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We developed, implemented, and evaluated a participatory arts-based storytelling initiative called the Reflection Room project. Our aim was to investigate if visiting a Reflection Room, (1) creates opportunities for disclosing emotions and processing thoughts, (2) increases comfort discussing dying and death, and (3) supports advance care planning (ACP), conversations. In the pilot phase of the Reflection Room project, a Reflection Room was installed in 25 sites across Canada from 2016-2017. Data collection included reflection cards (n = 463), and surveys completed by visitors upon exiting a room (n = 271) and 3 months later (n = 50). Analysis involved theoretically driven coding, inductive content analysis, and descriptive statistics. We found reflections contained both emotional disclosures and reflective processing. Survey data indicated visiting a Reflection Room increased comfort in thinking and talking about dying and death as well as the likelihood of engaging in ACP. In the future, we will explore the extent to which the project fosters social connections and well-being.

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Palliative care volunteers play a crucial role in supporting people who are terminally ill. Previous studies have indicated that a personal experience of grief and bereavement is a motivating factor for wanting to be a palliative care volunteer. Using reflexive thematic analysis as a methodological approach, the aim of this qualitative study was to explore the lived experience of grief and bereavement in a group of 11 Australian volunteers in adult palliative care settings. Three themes were identified from the dataset: witnessing and finding community; approaching death and dying with curiosity and openness; living well through death awareness. Importantly, death awareness was felt by volunteers to be an essential part of sense making around their past grief and a source of guidance for appreciating life. The findings of this study contribute to a deeper understanding of volunteering motivations, end-of-life care, and the changing nature of grief as a lived experience.

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A growing number of nonmedical caregivers seek to improve dying in the United States. They call themselves end-of-life doulas, death midwives, soul guides, compassionate companions, and vigilers, among other names. These new faces at the bedside share a common goal of comforting the dying and their loved ones. Their work is both humanitarian and spiritual as they bring compassionate presence into the sacred space of dying. Thousands of individuals provide end-of-life caregiving through volunteer programs in hospitals, hospices, and community non-profits; hundreds more provide their services to clients for a fee. Using in-depth interviews and analysis of print and online materials, this article traces the development of nonmedical end-of-life caregiving from volunteer vigiling and companioning programs to the professionalization of end-of-life doulaing. Though professional doulas are in the media spotlight, this work began with volunteers who continue to provide most of the nonmedical end-of-life care support for the dying in the United States.

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Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. This systematic review and qualitative evidence synthesis aims to identify the factors that healthcare professionals experience when working within assisted dying frameworks. PRISMA guidelines for systematic reviews were followed. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. Remaining papers were subjected to critical appraisal and a thematic synthesis. Eight themes fell under the domain of 'barrier' and represented different personal and professional factors that hinder professionals from delivering assisted dying healthcare. Five themes came under the domain of 'facilitators' and represent factors that contribute to the smooth implementation and delivery of assisted dying services. Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks.

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Background: The global COVID-19 pandemic confronts people with their fragility, vulnerability, and mortality. To date, scales to measure death awareness mainly focus on the anxiety-provoking aspect of mortality cues. This study aims to cross-culturally adapt and validate the Death Reflection Scale (DRS), a scale for measuring positive, growth-oriented cognitions of life reflection and prosocial behavior following confrontation with the finiteness of life. Materials and Methods: The Death Reflection Scale was translated and adapted in a multi-step process to the German language. In this anonymous, cross-sectional, online survey at a large university in Germany, students, healthcare professionals (HCP) and other staff completed the DRS alongside comparison measures. Multi-group confirmatory factor analysis was used to assess configural, metric, and scalar measurement equivalence across four age and occupational groups. Convergent/divergent validity testing was done via Spearman correlations. Results: 1,703 participants provided data for a response rate of ∼5%. 24% of respondents were HCP, 22% students. Confirmatory factor analysis showed a higher-order structure of the DRS with a strong general factor and the originally proposed five subscales (CFI 0.945, SRMR 0.045, RMSEA 0.055). Multi-group CFA showed partial metric equivalence across age groups and partial scalar invariance across occupational groups. Non-invariant scales were the Motivation to live, Putting life into perspective, and Legacy subscales. In the convergent validity testing, two hypotheses were fully confirmed, two partially and four were not confirmed. Experiencing a propensity for increased contemplation and life reflection during the pandemic together with spirituality showed correlations of moderate to large size to the DRS and its subscales (Spearman's rho ranging from 0.31 to 0.52). Conclusion: Further conceptual work for death awareness to explore the construct's stability in different population groups needs to be undertaken. However, the DRS can be mostly used to assess positive and growth-oriented aspects of death awareness and death reflection which may be an important avenue when developing counseling and support interventions for groups experiencing a high burden during the pandemic.

