (v. 23). Following multivariate analyses, findings revealed that those participants with their main source of income derived from family or a government pension and with College or intermediate educational levels were more likely to have higher QoL. Those participants with average or poor socioeconomic status reported higher QoL than those who were more affluent. Furthermore, younger patients (- 0.2, 95% CI - 0.3 to - 0.003, p = 0.016) and those with higher social support (0.7, 95% CI 0.2 to 1.3, p = 0.006) and spiritual well-being (0.2, 95% CI 0.1 to 0.3, p < 0.001) had significantly better QoL. In the current study, spiritual well-being and social support led to reduced negative psychological sequelae and improved QoL in cardiac patients.

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n = 63, 31.3%, women, n = 138, 68.7%, mean age = 40.1, SD = 10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

Meeting death and embracing existential loneliness: A cancer patient's experience of being the sole author of his life

Facing the truth of death in silence instead of fearing and denying it enables people to regain their freedom. This qualitative case study aimed to illuminate the meaning of a single person's experience of confronting death and living with cancer. The transcripts of unstructured interviews were analyzed using the hermeneutic phenomenological method. Data analysis led to extraction of four themes including "Confronting death, meeting nonbeing and longing for being", "Embracing existential loneliness, responsibility and freedom", "Taking over the mind, living mindfully, a meaningful life", and "Flourishing authentic self-love, moving in the path of caring and healing the self".

A Cross-Cultural Evaluation of the Construct Validity of Templer's Death Anxiety Scale: A Systematic Review

Ensuring use of valid and reliable scales for evaluating death anxiety that are relevant to the cultural context where they are applied is essential. The purpose of the study was to conduct a systematic review of the psychometric properties of Templer's Death Anxiety Scale (DAS) across cultures. PubMed, Scopus, Web of Knowledge, SID, and Magiran databases were systematically searched for studies published between 1970 and 2017 using Mesh terms. Two independent researchers used Quality Assessment of Diagnostic Accuracy Studies and Checklist of Standards for Reporting of Diagnostic Accuracy to evaluate study quality. Included studies were conducted in Iran, United States, Italy, China, Egypt, Spain, and Australia. Overall study quality was acceptable in 15 evaluated articles. However, findings demonstrated that two (one study), three (seven studies), four (four studies), and five factors (three studies) were extracted across the respective studies. Confirmatory concurrent validity was assessed in two studies. While Templer's DAS has stood the test of time as a commonly used index of capturing the conscious experience of death anxiety, there are psychometric inconsistencies in identified factor solutions across cultures. Findings emphasize the need for continued evaluation of how the DAS is translated in specific countries with assessment in relation to other death construct tools.

Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan

Among several forms of miseries experienced by cancer patients, one of the significant experiential problems is the inevitable fear of death. The present study aimed at exploring the relationship between death anxiety, perceived social support, and different demographic variables. A sample of 80 breast cancer patients was recruited from different departments of oncology in Pakistan. Research findings revealed that death anxiety was negatively associated with social support. Moreover, it was found that education and marital status were associated with death anxiety among patients with breast cancer. Results suggest that social support assist in reducing death anxiety and enhance their recovery course.

Predictors of death anxiety among patients with heart disease

Objective: This research examines whether or not socio-demographic factors and hope predict death anxiety among patients with heart disease.Materials and Methods: Our sample consisted of 500 respondents who were hospitalized in a medical institution in Iran. Data were collected using the Templer Death Anxiety Scale (TDAS) and the Herth Hope Index (HHI).Results: The results of current study indicated that higher economic status, having one's main source of income from friends, increased age, increased religious belief, and increased hope were associated with lower death anxiety.Conclusion: These results highlight that improving hope, and religiosity among cardiac patients may be an effective means by which to reduce their death anxiety.

Development of death education training content for adult cancer patients: A mixed methods study

AIMS AND OBJECTIVES

The aim of this mixed methods study was to develop science-based content for a systematic death education training system based on the needs of adult cancer patients. The study contained two parts: survey development and Delphi survey. First, a small sample test was conducted to check the reliability and validity of the questionnaire. Next, this questionnaire was applied to investigate adult cancer patients' needs for death education. Then, we invited experts in the fields of nursing management, clinical medicine, clinical nursing and psychological care to carry out two rounds of Delphi consultations to revise the training content.

BACKGROUND

Death education is often combined with hospice care, which is based on a clear 6-month survival period. However, the survival of adult cancer patients has improved with improved cancer diagnoses and treatments, and death education should be initiated before the dying stage. At the same time, patients' needs for medical information become increasingly important in daily clinical practice. Therefore, a death education programme based on adult cancer patients' needs was developed to help these patients reflect on the meanings of life and death.

DESIGN

A mixed methods study.

METHODS

During the survey development period (from April 2017-September 2017), a small sample test (n = 150) was conducted to verify the reliability and validity of the questionnaire on death education needs of adult cancer patients. This questionnaire was developed based on a literature review and discussion among the study group. Next, 324 adults with cancer, recruited from a three-level cancer hospital in Tianjin, China, were surveyed to analyse their needs for death education, using the questionnaire that had been tested in the pretest period. Finally, a Delphi survey was conducted from October 2017-January 2018. A panel of experts (n = 23) recruited from major hospitals, nursing schools and universities in China in the fields of clinical nursing, nursing management, clinical medicine and psychological care took part in the study to revise the training contents based on the investigation results.

