Abstract
Dear Editor:
According to the Lancet Commission on the Value of Death (the Commission), the story of death today is highlighted by an imbalance between those who are overtreated and those who are undertreated. 1 One driver of the overtreatment is death anxiety and one solution could be helping health care providers (HCPs) “to become more aware of their own death anxiety.”1(p. 16) Unfortunately, little research is available to guide interventions for HCPs facing the threats to their own lives by the COVID-19 pandemic.
Frontline HCPs have been challenged to maintain pride, enhance continuity of self, and ultimately make meaning of their life during the COVID-19 pandemic. They faced not only the usual challenges of their jobs, 2 but also the vast number of deaths and the daily reality that they could be infected by this life-threatening virus and spread it to their families. The purpose of our pilot study was to determine the feasibility of a legacy-oriented intervention, dignity therapy (DT), 3 to help HCPs toward existential maturity 4 with less death anxiety and professional burnout and greater quality of life and sense of peace during this time of crisis.
Recruited by convenience between September 2020 and February 2021, 13 HCPs (5 chaplains, 3 nurses, 5 physicians) enrolled in the single group, pre-/post-test pilot study with a three- to four-week protocol. Through Qualtrics, the HCP completed valid and reliable questionnaires, including death anxiety, professional burnout, quality of life, and sense of peace before and after DT. The DT intervention consisted of three sessions, each of which was 15–60 minutes in duration (∼2 hours total). The DT was delivered by Zoom with e-mail legacy document delivery. The HCP also completed a study acceptability questionnaire at the end of the study. Descriptive statistics and pairwise t tests were used to analyze the data.
Of the 13 HCPs, 11 completed the study (28–58 years old with mean age 42.5 years [standard deviation 9.4], 55% female, 40% Black/African American or mixed race, 9% Hispanic, and 91% married/partnered). In general, the participants reported the study was acceptable: 89% not too hard, 89% enjoyed or somewhat enjoyed, 89% right length, was not difficult to complete (100%), schedule (89%), and complete questionnaires (100%), found DT helpful (56%) or somewhat helpful (44%), and reported that others would accept (56%) or somewhat accept (44%) the study. Although not statistically significant, the mean before and after DT death anxiety reduced by nearly half, whereas burnout and quality of life were essentially unchanged.
DT holds promise for reducing death anxiety among HCPs facing mortal threat of a pandemic, such as COVID-19, thus increasing their ability to help re-establish the balance as the Commission advocates. 1 Feasibility indicators were mixed, but indicate potential for successfully conducting a larger study with more effective recruitment strategies. The effect size for death anxiety reduction, if reproduced, could be large.