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Death awareness and near-death experiences initiate shifts in awareness, priorities, and relationships. This narrative inquiry explored the stories of four individuals who had near-death experiences. Participants shared their experiences before and after the experiences. Findings include considerations of how mortality awareness connects with life experiences. Resonant threads across narratives included Interactions with Death, Life after Death, and Meaning in Life after Death. Specifically, findings explore near-death experiences, how life was changed following interactions with death, and the meaning-making process through death awareness. Findings and discussion explore the impact of death awareness as well as considerations for those in death and trauma-related fields.

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The overarching mission of Death Cafes is to raise people's consciousness about life's temporality so that they make the most of their finite lives. Death Cafés create a space for people to gather and have an open dialogue about death and dying. The current qualitative research study explores the experience of nine participants who engage in Death Cafes as facilitators or attendees. Findings including themes of "The Setting", "The Players", and "The Conversation" explore the experiences of Death Cafe participation. Discussion of findings and implications include death rituals, commercialization of death experiences, and the supportive community of the Death Cafe.

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Western society is in an era of death awareness, its most recent salience: A Positive Death Movement. This article traces the evolution of American death culture by describing key periods of change, starting with the 1700s and going through the 21st century, and overviews contemporary movement scholarship. Experts suggest our current epoch is one in which a diffuse collection of individuals and organizations advocate for approaching death differently. Movement proponents aim to modify society's "conventional" death framework, which is characterized as medicalized, institutionalized, impersonal, and lacking psychosocial emotional preparation and engagement.

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The purpose of this study is to develop and test a theoretical model that distinguishes how death anxiety and death reflection influence organizational citizenship behavior (OCB) directed towards the organization (OCB-O) and individuals within it (OCB-I). We draw from terror management and posttraumatic growth (PTG) theories to argue for prosocial motivation as a mediator for these relationships. We also examine organizational identification (OI) as a potential moderator. Data were collected from 241 employees every month for 3 months. Our findings support the mediating role of prosocial motivation. Death anxiety was negatively related to prosocial motivation, whereas death reflection was positively related to prosocial motivation. In turn, prosocial motivation was positively related to OCB-I and OCB-O. Regarding moderation, lower levels of OI strengthened the indirect effects of death anxiety on OCB-I and OCB-O through prosocial motivation. However, OI did not moderate the indirect effects of death reflection on OCB-I or OCB-O. These results highlight the conceptual differences between death anxiety and death reflection. In addition, these results emphasize the need to explore death anxiety and death reflection in organizational research.

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Psychological science has a hard time assessing affective processes of the individuals that they may not recognize or do not like to report on. Here, the authors used the Implicit Positive and Negative Affect Test (IPANAT; Quirin et al., 2009) to investigate whether reminders of an existential threat induce unpleasant implicit affect in soldiers waiting for their deployment to a country with high levels of terrorist threat, Afghanistan. As expected, relative to reminding participants of a television evening, implicit negative affect was higher and implicit positive affect was lower after reminding participants of terror acts performed in different cities. No significant effects were found in self-reports of negative or positive affect. Our findings suggest that reminders of existential threat can elicit implicit negative affect that individuals may not report on explicitly and thus, validate the IPANAT as an easily applicable measure in emotional contexts.

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Background: Near-death awareness (NDA) refers to visions and dreams commonly experienced by terminally ill individuals within months to hours before death. Methods: A case report of a 68-year-old Jamaican male diagnosed with advanced cholangiocarcinoma, who experienced visions of his deceased mother during hospitalization. Results: This article discusses how to differentiate NDA from delirium, core components for determining decisional capacity, and how clinicians can use a cultural guide to optimize patient-centered care. Conclusion: Improved recognition of NDA may promote cultural humility/competency and help to differentiate NDA from an underlying medical/psychiatric condition. It may assist the clinician in understanding the significance of NDA and the comfort and meaning these experiences may hold for both the individual and their family.

