Indian Journal of Palliative Care
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Table of Contents 
Year : 2013  |  Volume : 19  |  Issue : 3  |  Page : 196-198

Healthcare professionals' fear of death and dying: Implications for palliative care

1 Srinivas College of Physiotherapy and Research Centre, Mangalore, Karnataka, India
2 Department of Psychiatry, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India

Date of Web Publication18-Nov-2013

Correspondence Address:
Senthil P Kumar
Srinivas College of Physiotherapy and Research Centre, Mangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1075.121544

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How to cite this article:
Kumar SP, DíSouza M, Sisodia V. Healthcare professionals' fear of death and dying: Implications for palliative care. Indian J Palliat Care 2013;19:196-8

How to cite this URL:
Kumar SP, DíSouza M, Sisodia V. Healthcare professionals' fear of death and dying: Implications for palliative care. Indian J Palliat Care [serial online] 2013 [cited 2020 Sep 28];19:196-8. Available from:


I wish to congratulate the editor for the editorial published in Indian Journal of Palliative Care (May-August issue) on "who is really afraid of death?" by Bhatnagar. [1] This letter was aimed to throw light on the fear of death among healthcare professionals, with implications for palliative care assessment and intervention in the developing countries.

According to Penson et al., [2] "For many, cancer is synonymous with death and fearing death is a rational response. For too long, medicine has ignored this primeval fear." Lowry [3] quoted the thoughts of Dr. Balfour Mount, a palliative care specialist who said that one of the factors preventing the healthcare professionals from providing good and compassionate care for the dying was a deep-rooted existential fear of death that lurks suppressed in their unconscious most of the time.

Medical trainees associated their highest fear of death with avoidance, dismissal, and seeking advice and their lowest fear of death with rationalization of the event. Individual differences such as gender, empathy, parental death, parental anxiety, and stress influenced their own fear of death. [4] The first experience of clinical death creates a tension between emotional concern and professional detachment among medical students, which could be negotiated by patient's clinical circumstances, supervisor role-modeling, and most importantly, the support of supervisors and peers, including debriefing opportunities. [5]

Howells et al. [6] reported that medical students' intensity of fear of death did not depend upon previous clinical experience, but those with previous experience tend to think more frequently about their own dying process. Personal fear of own death and low level of determination of philosophy of life may restrain medical professionals from breaking bad news to patients. [7] Misperceptions such as death and emotion are negative aspects of medicine existing amongst medical students, and hence, supervising physicians need to ensure adequate debriefing sessions to support students in order to teach about death, emotions, and coping with stress. [8]

Del Vecchio Good et al. [9] found three major factors influencing internists' perceptions of emotionally powerful death - Time and process: Whether death was expected or unexpected, peaceful, chaotic, or prolonged; medical care and treatment decisions: whether end-of-life care was rational and appropriate, facilitating a "peaceful" or "gentle" death, or futile and overly aggressive, fraught with irrational decisions or adverse events; and communication and negotiation: whether communication with patients, family, and medical teams was effective, leading to satisfying management of end-of-life care, or characterized by misunderstandings and conflict.

Bruce, [10] a hospice bereavement coordinator and counselor, opined that medical professionals need both didactic and personal preparation to assist in the often intense experience and intimate passage of life into death and later. Baider and Wein [11] reported physicians' experiences, perceptions, behavior, and vulnerability, especially when confronted with death and dying, and the authors recommended that the success of a physician can be measured by the empathic, yet objective relationship he/she establishes with the patient, while simultaneously building clear emotional and professional boundaries.

Physicians' emotional reactions to patient death affect not only patient care but also the personal lives of physicians. Emotionally powerful deaths were capable of teaching physicians on caring for dying, coping strategies leading to changes in clinical behaviors and career paths. [12] Hare and Pratt [13] found among nurses that the level of perceived comfort and fear of death while working with dying patients differed significantly by exposure to such patients and by the occupational role.