RESULTS

The reliability and validity of results based on the small sample test revealed that the Cronbach's alpha coefficient and the half-degree of reliability of the questionnaire were 0.924 and 0.951, respectively. This demonstrated that the questionnaire had high reliability. The KMO was 0.756 and the Bartlett Test of Sphericity showed p < 0.001, indicating that the factor analysis was justified in the sample. Eight components with eigenvalues greater than one were retained by the factor analysis. The investigation of the patients' needs for death education showed that the overall score of patients' needs was 3.60 ± 0.709 points (needs were measured on a scale from 1-5, where 5 indicates high needs), and there were high demands for education regarding "cancer patient life reviews," "death-related ethical issues" and "to leave peacefully." Data from expert panel members were collected in two rounds over a 4-month period, and consensus was achieved in the second Delphi round. The final death education contents of adult cancer patients contained four sections: cancer, death, psychology and practice. These were divided into 54 teaching topics to be included in 14 courses.

CONCLUSIONS

The adult cancer patient death education training content devised in this study is science-based, practical and can be used as a guide for clinical nurses to provide high-quality care to adult cancer patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses could become more involved in providing death education to adult cancer patients and their families. Further research is needed to explore the applicability of the training content and to develop the content according to changing times and patients' needs.

Exploring the Relationship Between Spiritual Well-Being and Death Anxiety in Survivors of Acute Myocardial Infarction: Moderating Role of Sex, Marital Status and Social Support

Previous empirical studies have shown that both spiritual well-being (SWB) and death anxiety (DA) significantly affect the mental health of patients with acute diseases. In this regard, our paper contributes to the extant literature by scrutinizing the conditional relationship between SWB and DA as well as the various mechanisms underpinning such a relationship in patients with acute myocardial infraction (AMI). A descriptive, correlational methodology was utilized. Our main sample consisted of 300 patients with acute myocardial infraction who were hospitalized in a specialized medical institution in Iran throughout a two-month period (i.e. August-October 2015). Patients completed Spiritual Well-Being Scale (SWBS) and Templer's Death Anxiety Scale (TDAS). Even though our study showed that the relationship between SWB and DA in patients with AMI is non-significant, we found that (1) single patients with higher SWB have lower DA, (2) single patients with higher SWB as well as social support have significantly lower DA, and (3) for single men/men without social support, there is a negative relationship between SWB and DA. The relationship between SWB and DA is influenced by factors such as sex, marital status and social support. In addition, the specific nature of this relationship (i.e. strength and sign) is dependent upon the sociodemographic characteristics of patients as well as other contextual influences. Result revealed that although relationship between SWB and DA is non-significant, this is influenced by factors such as sex and social support. In addition, the specific nature of this relationship (i.e. strength and sign) is dependent upon the sociodemographic characteristics of patients as well as other contextual influences.

Psychometric Properties of the Death Anxiety Scale-Extended among Patients with End-Stage Renal Disease

This study aimed to evaluate the validity and reliability of the Persian version of Death Anxiety Scale-Extended (DAS-E). A total of 507 patients with end-stage renal disease completed the DAS-E. The factor structure of the scale was evaluated using exploratory factor analysis with an oblique rotation and confirmatory factor analysis. The content and construct validity of the DAS-E were assessed. Average variance extracted, maximum shared squared variance, and average shared squared variance were estimated to assess discriminant and convergent validity. Reliability was assessed using Cronbach’s alpha coefficient (α = .839 and .831), composite reliability (CR = .845 and .832), Theta (θ = .893 and .867), and McDonald Omega (Ω = .796 and .743). The analysis indicated a two-factor solution. Reliability and discriminant validity of the factors was established. Findings revealed that the present scale was a valid and reliable instrument that can be used in assessment of death anxiety in Iranian patients with end-stage renal disease.

Death talk and relief of death-related distress in patients with advanced cancer

OBJECTIVES

The circumstances of advanced cancer heighten the need for affected individuals to communicate mortality-related concerns, although there may be obstacles to such communication. Managing Cancer and Living Meaningfully(CALM) is a supportive-expressive therapy designed to address such barriers and to facilitate communication of mortality-related concerns in patients and caregivers facing advanced disease. This study explores death-related distress in patients with advanced cancer and the perceived influence of CALM therapy on overcoming barriers to communication of this distress.

METHODS

Semistructured interviews were conducted with a subset of patients with advanced cancer (n=17) participating in a CALM phase III trial at a large urban regional cancer centre. Interviews were transcribed, and qualitative data were analysed using thematic analysis.

RESULTS

Death-related distress was experienced in terms of three key themes: diffuse and overwhelming fear, fear of uncertainty and fear of suffering. The perceived barriers to communicating such distress were as follows: reluctance of loved ones to discuss mortality-related issues and the participants´ own reluctance to discuss death-related concerns to protect their loved ones or themselves from distress. CALM therapists were perceived to facilitate discussions on dying and death in sessions and to support patients´ communication of death-related distress with healthcare providers and loved ones.

CONCLUSIONS

Patients with advanced cancer perceive barriers to effective communication of death distress to be related to their own reluctance, as well as reluctance of their loved ones to address such fears. CALM therapy may help patients with advanced cancer to overcome obstacles to communication and to alleviate death-related distress.

TRIAL REGISTRATION NUMBER

NCT01506492.