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Italy and Spain are two representative examples on strict lockdown last March 2020, also suffering a high rate of mortality in Europe. The aim of this study is to examine their attitudes confronting death awareness during the Covid-19 outbreak. Moreover, Personality was also considered. Different sociodemographic, in situ questions related to attitudes and the brief Big Five of Personality were employed in a cross-sectional design. The main results suggested that Personality traits were stable across countries. A relationship was found between Fear to contagious diseases and Neuroticism and other attitudes during the Covid-19 outbreak, and two different clusters were identified with regards to attitudes, however these did not differ on Personality. Finally, a Cluster group, Neuroticism, Age and Sense of belonging to the Country did predict Fear to contagious diseases. Of note, no differences were found across countries during grief.

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Death is among the most avoided topics of conversation. Although end-of-life planning may greatly benefit individuals and their survivors, research and practice indicate that family, friends, and even health care providers resist discussing end-of-life plans. Consequences of not planning ahead have created a public health issue. This article describes a community-level intervention that facilitates those necessary conversations among elders who have at least begun to talk with others about their wishes. A free, three-part educational workshop series on end-of-life planning titled "Begin with the End in Mind" was developed at a midwestern university. A survey was distributed to all attendees to learn about their beliefs regarding end-of-life planning. Inductive content analysis was used to understand participants' thoughts about discussing end-of-life planning. Findings from 33 participants suggest a concern about making plans and ensuring others would follow their wishes. In conclusion, this article offers a roadmap for gerontologists and others to use in engaging the community to think about and act on end-of-life public health issues.

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OBJECTIVE: This paper is concerned with the phenomenology of death awareness within the context of being diagnosed with terminal cancer. The objective of the research presented here is to provide a deeper insight into terminally ill cancer patients' engagement with their mortality. METHOD: The analysis forms part of a wider project that involved conducting a metasynthesis of 23 phenomenological studies of the experience of living with the awareness of having terminal cancer published between 2011 and 2016.ResultThe metasynthesis identified four master themes that represent distinct experiential dimensions of living with terminal cancer. This paper focuses on one of these themes, liminality, to provide novel insights into the structure of death awareness whilst living with terminal cancer.Significance of resultsThe results suggest that liminality describes an experiential space from within which terminal cancer patients encounter a new relationship with their existence. Liminality offers opportunities for both connection (e.g., with the natural world) as well as disconnection (e.g., from loved ones and others who still have a future) and therefore contains the potential for suffering and distress as well as for joy and a sense of fulfillment. This understanding of liminality can help healthcare professionals provide psychological support for this client group.

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Terror management theory (TMT) contends that the need to manage the anxiety evoked by the awareness of one's own mortality, through proximal and distal defenses, lies at the heart of any human motivation. Proximal defenses aim at dismissing death awareness. Distal defenses aim at keeping them out of frame. The terror management health model (TMHM) applies TMT to issues of health and illness. TMT and TMHM are both explored mainly through empirical positivist research and theoretical discussions. Very few publications relate to the implementation of TMT. This article suggests further applications of the TMHM in social work practice.

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Societies, including those of humans, have evolved multiple ways of dealing with death across changing circumstances and pressures. Despite many studies focusing on specialized topics, for example necrophoresis in eusocial insects, mortuary activities in early human societies, or grief and mourning in bereavement, there has been little attempt to consider these disparate research endeavours from a broader evolutionary perspective. Evolutionary thanatology does this by adopting an explicit evolutionary stance for studies of death and dying within the sociological, psychological and biological disciplines. The collection of papers in this themed issue demonstrates the value of this approach by describing what is known about how various nonhuman species detect and respond to death in conspecifics, how problems of disposing of the dead have evolved in human societies across evolutionary time and also within much shorter time frames, how human adults' understanding of death develops, and how it is ultimately reflected in death-related language. The psychological significance and impact of death is clearly seen in some species' grief-like reactions to the loss of attachment figures, and perhaps uniquely in humans, the existence of certain psychological processes that may lead to suicide. Several research questions are proposed as starting points for building a more comprehensive picture of the ontogeny and phylogeny of how organisms deal with death.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.

