Systematic review and meta-analysis shows death education improves end-of-life care competence in nurses

This systematic review and meta-analysis examined the impact of death education programs on nurses and nursing students. The pooled analysis included a total sample size of N = 1,142 participants across included studies. The primary outcome assessed was end-of-life care competence, while secondary outcomes included attitudes toward death. Only 3 of the 13 included studies reported follow-up data.

The meta-analysis demonstrated a significant improvement in end-of-life care competence with a standardized mean difference of 1.05. The 95% CI for this effect was 0.76 to 1.34 with a p value less than 0.001 and I2 of 54%. In contrast, the effect on attitudes toward death was not significant with a standardized mean difference of 0.25 and a 95% CI ranging from -0.17 to 0.66. The p value for this secondary outcome was 0.24 with an I2 of 83%.

Authors noted several limitations including a high risk of bias and significant heterogeneity across studies. Long-term follow-up was lacking as only 3 of 13 included studies provided such data. The certainty of evidence was moderate for end-of-life care competence but very low for attitudes toward death. No adverse events or discontinuations were reported in the safety analysis.

Practice relevance is limited by these methodological concerns. The findings should be considered hypothesis-generating rather than definitive proof of efficacy. Clinicians should interpret these results with caution until higher quality evidence becomes available.