The Effectiveness of Death Education on Death Anxiety, Depression, and Quality of Life in Patients With Advanced Cancer: A Meta-Analysis of Randomised Controlled Trials.

Abstract

Background: Patients with advanced cancer can suffer from serious distress like death anxiety and depression, in addition to facing a reduced quality of life. Death education interventions have been shown to improve these outcomes, but their effectiveness remains unclear, especially in the advanced stages.

Objective: This meta-analysis aimed to examine the efficacy of death education interventions on death anxiety, depression, and quality of life in advanced cancer sufferers, and to explore the influence of the intervention site, duration, the age of participants, and dyadic relationships with caregivers on the effectiveness of these interventions.

Design: A meta-analysis of randomized controlled trials was performed.

Methods: A systematic search of 10 electronic databases identified 19 eligible RCTs with 1531 participants. Data were extracted and analyzed via Review Manager 5.4. Subgroup analyses were performed on the basis of the intervention site, duration, age of participants, and presence of caregivers.

Results: In comparison to the control intervention, the death education intervention notably alleviated death anxiety (SMD = -2.11, 95% CI: -5.91 to -0.89, p = 0.008) and depression (SMD = -0.45, 95% CI: -0.72 to -0.18, p = 0.001). Quality of life (SMD = 0.86, 95% CI: 0.39-1.33, p = 0.0003) was also significantly improved. Subgroup analyses revealed that interventions with longer durations, conducted in professional settings, and targeting younger patients were more likely to be effective in reducing depression and enhancing the quality of life. Interventions without family companionship were more effective in improving depression, while interventions with family companionship were more effective in improving quality of life.

Conclusion: Death education interventions are effective at improving death anxiety, depression, and quality of life in patients with advanced cancer. Tailoring interventions to individual features and cultural backgrounds is crucial to achieving the best effect.

Clinical relevance: Death education is an effective and important intervention measure that can help patients with advanced cancer better cope with death anxiety and depressive emotions and improve their quality of life. Clinical medical workers should select appropriate death education programs based on the specific conditions of patients and provide necessary support and guidance.

Trial registration: CRD42024565376.