Table 2: Summary of Death Anxiety Studies and their Outcomes

Author/Setting/ Nursing Discipline Design/Sample & Instruments Findings Outcomes Effect/Correlations
Black (2007)[22]Healthcare Professionals including nurses in New York state, USA Cross-sectional survey (N=135) (nurses, doctors social workers): who managed older patients- using Death Attitude Profile-Revised (DAP–R). Age correlated positively with fear of death, (p= .004), avoidance of death (p= .007); negatively with neutral acceptance of death (p =.001), escape acceptance of death (p=.034). Negative correlations were found between collaborating with other professionals regarding directives and fear of death, avoidance of death, and escape acceptance of death. Death anxiety was a predictor of professionals, communication with others about advance directives. Experts in end-of-life care recommend probing the relationship between healthcare provider communication behavior and personal death attitudes. Significant inverse relationship between 2 attitude subscales ‘Avoidance, and ‘Escape, and caring for dying.
Braun 2010[4] Oncology nurses in Israel Survey of nurses (N=147) using Frommelt Attitude Toward Care of the Dying Scale (FATCOD), Death Attitude Profile - Revised (DAP-R) Nurses had moderate levels of fear of death (x2=4.11), death avoidance (x2=2.93), approach acceptance (x2=3.53), & escape acceptance (x2=3.6), with correlation of Fear of death with Death avoidance & Approach acceptance. Approach acceptance was correlated with Death avoidance & Escape acceptance. Mean FATCOD: 125.7. Nurses, personal attitudes towards death were associated with their attitudes to caring for dying patients, with most demonstrating positive attitudes. A mediating role was found for death avoidance, suggesting some may use avoidance to cope with fear of death. Culture and religion may be key to attitudes (most were Jewish). Significant positive relationship between 4 subscales.
Deffner 2005 [11] Registered nurses in USA Correlation study- Cross sectional survey (N= 190) using Death Anxiety Scale Regression analysis showed death anxiety level was significantly inversely related to comfort level of nurse when communicating with patients/ families regarding death (p = .000). Age, education, years of nursing, exposure to communication education for dealing with death showed negative Gamma values or R, indicating that discomfort decreases as age, education, experience, current nursing employment, work in other areas, and exposure to communication education increase. Comfort level of the nurse during communication with patients and families is adversely affected by an increase in the nurse's own death anxiety, and positively affected by exposure to communication education. Importantly, nurses should identify their level of death anxiety/be exposed to education on communicating with patients/families regarding death. Significant inverse relationship: comfort and attitude to death.
Dunn 2005 [16] Oncology and med-surg registered nurses in USA Cross-sectional survey (N=58) using Fromelt Attitudes Towards Care of the Dying (FATCOD) and Death Attitude Profile- Revised (DAP-R) scale Nurses who reported spending more time with dying patients had more positive attitudes. No significant association was found between nurses,’ attitude towards death and attitude to caring for dying patients. Nurses were positive about caring for the dying; there was no effect of death anxiety on attitude towards caring for dying patients; some subscales were associated with demographic variables & scales.Education programs on death and dying are recommended. Non-significant relationship death anxiety and caring for dying.
Ho et al.2012 [21] Renal registered nurses in Spain Cross sectional survey (N=202) using Frommelt Attitude Toward Care of the Dying Scale-Form B. Nurses were managing elderly patients at end of life (EOL); they held positive attitudes towards caring for the dying, 88.9% viewed EOL care as an emotionally demanding task, 95.3%% reported that addressing death issues require special skills and 92.6% reported that education on EOL care is necessary. Further education about end of life care was recommended for Spanish renal nurses. N/A
Author/Setting/ Nursing Discipline Design/Sample & Instruments Findings Outcomes Effect/Correlations
Hutchison and Sherman 1992 [23] Student nurses in USA Non-random trial of didactic or experiential death & dying training for students (N=74): pretest- posttest using Templer Death Anxiety Scale (DAS) No differential effects of training technique were found. However, DAS post-test scores were significantly lower than the pre-test scores for both groups; also maintained at 8-week follow-up. There was inconclusive evidence of the effect of training on students’ level of death anxiety. Training positively impacted on students’ levels of anxiety. Anxiety was lower after training and at 8 weeks.
Inci 2007 [12] Oncology & ICU Nurses in Turkey (not in English) Pretest-postest- Surveys: Effects of death education - using Death Anxiety Scale (DAS), Death Depression Scale (DDS), & Attitude Scale Euthanasia, Death and Dying Patients (EDDP). DAS and DDS scores decreased significantly (p=<.05) after training; Non significant change in EDDP (p>0.05). No effect of death education by age, years of work, how they were affected by terminal patient nursing or the meaning attributed to death. There was a positive effect on nurses, death anxiety after death and dying training over 7 sessions, however there was no impact of nurses’ age, years working or how they reported being affected. Anxiety was lower after training.
