Death and End of Life: Perceptions Throughout The Career About Death, Palliative Care, and Educational Process

Abstract

Purpose: To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula. Method: Cross-sectional study of 12 attending physicians, residents, and undergraduate medical students randomly selected from a single teaching hospital in São Paulo, Brazil, 2018. Semi-structured interviews were conducted, transcripts were coded in depth, and categorizing analysis was carried out. Results: Three topical categories were recognized: Negative feelings about death and the EoL, importance of PC, and gaps in curricular structure hindering preparedness for PC and EoL communication. Besides differing perspectives depending on their years of experience, all participants strongly endorsed that the current medical school curriculum does not train and support physicians to handle EoL and PC. Conclusions: Medical education plays a fundamental role in the development of knowledge and skills on death, dying, and PC. Such practices should extend throughout the course and be continuously improved after graduates move to clinical practice.

Psychology Students' Perceptions of COVID-19 in a Death Education Course

“…The present study, which has been summarized from its elaboration to its main results in Figure 2, aimed to explore psychology students' experiences and perspectives concerning the present COVID-19-related mortality salience situation and especially lockdown measures, in light of the death education course they attended. Concerning the theme of death and the end-of-life, international studies have indeed already highlighted how other healthcare students, especially medical and nursing ones, report not to feel adequately prepared to face these issues and support a dying patient, and how the intense need for proper death education and palliative care trainings is indeed still extremely high (31,32).…”

The Relationship Between Humor Style and Death Anxiety of Palliative Care Patients

“…In determining the lower limit of the palliative performance score of the patients be included in the study, level of %40 which includes the criteria of being conscious and has normal or decreased nutrition, being able to perform self-care with a great deal of assistance, being "unable to perform most of the activities" and having "disseminated disease" in terms of activity and diagnosis, and being "usually in bed" in terms of mobility has been taken as the basis of the lower limit. Patients below this level were not included in the study because they could get very tired during the interview due to the inadequacy of their functional capacity, and healthy data might not be collected due to variable consciousness levels [3,6]. The ambulation, activity performance, and conscious level of the patients were observed by the researcher while the level of self-care and oral intake asked the patients.…”

“…The scale, which consists of 25 items, is a five-point Likert type. While 17 items of the Death Anxiety Scale have a positive sentence structure (1,2,3,5,6,7,8,9,12,14,15,16,18,19,20,22, 24 th items) the other 8 items have a negative sentence structure (items 4, 10, 11, 13, 17, 21, 23, 25 th items). For the scale to determine the death anxiety level, the lowest 0 and the highest 100 points can be obtained, and a high score indicates a high level of anxiety.…”

“…In situations where life is under threat and diseases are severe, people often experience a liferelated crisis [5,6]. Being a palliative care patient, which is one of the situations that cause a life crisis, reminds the patient that the risk of death is higher [1,2].…”

“…Death anxiety is an emotion experienced most of the time, and terminal illnesses may cause this anxiety to increase [4,7]. Death anxiety is a feeling that exists from birth, continues throughout life, lies at the root of all fears, develops after the awareness that people will no longer exist, that they can lose themselves and the world, and that they can become nothing [6,7]. Due to human nature, it may be difficult to maintain the same mood all the time and to keep calm.…”