OBJECTIVE: This study aimed to investigate death anxiety (DA) in caregivers of patients with advanced cancer and identify associated factors in the context of Chinese culture.
METHODS: Caregivers (N = 588) of advanced cancer patients in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of the Templer Death Anxiety Scale (C-T-DAS), the Quality-of-Life Scale, the State-Trait Anxiety Scale, and the Social Support Rating Scale. Data were analyzed in SPSS (IBM Corp, Armonk, NY, USA) using descriptive statistics, Pearson\'s correlation test, and linear regression.
RESULTS: Respondents returned 588 (93.03%) of the 632 questionnaires. The total C-T-DAS score was 7.92 ± 2.68 points. The top-scoring dimension was \"Stress and pain\" (3.19 ± 1.29 points), followed by \"Emotion\" (2.28 ± 1.31 points) and \"Cognition\" (1.40 ± 0.94 points). In contrast, the lowest-scoring dimension was \"Time\" (1.06 ± 0.77 points). Factors associated with DA (R2 = 0.274, F = 13.348, p < 0.001) included quality of life (QoL), trait anxious personality, social support, caregiver length of care, caregiver gender, and patients\' level of activities of daily living (ADL).
CONCLUSIONS: Our results demonstrated high levels of DA in caregivers of patients with advanced cancer. Generally, female caregivers and those with low social support had high DA. Caregivers caring for patients with low ADL levels or with a low QoL and trait anxious personality reported high DA. Certain associated factors help to reduce caregivers DA. Social interventions are recommended to improve the end-of-life transition and trait anxious personality as well as quality of life for caregivers.

OBJECTIVE: To explore the mediating role of trait anxious personality in the association between quality of life (QoL) and death anxiety (DA), as well as to test the moderating effect of social support in the mediation model.
METHODS: The Death Anxiety Scale, Quality of Life Scale, State-Trait Anxiety Scale, and Social Support Rating Scale were used to measure 588 family caregivers of advanced cancer patients. We then constructed a moderated mediation model.
RESULTS: The presence of QoL was negatively associated with DA (β =  - 0.67, p < 0.01). Trait anxious personality partially mediated the relationship between QoL and DA (indirect effect β =  - 0.08, p < 0.01). Social support moderated both the antecedent and subsequent segments of the mediating paths of \"QoL → trait anxious personality → DA\" and the direct relationship between QoL and DA. Among caregivers with a low level of social support, the mediating effect coefficient of trait anxious personality was higher at 0.25 (95% confidence interval (CI): 0.059-0.182), in contrast to caregivers with a high level of social support, where the mediating effect coefficient of trait anxious personality was 0.11 (95% CI: 0.029-0.072).
CONCLUSIONS: QoL is directly associated with an increased risk of DA and indirectly related to DA by increasing the risk of trait anxious personality among caregivers. Social support can moderate the mediating effect of trait anxious personality and the relationship between QoL and DA. The intervention strategy for preventing DA among caregivers who have encountered QoL reduction should focus on reducing trait anxious personality and social support.

BACKGROUND: This study investigates the mediating effect of meaning in life between death anxiety and attitude toward palliative care among nursing students.
METHODS: We enrolled 363 undergraduate nursing students using a convenience sampling method as the respondents and conducted a survey using general information about nursing students, the Chinese version of the FATCOD-B Scale, the Chinese version of the Death Anxiety Scale, and the Chinese version of the Meaning in Life Questionnaire. The SPSS25.0 statistical software was used to analyze the mediating effect.
RESULTS: The mean total attitude score toward palliative care was (104.72 ± 10.62). Death anxiety had a significant negative predictive effect on the attitude toward palliative care (β = -0.520, P < 0.01). When the mediating variable of the presence of meaning in life was included, the negative predictive effect of death anxiety on attitude toward palliative care remained significant (β = -0.379, P = 0.036); the mediating effect (-0.141) accounted for 27.12% of the total impact (-0.520).
CONCLUSIONS: The presence of meaning in life mediates the relationship between death anxiety and attitude toward palliative care. This implies that nursing educators, through their role in educating nursing students about the meaning of life, can significantly influence the development of a positive attitude toward palliative care.

OBJECTIVE: This study aims to investigate the association between fear of cancer recurrence (FCR) and death anxiety (DA) among Chinese cancer patients, while considering the mediating effects of experiential avoidance (EA) and meaning in life (MIL).
METHODS: From February to June 2023, convenience sampling was used to select newly diagnosed cancer patients in a tertiary Cancer Hospital in Chinese Hunan Province as the survey objects. A total of 436 cancer patients completed the Fear of Cancer Recurrence Inventory, the Meaning in Life Questionnaire, the Acceptance and Action Questionnaire-II, and the Templer\'s death anxiety scale. Descriptive analysis and Pearson correlation analysis were conducted using SPSS 28.0 software. Serial mediation analysis was performed by Hayes\' PROCESS macro.
RESULTS: Gender, age, educational level, marital status, residence, occupation, per capita monthly household income, tumor type, and cancer stage were controlled in the model. The results revealed that fear of cancer recurrence had a significant direct effect on death anxiety (Effect = 0.075, 95% CI: 0.064 to 0.087). Additionally, three indirect pathways were identified: (1) through experiential avoidance (Effect = 0.037, 95% CI: 0.026 to 0.049), (2) through meaning in life (Effect = 0.022, 95% CI: 0.014 to 0.031), and (3) through the serial mediators involving meaning in life and experiential avoidance (Effect = 0.016, 95% CI: 0.010 to 0.023). The total indirect effect of the three mediation paths was 63.56%.
CONCLUSIONS: Fear of cancer recurrence is a significant psychological distress experienced by cancer patients, which not only directly contributes to death anxiety but also may triggers changes, such as experiential avoidance and meaning in life. Ultimately, this comprehensive psychological distress leads to death anxiety.

