
Understanding death anxiety in health care
Talking about death is difficult. Whether contemplating our own mortality, mourning the loss of a loved one, or reflecting on the passing of a public figure we have never met before, feelings of sadness, fear, awkwardness, and anxiety may arise. These emotions persist as health care professionals, patients and their family members decide between life-prolonging treatments and end-of-life care. In this blog, we will explore the profound impact of death anxiety on the health care system and share strategies for addressing it.
Impacts on health care professionals
The term “death anxiety,” introduced in 2009 by researchers Rebecca Lehto and Karen Stein, refers to the fear associated with “the anticipation and awareness of death, dying, and nonexistence.” This anxiety is often overlooked among health care professionals, yet it significantly impacts their ability to provide high-quality care. A 2016 literature review published in the International Journal of Community Based Nursing & Midwifery found death anxiety can hinder effective communication with patients, their families, and colleagues regarding treatment options. Burnout has also been associated with death anxiety, resulting in absenteeism and job turnover.
Recent research suggests that addressing death anxiety can enhance care delivery and reduce burnout among health care workers. In a 36-hour group training program offered by the University of Kent, health care professionals learned about topics related to death, such as relationships, coping and meaning of life. Participants also engaged in exercises to build communication skills when talking about death. Findings demonstrated the intervention reduced burnout and improved well-being among participants.
Confronting death anxiety
Despite increasing research on the effects of death anxiety on health care workers, medical schools vary in their palliative and hospice care training programs. Research conducted by Robert Horowitz and colleagues found that some medical school curriculums dedicate as little as two classroom hours to end-of-life care, while others spend several weeks in palliative or hospice care settings.
One initiative at Tufts University School of Medicine hopes to address death anxiety and improve end-of-life conversations. Medical students complete an end-of-life care plan for themselves using the “Five Wishes” exercise developed by Aging with Dignity. The purpose of the exercise is to prepare future health care professionals to talk about end-of-life care with patients and family members in the future. Even though medical schools vary in patient death education, hospitals can also implement programs to support their staff.
In 2015, Memorial Sloan Kettering Cancer Center piloted patient death debriefing sessions to provide an opportunity for resident doctors to talk about their emotional reactions the day after a patient’s death and receive guidance from veteran physicians. In these sessions, the patient care teams were asked the following questions:
- How does this patient’s death compare to your prior experiences with a patient’s death?
- Was this patient’s death expected or unexpected?
- Did you feel prepared for this patient’s death? How could you or the team have been better prepared for the patient’s death?
- How does this patient’s death emotionally impact you?
- How do you deal with death and dying?
The medical residents reported the debriefing sessions increased their willingness to receive support from the hospital’s leadership.
Resources for navigating death anxiety
Since the COVID-19 pandemic, awareness from the public about death anxiety and burnout among health care professionals has increased. One way to support family members and friends working in health care is knowing where to find resources. Listed below are resources created for health care professionals for navigating death anxiety, burnout and trauma.
- Tips for Health Care Practitioners and Responders (Substance Abuse and Mental Health Services Administration)
- Tools on Dealing with Grief (American Psychological Association)
- Health Care Professionals: Mental Health Resources (Colorado Department of Public Health & Environment)
- Understanding Grief and Loss: Coping with Loss (UC Health)
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ABOUT THE AUTHOR
Rachel Washburn received her bachelor’s degree in health and exercise science, with a minor in gerontology, from Colorado State University in 2024. She formerly served as a student ambassador at CSU’s Center for Healthy Aging and is now a doctoral student in CSU’s occupational therapy program.