Advancing the study of life and death education: theoretical framework and research inquiries for further development

The need for culturally responsive teaching in death education: a call to action

With an aging population growing in size and diversity, more older adults will need support from the future geriatric workforce. Professional services will face issues related to end-of-life, making knowledge about death, grief, and loss essential. Most, however, report inadequate access to gerontological, geriatrics, or death education, particularly delivered with cultural humility. Colleges/universities can help fill this gap through formal death-and-dying-curricula, but faculty often feel unprepared to teach these sensitive topics. This study explored the experiences (e.g. lessons learned, best practices) of 27 instructors teaching death-related courses via semi-structured interviews. A consistent concern emerged among faculty regarding limited resources on cultural diversity. This prompted a post-hoc analysis of the existing data via a deductive content analytic approach to explore how a culturally responsive-sustaining (CR-S) education framework could inform future work. Evidence to support all four principles of CR-S emerged and three additional principles were identified that may build on the CR-S framework. Findings emphasize the need for more culturally relevant materials and multidisciplinary course delivery. We offer actionable suggestions for integrating cultural humility into death education and advocate for amplifying diverse voices in the field.

Exploring the impact of a life education program on the resilience of nursing students

This study explores the impact of a life education program on nursing students' psychological resilience, focusing on meaning in life, life attitudes, and positive psychology. A quasi-experimental design with pre- and post-tests was used, involving 87 nursing students (40 in the experimental group, 47 in the control group) aged 20-25 years, with 85% being female. The experimental group attended a five-week life education program (500 minutes total). The Purpose in Life Test, Life Attitude Scale, and Positive Mental Health Scale were used as measurement tools, and data were analyzed using Generalized Estimating Equations (GEE). The results showed significant interaction effects in the experimental group on meaning in life (B = 4.09, p < 0.001), life attitudes (B = 11.29, p < 0.001), and positive psychology (B = 4.81, p = 0.009). Paired t-tests further confirmed significant within-group improvements, while the control group showed no changes. This study recommends integrating life education into nursing curricula and providing teacher training to enhance course delivery. Collaboration with mental health organizations is also suggested to offer additional support. Future research should expand the sample and explore qualitative methods to deepen understanding of life education's impact.

Pediatric Oncology Hospice: A Comprehensive Review

Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.

Advancement of life and death education research: recommending implementation of the Life + Death Education Framework for teaching and research purposes

Life and death education is a distinct field of study that has potential practicality and life relevance for us to consider. For example, one notable inquiry pertaining to life education teaching entails appreciation and theoretical understanding of quality life functioning (e.g., a person's desire to attain spiritual wisdom vs. a person's desire to attain immense financial wealth). Our research undertakings recently involved the development of a blueprint or framework, which we termed as the 'Life + Death Education Framework'. This framework is intended to provide relevant information that may serve to assist educators, stakeholders, caregivers, etc. with their teaching practices of life and death education. We premise that to date, there is no clear consensus or agreement among educators as to what one is expected (e.g., specific learning outcome) to teach to students who wish to study and learn about life and death education (e.g., do we introduce to students the metaphysical lens about death?). Moreover, from our point of view, the Life + Death Education Framework may yield insightful guidelines and life-related benefits, such as the heightening of a person's well-being and/or his or her daily life functioning. As such, then, the focus of the present theoretical-conceptual article is for us to provide an in-depth narrative of the Life + Death Education Framework and how this framework, or potential universal blueprint, could help introduce and clarify our proposition of a life functioning-related concept known as 'self well-being'. Self well-being, for us, is an alternative nomenclature that may be used in place of subjective well-being.

The Life + Death Education Framework: Proposition of a 'Universal' Framework for Implementation

Life and death education is a distinct field of study that has potential life relevance for consideration (e.g., self-awareness and subsequent improvement of one's own health well-being). Existing research development, situating in different learning-sociocultural contexts, has provided consistent evidence that showcases the differing viewpoints of life functioning (e.g., what is the true meaning of life?) and the intricate nature of death and dying (e.g., a death ritual that closely associates with a particular cultural group). Some of the research studies undertaken indicate the effective use of 'philosophization' or the discourse of philosophical analysis, enabling individuals to philosophize, contemplate, and seek transpersonal understanding of the subject matters of life and death (e.g., can a state of 'spiritual transcendence' help to alleviate a person's fear of death?). Such discourse, interestingly, has offered some informative yields for enriching and meaningful life purposes - for example, the seeking to attain transpersonal understanding of life (e.g., what does a state of self-transcendence actually mean?) and/or transpersonal life experience may assist a senior citizen to cope with his mental health during a temporary health crisis. Our teaching and research interest of life and death education over the past decade has led us to consider one important line of inquiry for development: namely, the proposition of a 'universal' blueprint or framework of life and death education for curriculum development, teaching, and research purposes. We are cognizant of the fact that, to date, there is no clear consensus or agreement as to what one is expected (e.g., specific learning outcome) to teach students who wish to study and learn about life and death education. On this basis, the present theoretical article introduces a theoretical framework, termed as 'The Life + Death Education Framework' (e.g., for universities), to assist educators for their quality teaching and/or research inquiries of life and death education. We firmly believe that the Life + Death Education Framework can be universal and, in this case, apply to different learning-sociocultural contexts.

Translation and cross-cultural adaptation of the Posthumous Dignity Therapy Schedule of Questions to Brazilian Portuguese

OBJECTIVES

Dignity Therapy (DT) is a brief form of psychotherapy that helps people with life-threatening illnesses and their loved ones cope with emotional pain and demoralization. Unfortunately, not everyone has the opportunity to receive DT during their lifetime. Posthumous Dignity Therapy (PDT) was then devised to be administered to bereaved family members. However, PDT has not yet been validated or studied in the specific cultural and linguistic context of Portuguese-Brazilians. This study aims to fill this gap by validating PDT for the Portuguese (Brazilian) context.

METHODS

Using Beaton's methodology, including the processes of translation, synthesis, back-translation, evaluation by an expert committee, and pre-testing, the PDT Schedule of Questions underwent validation and cultural adaptation. The research was conducted in a Palliative Care Unit at a tertiary cancer hospital in Brazil.

RESULTS

The questionnaire was translated, back-translated, and evaluated by the panel of experts, obtaining a Content Validity Index of 0.97. During the pretest phase, it was observed that the participant's interview method needed to be changed from remote (telephone or videoconference) to in-person. Additionally, it was necessary to modify some terms related to death and dying, as they caused discomfort to the participants. As a result of this process, the PDT was modified, and adapted to the Brazilian cultural and linguistic reality.

SIGNIFICANCE OF RESULTS

This validation study will be significant for future DT research from the caregivers' perspective and for projects aiming to implement this therapeutic modality in palliative care units, in addition to helping participants remember their loved ones better by providing a tangible legacy document that assists them emotionally and materially in coping with the grieving process.