BACKGROUND: Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables.
METHODS: A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer\'s Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety.
RESULTS: A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = - 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = - 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (β = 0.464) and presence of meaning (β = -0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect.
CONCLUSIONS: Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management.

Death anxiety arousal, provoked by anticipating self-nonexistence, may be used as a fraud tactic by scammers on older adults; however, little is known about how it affects older adults\' decision making when confronted with a scam and the mechanisms underlying these effects. This study used a questionnaire survey and experimental design to examine them. In Study 1, 307 older adults in China completed questionnaires. The results showed a positive link between death anxiety and vulnerability to fraud, partially mediated by materialism. In Study 2, 82 older adults in China were randomly assigned to the mortality salience group and control group to examine whether death anxiety arousal can increase older adults\' vulnerability to fraud and the mediating role of materialism. The results indicated that death anxiety and materialism increase the risk of consumer products and services fraud; therefore, targeting these risk factors might protect older adults from fraud.

UNASSIGNED: This research intended to assess and compare influence of psychosocial interventions in death anxiety in patients, providing evidence-based guidance for both patients and healthcare providers.
UNASSIGNED: The present study exclusively gathered randomized controlled trials by comprehensively searching across multiple databases, comprising of PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The methodological quality of the enrolled studies involved in the analysis was assessed using the Cochrane bias risk assessment tool, and data analysis was performed utilizing appropriate software.
UNASSIGNED: This research, encompassing 15 randomized controlled trials with a cumulative sample size of 926 patients, spanned from the earliest possible date to December 2023. The findings of network meta-analysis unveiled that the Rational-Emotive Hospice Care Therapy significantly reduced death anxiety among patients (Sequentially Updated Cumulative Ranking Analysis: 100%).
UNASSIGNED: The ranking plot of the network suggested that the rational-emotive hospice care therapy exhibited superior efficacy as a psychological treatment for reducing the death anxiety of patients.Systematic review registration: [https://clinicaltrials.gov/], identifier: [CRD42023484767].

BACKGROUND: Anatomy education is a fundamental part of clinical nursing, but anatomy courses may lead to a range of psychological changes, such as death anxiety and sense of meaning in life. Such experiences and changes may influence student\'s willingness to donate their body. There is insufficient evidence on whether anatomy courses bring about these changes, and the reasons behind experiences are unclear. Focusing on these changes is essential to improve anatomy education in nursing and to promote the mental health of students in the nursing field.
OBJECTIVE: To explore changes and underlying reasons for death anxiety, sense of meaning in life, and the willingness to donate a body before and after anatomy courses.
METHODS: An explanatory sequential explanatory mixed-methods study.
METHODS: A total of 60 students completed quantitative surveys and 16 students from the sub-samples of the quantitative stage were included in the qualitative interviews. All students were from a comprehensive university in Changsha, Hunan Province, China.
METHODS: Data were collected from September 2022 to April 2023, including two rounds of questionnaire surveys and one interview. The questionnaires included sociodemographic data, the Death Anxiety Scale (CT-DAS), the Meaning of Life Scale (MLQ), and a body donation willingness question. Interviews were conducted based on the research objectives. The statistical methods included descriptive statistics, z-tests, and thematic analysis.
RESULTS: Quantitative results showed a decrease in emotional dimension of death anxiety (z = -2.534, P < 0.05) and an increase in body donation willingness (z = -3.183, P < 0.05). Qualitative analysis revealed cognitive experience and value assessment may relate to the changes. Based on the two themes, the reduction of death anxiety in emotional dimension can be further attributed to four factors: demystification, instrumentalization, desensitization, and respect and gratitude towards donors. The increase in willingness to donate bodies can be further attributed to two aspects: increase in knowledge of body donation and the affirmation of the value of donation.
CONCLUSIONS: The study found that students experience a decrease in death anxiety in the emotional dimension and an increased inclination to donate their bodies after anatomy courses, which may be related to cognitive experience and value assessment. Future nursing anatomy education could delve deeper into these two perspectives and support students to positively cope with death anxiety and rethink body donation through enriching death education activities such as donor memorial ceremonies. These results provide a basis for designing anatomy courses and improving the psychological well-being and professional competence of nursing students.

UNASSIGNED: Population aging is a global trend, and the number of older adults living alone is increasing. Tai chi, a traditional Chinese exercise, has been shown to improve the physical and mental health of older adults.
UNASSIGNED: To investigate the effects of tai chi on death anxiety in older adults living alone and the role of social support and psychological capital in this relationship.
UNASSIGNED: A cross-sectional study of 493 older adults living alone in four cities in southwestern China. Participants were assessed using questionnaires on tai chi practice, social support, psychological capital, and death anxiety.
UNASSIGNED: Tai chi practice significantly reduced death anxiety in older adults living alone. It also positively correlated with social support and psychological capital, both of which negatively correlated with death anxiety. Social support and psychological capital mediated the relationship between tai chi practice and death anxiety, suggesting that tai chi may reduce death anxiety through these factors. These findings encourage older adults living alone to practice tai chi, as it may improve their mental and physical health and reduce their risk of death anxiety.
UNASSIGNED: Tai chi practice may reduce death anxiety in older adults living alone through the chain-mediated effects of social support and psychological capital. This suggests that tai chi may be a beneficial intervention for older adults living alone.

OBJECTIVE: A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.
METHODS: This systematic review and meta-analysis followed the PRISMA 2020 guidelines.
METHODS: Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.
RESULTS: In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.
CONCLUSIONS: Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.
CONCLUSIONS: Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients\' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.
UNASSIGNED: This was a meta-analysis based on data from previous studies.