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This article presents an action research study that explores how a fifth-grade classroom of 10- to 11-year-old children in Cyprus perceive the concepts of grief and grieving, after an educational intervention provided space for discussing such issues. It also explores the impact that the intervention program had on children's emotions while exploring these concepts and illustrates how it affected their behavior. The findings suggest that the intervention had a constructive impact on children's understandings of grief and grieving along two important dimensions. First, the intervention helped children better define emotional responses to loss (grief). Second, children seemed to overcome their anxiety while talking about grief and grieving and were able to share relevant personal experiences. The study has important implications for curriculum development, pedagogical practice, and teacher training on death education.

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AIMS: To explore the lived experience of resuscitation team members involved in notifying family members when a patient dies following a resuscitation event in an Iranian cultural context. BACKGROUND: Death notification to the family is indeed a difficult and an important issue for resuscitation team members. The way health professionals deliver news to family members should incorporate elements of sensitivity, timing and adequate clinical explanations with emphasis on the efforts made by the professionals during the resuscitation. DESIGN: A phenomenological study. METHOD: Over a period of 5 months (June 2016-November 2016) eleven nurses and six physicians were interviewed using an in-depth interview process applying Van Manen's hermeneutic phenomenological approach for data collection and analysis. The participants were recruited from six tertiary hospitals in Tabriz, Iran. FINDINGS: There were two main themes that emerged from the data analysis including: "contributing factors on the impact of notification" and "notification strategies". A further 13 subthemes emerged under the main themes. Several culturally related issues emerged with the participants feeling more comfortable informing male rather than female relatives about the death of the patient following a resuscitation. CONCLUSIONS: Notifying family members of a patient's death is a stressful and culturally sensitive task for the resuscitation team members. The nature of the patient's presenting condition, together with the various resuscitation interventions can result in relatives responding unpredictably. Providing health professionals with the appropriate training and skills to effectively communicate with family members will ensure that the families' level of preparedness, understanding and cultural beliefs are taken into consideration.

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OBJECTIVES: To explore how psychology trainee death concerns and ageist behavior relate to their willingness and desire to work with older adults. METHOD: Trainees (N = 104; 80.8% women) completed the Death Thought-Accessibility Measure, Relating to Older People Evaluation (ROPE), Death Anxiety Scale-Extended (DASE), and Beck Anxiety Inventory (BAI) and rated their willingness and desire to work with older adults and their willingness to obtain training on how to work with older adults. RESULTS: Pearson correlations showed that salience of death-related thoughts, death anxiety (but not general anxiety), and negative behaviors toward older adults were significantly negatively associated with trainees' willingness and desire to work with older adults. Regressions revealed that negative behaviors toward older adults was the strongest factor associated with willingness and desire to work with older adults, whereas positive behaviors toward older adults was the strongest factor associated with being willing to obtain training in working with older adults. Death anxiety and salience of death-related thoughts positively correlated with each other and were each positively associated with negative behaviors toward older adults. CONCLUSION: Helping graduate trainees become more comfortable with mortality and changing negative behaviors toward older adults may increase their interest in gerontology and geriatrics.

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Anxiety is common in the context of cancer, but there are few theoretical models that apply to people with cancer across the trajectory of their illness. The aims of this review are to identify existing theories and to propose an integrated model of cancer-related anxiety. Using a systematic literature search of Medline, Premedline and PsycINFO databases, we identified nine theoretical models of anxiety in the context of cancer. We reviewed these for psychological concepts that fell under five themes: pre-existing schema, the inherent nature of cancer, cognitive factors, coping responses and contextual factors. From these themes, we integrated concepts from different models to develop a theoretical framework to explain the development and maintenance of anxiety in the context of cancer. The resulting model suggests that pre-existing schema, past experiences of cancer, an intolerance of uncertainty and meta-cognitive beliefs about worry interact with the inherent nature of cancer to produce overwhelming distress. The distress activates cognitive processes characterized by vigilance, worry and rumination. Attempts to cope by re-establishing control, and a pattern of vigilance to cancer-related cues and/or avoidance reinforce anxiety, in the context of a range of systemic factors that can either buffer against or worsen the anxiety.

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