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http://dx.doi.org/10.17496/kmer.2018.20.3.150

The Influence of Death Education on Medical Students' Attitudes towards End-of-Life Care: A Preliminary Study  

Kim, Hae Won (Department of Medical Education, Yonsei University College of Medicine)
Park, Joong Chul (Department of Family Medicine, Green Hospital)
Publication Information
Korean Medical Education Review / v.20, no.3, 2018 , pp. 150-155 More about this Journal
Abstract
End-of-life care competencies have been perceived as important and essential, so it has been suggested that end-of-life care be studied in undergraduate medical education. However, end-of-life care curriculum has mostly focused on acquisition of knowledge and skills rather than attitudes. Therefore, we aimed to explore whether education about death affects medical students' attitudes towards care for dying patients and perception of death anxiety, meaning in life, and self-esteem. A total of 15 first- or second-year medical students were surveyed with questionnaires before and after completing a 6-week death education course. Paired data analysis showed that participants' attitudes towards caring for terminally ill patients and their caregivers improved significantly (t=-2.84, p=0.013) with an effect size of 0.73. In contrast, no significant changes were found in death anxiety, meaning in life, or self-esteem. All participants agreed that formal teaching about death and dying must be encouraged in medical schools. Our results suggest that death education may positively influence attitudes towards end-of-life care. Although replication with larger samples is necessary, this preliminary finding may support the importance of developmentally appropriate end-of-life care education in medical schools.
Keywords
Attitude to death; Death education; End of life care; Medical students;
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1 Choi YS, Choi JK, Tae YH, Kim DH. Public awareness of hospice palliative care and its implications. Korean Soc Secur Assoc. 2015;2015(1):93-107.
2 Korean Statistical Information Service. Press releases: preliminary results of birth and death statistics in 2015 [Internet]. Daejeon: Statistics Korea; 2016 [cited 2018 Jun 21]. Available from: http://kostat.go.kr/portal/korea/kor_ko/5/2/index.board?bmode=read&aSeq=351953&pageNo=&rowNum=10&amSeq=&sTarget=&sTxt=.
3 Pivodic L, Pardon K, Morin L, Addington-Hall J, Miccinesi G, Cardenas-Turanzas M, et al. Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries. J Epidemiol Community Health. 2016;70(1):17-24.   DOI
4 Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007-14.   DOI
5 Wilkinson DJ, Truog RD. The luck of the draw: physician-related variability in end-of-life decision-making in intensive care. Intensive Care Med. 2013;39(6):1128-32.   DOI
6 Yun YH, Kwon YC, Lee MK, Lee WJ, Jung KH, Do YR, et al. Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness. J Clin Oncol. 2010;28(11):1950-7.   DOI
7 Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665-73.   DOI
8 Sullivan AM, Warren AG, Lakoma MD, Liaw KR, Hwang D, Block SD. End-of-life care in the curriculum: a national study of medical education deans. Acad Med. 2004;79(8):760-8.   DOI
9 Liaison Committee on Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree. Washington (DC): Association of American Medical Colleges, American Medical Association; 2018.
10 General Medical Council. Tomorrow's doctors: outcomes and standards for undergraduate medical education. London: General Medical Council; 2009.
11 Lloyd-Williams M, MacLeod RD. A systematic review of teaching and learning in palliative care within the medical undergraduate curriculum. Med Teach. 2004;26(8):683-90.   DOI
12 Gibbins J, McCoubrie R, Forbes K. Why are newly qualified doctors unprepared to care for patients at the end of life? Med Educ. 2011;45(4):389-99.   DOI
13 Alexander SC, Keitz SA, Sloane R, Tulsky JA. A controlled trial of a short course to improve residents' communication with patients at the end of life. Acad Med. 2006;81(11):1008-12.   DOI
14 Porter-Williamson K, von Gunten CF, Garman K, Herbst L, Bluestein HG, Evans W. Improving knowledge in palliative medicine with a required hospice rotation for third-year medical students. Acad Med. 2004;79(8):777-82.   DOI
15 Leombruni P, Loera B, Miniotti M, Zizzi F, Castelli L, Torta R. Confirmatory factor analysis of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B) among Italian medical students. Palliat Support Care. 2015;13(5):1391-8.   DOI
16 Templer DI. The construction and validation of a Death Anxiety Scale. J Gen Psychol. 1970;82(2d Half):165-77.   DOI
17 Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: assessing the presence of and search for meaning in life. J Couns Psychol. 2006;53(1):80.   DOI
18 Rosenberg M. Society and the adolescent self-image. Princeton (NJ): Princeton University Press; 1965.
19 Billings ME, Engelberg R, Curtis JR, Block S, Sullivan AM. Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. J Palliat Med. 2010;13(3):319-26.   DOI
20 Kim HK, Nam EM, Lee KE, Lee SN. Awareness and attitude change after end-of-life care education for medical students. Korean J Hosp Palliat Care. 2012;15(1):30-5.
21 Wechter E, O'Gorman DC, Singh MK, Spanos P, Daly BJ. The effects of an early observational experience on medical students' attitudes toward end-of-life care. Am J Hosp Palliat Care. 2015;32(1):52-60.   DOI
22 Rodenbach RA, Rodenbach KE, Tejani MA, Epstein RM. Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality. Patient Educ Couns. 2016;99(3):356-63.   DOI
23 Barr P. Relationship of neonatologists' end-of-life decisions to their personal fear of death. Arch Dis Child Fetal Neonatal Ed. 2007;92(2):F104-7.   DOI
24 Thiemann P, Quince T, Benson J, Wood D, Barclay S. Medical students' death anxiety: severity and association with psychological health and attitudes toward palliative care. J Pain Symptom Manage. 2015;50(3):335-42.   DOI
25 Hegedus K, Zana A, Szabo G. Effect of end of life education on medical students' and health care workers' death attitude. Palliat Med. 2008;22(3):264-9.   DOI
26 Morrison LJ, Thompson BM, Gill AC. A required third-year medical student palliative care curriculum impacts knowledge and attitudes. J Palliat Med. 2012;15(7):784-9.   DOI
27 Juhl J, Routledge C. Putting the terror in terror management theory: evidence that the awareness of death does cause anxiety and undermine psychological well-being. Curr Dir Psychol Sci. 2016;25(2):99-103.   DOI
28 Horowitz R, Gramling R, Quill T. Palliative care education in U.S. medical schools. Med Educ. 2014;48(1):59-66.   DOI
29 Routledge C, Ostafin B, Juhl J, Sedikides C, Cathey C, Liao J. Adjusting to death: the effects of mortality salience and self-esteem on psychological well-being, growth motivation, and maladaptive behavior. J Pers Soc Psychol. 2010;99(6):897-916.   DOI