Iranmaneshet al. 2008 [13] Hospital general and oncology nurses in Iran Cross sectional survey of nurses (N=114) using translated Death Attitude Profile-Revised (DAP-R) and Frommelt,s Attitude towards Caring for Dying Patients (FATCOD) Fear of death was negatively (r -.199) correlated with attitude toward giving care to the dying. Neutral to moderately positive attitude toward caring for dying (FATCOD mean 3.55/15). Most were likely to give care and emotional support to persons at the end of life whilst taking an authoritative approach. Lack of education and experience, as well as cultural and professional limitations, may have contributed to the negative attitude toward some aspects of the care for people who are dying among the nurses surveyed. Significant inverse and also positive relationships between attitude to death and caring for dying.
Lange, Thom and Kline 2008 [17] Inpatient & outpatient oncology nurses in USA Cross-sectional survey (n= 355) using FATCOD & DAP-R instruments. Statistically significant relationships were found among age, nursing experience, previous experience with caring for the terminally ill, and scores on FATCOD and DAP-R. Nursing experience and age were the variables most likely to predict nurses' attitudes toward death and caring for dying patients. RNs with more work experience tended to have more positive attitudes toward death and caring for dying patients. Less experienced oncology nurses will benefit from increased education, training, and exposure to providing and coping effectively with end-of-life care. Significant inverse relationship: attitude to death and caring for dying.
Matsui & Braun 2010 [14] Hospital adult and childrens’ nurses caring for terminal patients in Japan Pretest- posttest survey (N=190 RNs;176 care workers): using Death Attitude Profile (DAP), Japanese version, and Attitude Scale about Euthanasia, Death, and Dying Patient. After 7x 90min sessions of nurse education on death and dying- multiple regression showed better attitudes toward caring for the dying were positively associated with seminar attendance and negatively associated with fear of death. There was no difference between RNs and care workers’ responses. Attitudes (measured by FATCOD) were not correlated with job certification or work setting but with death attitudes and seminar attendance. Staff education is important for maintaining and improving standards in end of-life care in institutional settings. Significant inverse relationship: attitude to death and caring for dying.
Myashita et al. 2007 [15]=Hospital general nurses in Japan Cross-sectional survey (n= 178) using FATCOD & Death Attitude Inventory (DAI). (Japanese versions) & Pankratz Nursing Questionnaire. Multivariate linear regression identified various subscales that were related to caring; Death anxiety domain, DAI (r= –.17, P =.02), death relief (r = –.19, P = .012), death avoidance (r= .33, P = .001), and life purpose (r = .38, P = .001) were significantly correlated with DAI (positive attitude toward caring for the dying). Most participants had a positive attitude toward caring for the dying patient and recognized the need for patient- and family-centered care. Educational and administrative efforts to strengthen nursing autonomy are necessary. Significant inverse & positive relationships for attitude to death and caring for dying.
Payne et al. 1998 [19] Hospice and emergency nurses in England Mixed methods: survey (N=60) using Death Attitude Profile-Revised Questionnaire & semi-structured interview. Hospice nurses had lower death anxiety, as shown by 8 of 32 items with significantly more positive responses than emergency nurses. Subscale differences were not reported. Limited differences were shown between disciplines. Between groups- hospice nurses appeared to have low death anxiety despite frequent exposure to deaths. Significant difference by demographics.
Author/Setting/ Nursing Discipline Design/Sample & Instruments Findings Outcomes Effect/Correlations
Rooda 1999 [3] Metropolitan private hospital nurses and visiting nurses (USA) Cross-sectional survey (N=403) using Frommelt Attitude Toward Care of the Dying Scale, and Death Attitude Profile-Revised (DAP-R), DAP-R scores were related to sex, religious affiliation, and current contact with terminally ill patients. FATCOD scores (e.g., showing acceptance of death) were positively related to current contact with dying patients, negatively correlated with two DAP-R subscales (Fear of Death and Death Avoidance), and positively correlated with two other DAP-R subscales (Approach Acceptance and Neutral Acceptance). Nurses' attitudes toward death and their current contact with terminally ill patients were predictive of their attitudes toward caring for terminally ill patients. Significant inverse relationship: 2 subscales of DAP-R and between attitude to death and caring for dying.
Santisteban 2006 [20] Various practitioners in palliative care unit in Spain Cross-sectional survey (N=24) using Templer's DAS and Maslach's MBI Average death anxiety was 5.75. Nurses scored highest on depersonalization. Factors related to team relationships were most stressing. Assistant nurses hardly ever sought family or colleague support to discuss work-related topics. Average death anxiety was 5.75, similar to other studies, but this figure varies depending on the presence of spiritual beliefs or otherwise. Differences in MBI variables were seen between professions. Mean death anxiety 5.75.- context not reported.
Zyga 2012 [25]Renal nurses including palliative- trained- in Greece Descriptive quantitative survey(N=49) using Death Attitude Profile-Revised (DAP-R) Nursing experience and age predicted nurses' attitudes towards death. Nurses with specific education on palliative care had less difficulty talking about death and dying and did not have a fear of death. Hospital-based teams (palliative care, supportive care or symptom assessment teams) had statistically significant different relationships with fear of death and neutral acceptance scores. Significant difference by demographics.