Effects of a Death Education Intervention for Older People with Chronic Disease and Family Caregivers: A Quasi-Experimental Study

Abstract

Purpose: To investigate the effectiveness of a structured death education program for older adults with chronic illness and their family caregivers. Methods: This study adopted two-group, nonrandomized quasi-experimental design. Patientecaregiver dyads in the intervention group (N ¼ 40 dyads) engaged in the death education program at the bedside once a week for 5 weeks, and were compared with participants (N ¼ 40 dyads) in the control group who received usual health education. The program consisted of five sessions based on the Interaction Model of Client Health Behavior. Death attitude, death competence, well-being, family function, and satisfaction were measured at baseline (T0), immediately after the intervention (T1), and 1 month later (T2). Data collection was conducted from July 30, 2019, to December 30, 2019. Results: The intention-to-treat analysis The intention-to-treat analysis of between groups at 1-month follow-up revealed that the intervention group had greater decreases in the fear of death (p=.002, 95% CI -2.53, -0.47; p<.001, 95% CI -3.61, -1.65) and death avoidance (p<.001, 95% CI -3.46, -1.84; p<.001, 95% CI -3.89, -2.43), had greater increases in the neutral acceptance (p=.032, 95% CI 0.05, 1.38; p<.001, 95% CI 0.99, 2.56) and death competence (p<.001, 95% CI 4.10, 8.01; p<.001, 95% CI 7.80, 12.11) in patients and caregivers, respectively. There were significant intergroup differences over time for patient well-being of (p<.001, 95% CI 3.06, 9.74) and satisfaction of (p<.001, 95% CI 2.01, 4.59). Results were consistent with the results from the sensitivity analysis. Conclusion:This study demonstrated the feasibility and benefits of death education in hospitals and provided an implementation plan for nursing professionals. Nurses should consider providing death education for older adults with chronic diseases and their families to promote the development of palliative care and the quality of end-of-life.

The ‘good death’ in Mainland China - A Scoping Review

“… Chen et al. ( Chen et al., 2020 ) Wuhan 2020 Asian Nursing Research (2019: 0.988) To investigate the effectiveness of a structured death education program 80 older adults with chronic illness and 80 related relatives Two-group, non-randomised quasi-experimental study consisting of 5 weeks bedside death education was delivered to the intervention group and 5 weeks usually health education to the placebo group (July-December 2019) Death education improved patients' death attitudes and satisfaction in relation to ‘usual practice’ (p=.002). Patients’ fear of death was significantly reduced by the death education program (p < .001).…”

“…Two studies explored the components of the ‘good death’ by focusing on end-of-life decision-making processes ( Gu et al., 2016 , Liu et al., 2016 ). Two studies had primarily educational aims ( Chen et al., 2020 , Cui et al., 2011 ), and one about pain management ( Deng et al., 2014 ). However, the ‘good death’ was touched in these studies.…”

“…Seven studies used qualitative research designs, whereas six studies used semi-structured interviews ( Dong et al., 2016 , Pan et al., 2021 , Zheng et al., 2015 , Liu and van Schalkwyk, 2019 , Zhang et al., 2013 , Liu et al., 2016 ) and one was an ethnographic field study, using both observations and semi-structured interviews ( Keimig, 2020 ). Eleven studies used quantitative designs, whereas two studies were based on standardised questionnaires ( Yang et al., 2019 , Huang et al., 2015 ), five used self-designed questionnaires ( Wang et al., 2004 , Gu et al., 2007 , Ivo et al., 2012 , Tang, 2019 , Cui et al., 2011 ), two used empirical material from medical records ( Gu et al., 2016 , Deng et al., 2014 ), one used a non-randomised controlled design ( Chen et al., 2020 ), and one used selected game cards ( Li et al., 2021 ) . One study used mixed methods, combining a self-designed questionnaire and semi-structured interviews ( Huang et al., 2018 ).…”

“…However, two of the qualitative studies had a theoretical methodical framework ( Keimig, 2020 , Liu and van Schalkwyk, 2019 ), but the theories did not drive the result analysis nor the discussions. Four studies had a defined concept of the ‘good death’ ( Yang et al., 2019 , Huang et al., 2015 , Keimig, 2020 , Zhang et al., 2013 ), while 15 studies had an implicitly description of the ‘good death’ through use of related factors such as ‘pain control’ ( Deng et al., 2014 ), ‘attitude to death’ ( Dong et al., 2016 , Pan et al., 2021 , Wang et al., 2004 , Zheng et al., 2015 , Huang et al., 2018 , Ivo et al., 2012 , Tang, 2019 ), ‘place of death’ ( Gu et al., 2007 )’, ‘end-of-life preference’ ( Li et al., 2021 ), ‘death preparation’ ( Liu and van Schalkwyk, 2019 ), ‘death education’ ( Chen et al., 2020 , Cui et al., 2011 ), and ‘decision-making process’ ( Gu et al., 2016 , Liu et al., 2016 ).…”

How thoughts of death and intrinsic/extrinsic goal orientation affect well‐being during the pandemic

“…Conversely, individuals should be educated about death and learn to acknowledge it as a natural part of life. Recent death education intervention studies conducted with the elderly (Chen et al, 2020), adolescents (Testoni, Ronconi, et al, 2019), and preschoolers and their parents (Testoni, Cordioli, et al, 2019) have found that death education has positive psychological and emotional outcomes. Scholars and professionals have long insisted on including death education in the K‐12 curriculum (Aspinall, 1996; Galende, 2015; Oaks & Bibeau, 1987; Smilie, 2021; Wass, 2004; Willis, 2002).…”