Effect of mindfulness-based stress reduction on nursing interns' death anxiety, stress, and palliative care self-efficacy during oncology end-of-life training.

Abstract

Objectives: Nursing interns often experience high levels of death anxiety and stress, which can reduce their comfort and confidence in caring for dying patients. This study evaluated the effects of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on death anxiety, perceived stress, and attitudes toward care of the dying among nursing interns during palliative and oncology rotations.

Methods: A quasi-experimental pre-post design was used with 120 final-year Bachelor of Science in nursing interns at Prince Sattam Bin Abdulaziz University, Saudi Arabia. Participants completed the 8-week MBSR program following Kabat-Zinn's original protocol, including weekly 2-hour sessions, a silent retreat, and daily home practice. Pre- and post-intervention assessments were conducted using the Death Attitude Profile-Revised (DAP-R), Perceived Stress Scale (PSS-10), and Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Data were analyzed using paired t-tests, effect sizes (Cohen's d), Pearson correlations, and multiple linear regression to identify predictors of post-intervention attitudes.

Results: Post-intervention, nursing interns showed a significant reduction in death anxiety (DAP-R: 134.67 ± 6.70 vs. 118.46 ± 7.85; t = 33.39, p < 0.001, d = 3.05) and perceived stress (PSS-10: 20.29 ± 2.94 vs. 19.41 ± 3.36; t = 4.25, p < 0.001, d = 0.39). Attitudes toward caring for dying patients improved significantly (FATCOD-B: 84.10 ± 4.99 vs. 90.01 ± 5.64; t = -16.95, p < 0.001, d = 1.55). Baseline FATCOD-B scores were the strongest predictor of post-intervention attitudes (β = 0.778, p < 0.001). Correlations between constructs were weak, indicating that death anxiety, perceived stress, and care attitudes represent distinct dimensions.

Significance of results: These findings highlight that mindfulness training can enhance emotional resilience, reduce anxiety and stress, and positively shape attitudes toward caring for dying patients. Integrating MBSR into nursing education during palliative rotations may better prepare interns to provide compassionate, human-centered end-of-life care, ultimately improving patient and family experiences in terminal illness settings.