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Personal Fear of Death Affects Healthcare Workers' Ability to Discuss End of Life Issues with Patients
Description
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A4881 - Personal Fear of Death Affects Healthcare Workers' Ability to Discuss End of Life Issues with Patients
Author Block: M. Majumdar1, J. Dubowitz2, C. Green3; 1Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia, 2Department of Anaesthesiology, Peter MacCallum Cancer Centre, Melbourne, Australia, 3Intensive Care Unit, Frankston Hospital, Melbourne, Australia.
Rationale
Healthcare workers report a variety of attitudes to the death and dying of their patients. The relationship between personal fear of death and attitudes to end of life amongst healthcare workers is poorly understood. The extent of fear of death amongst Australian healthcare workers is not known and its impact on communication with patients on end of life issues has not been studied in Australia.
Methods
A multi centre survey of fear of death and attitudes to end of life was conducted in Victoria, Australia. Fear of Death was measured using the 4-axis (Death of Self, Dying of Self, Death of Others, Dying of Others) revised Collett Lester Fear of Death Score (rCLFODS) and the Templer Death Anxiety Scale (TDAS) and correlated with a six question binary response questionnaire on attitudes to end of life of patients.
Results
High scores on TDAS or axis 4 (Dying of Others) of rCLFODS were independent predictors of health care workers being uncomfortable initiating end of life conversations. High scores on axis 3 (Death of Others) and axis 4 (Dying of Others) of rCLFODS were associated with prioritisation of escalating therapies over patient comfort. Healthcare workers with greater duration of experience were likelier to feel comfortable discussing end of life issues, however, younger healthcare workers were likelier to prioritise dignity over active therapies. Nurses were likelier than medical staff to consider death an unacceptable outcome.
Conclusions
This is the first attempt to correlate objective measurements of aspects of fear of death among Australian healthcare workers with their attitudes to end of life care of patients. Specifically, we were able to identify and measure those aspects of fear of death which influenced initiation of conversations around end of life issues and the balance between ongoing therapies and patient dignity and comfort. Identification of thresholds above which fear of death influences end of life care not only provides insights into improvements in patient centred care in advanced disease but may inform changes to the training of health care workers, improving communication around and prioritisation of end of life therapies.
Author Block: M. Majumdar1, J. Dubowitz2, C. Green3; 1Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia, 2Department of Anaesthesiology, Peter MacCallum Cancer Centre, Melbourne, Australia, 3Intensive Care Unit, Frankston Hospital, Melbourne, Australia.
Rationale
Healthcare workers report a variety of attitudes to the death and dying of their patients. The relationship between personal fear of death and attitudes to end of life amongst healthcare workers is poorly understood. The extent of fear of death amongst Australian healthcare workers is not known and its impact on communication with patients on end of life issues has not been studied in Australia.
Methods
A multi centre survey of fear of death and attitudes to end of life was conducted in Victoria, Australia. Fear of Death was measured using the 4-axis (Death of Self, Dying of Self, Death of Others, Dying of Others) revised Collett Lester Fear of Death Score (rCLFODS) and the Templer Death Anxiety Scale (TDAS) and correlated with a six question binary response questionnaire on attitudes to end of life of patients.
Results
High scores on TDAS or axis 4 (Dying of Others) of rCLFODS were independent predictors of health care workers being uncomfortable initiating end of life conversations. High scores on axis 3 (Death of Others) and axis 4 (Dying of Others) of rCLFODS were associated with prioritisation of escalating therapies over patient comfort. Healthcare workers with greater duration of experience were likelier to feel comfortable discussing end of life issues, however, younger healthcare workers were likelier to prioritise dignity over active therapies. Nurses were likelier than medical staff to consider death an unacceptable outcome.
Conclusions
This is the first attempt to correlate objective measurements of aspects of fear of death among Australian healthcare workers with their attitudes to end of life care of patients. Specifically, we were able to identify and measure those aspects of fear of death which influenced initiation of conversations around end of life issues and the balance between ongoing therapies and patient dignity and comfort. Identification of thresholds above which fear of death influences end of life care not only provides insights into improvements in patient centred care in advanced disease but may inform changes to the training of health care workers, improving communication around and prioritisation of end of life therapies.
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