Assessment of fear of death and death-related competency [14] could be performed quantitatively using measurement tools such as Lester Attitude Toward Death Scale [15] and Collett-Lester Fear of Death Scale. [16] The interventions aimed at reducing the fear of death in healthcare professionals may include a contemplative care approach (training program on yoga) for hospice care volunteers, which fosters better emotional well-being and spiritual growth, [17] with training emphasis on philosophy and goals of palliative care, spiritual issues from a multi-cultural and multi-faith perspective, communication, the dying process, grief, and bereavement, and the role of the healthcare worker. [18]

With under-reporting of death and bereavement care among palliative care journals, [19] can Indian Journal of Palliative Care take another leading role in publishing evidence on fear of death among professionals and students, so that appropriate educational programs be implemented along an evidence-based palliative care model?

 Ľ References Top

1.Bhatnagar S. Who is really afraid of death? Indian J Palliat Care 2013;19:81-2.  Back to cited text no. 1
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2.Penson RT, Partridge RA, Shah MA, Giansiracusa D, Chabner BA, Lynch TJ Jr. Fear of death. Oncologist 2005;10:160-9.  Back to cited text no. 2
3.Lowry F. Does doctors' own fear of dying hinder palliative care? CMAJ 1997;157:301-2.  Back to cited text no. 3
4.Firth-Cozens J, Field D. Fear of death and strategies for coping with patient death among medical trainees. Br J Med Psychol 1991;64:263-71.  Back to cited text no. 4
5.Kelly E, Nisker J. Medical students' first clinical experiences of death. Med Educ 2010;44:421-8.  Back to cited text no. 5
6.Howells K, Gould M, Field D. Fear of death and dying in medical students: Effects of clinical experience. Med Educ 1986;20:502-6.  Back to cited text no. 6
7.Cia³kowska-Rysz A, Dzier¿anowski T. Personal fear of death affects the proper process of breaking bad news. Arch Med Sci 2013;9:127-31.  Back to cited text no. 7
8.Rhodes-Kropf J, Carmody SS, Seltzer D, Redinbaugh E, Gadmer N, Block SD, et al. "This is just too awful; I just can't believe I experienced that": Medical students' reactions to their "most memorable" patient death. Acad Med 2005;80:634-40.  Back to cited text no. 8
9.Del Vecchio Good MJ, Gadmer NM, Ruopp P, Lakoma M, Sullivan AM, Redinbaugh E, et al. Narrative nuances on good and bad deaths: Internists' tales from high-technology work places. Soc Sci Med 2004;58:939-53.  Back to cited text no. 9
10.Bruce CA. Helping patients, families, caregivers, and physicians, in the grieving process. J Am Osteopath Assoc 2007;107:ES33-40.  Back to cited text no. 10
11.Baider L, Wein S. Reality and fugues in physicians facing death: Confrontation, coping, and adaptation at the bedside. Crit Rev Oncol Hematol 2001;40:97-103.  Back to cited text no. 11
12.Jackson VA, Sullivan AM, Gadmer NM, Seltzer D, Mitchell AM, Lakoma MD, et al. "It was haunting": Physicians' descriptions of emotionally powerful patient deaths. Acad Med 2005;80:648-56.  Back to cited text no. 12
13.Hare J, Pratt CC. Nurses' fear of death and comfort level with dying patients. Death Stud 1989;13:349-60.  Back to cited text no. 13
14.Robbins RA. Death competency: A study of hospice volunteers. Death Stud 1992;16:557-69.  Back to cited text no. 14
15.Larrabee MJ. Measuring fear of death: A reliability study. J Psychol 1978;100:33-7.  Back to cited text no. 15
16.Kumar SP, Shetty SK, Adhikari P, Jeganathan PS, Kumar A, D'Souza M. Collett-Lester Fear of Death Scale (CL-FoDS)-implications for forensic medicine and pathology. Indian J Forensic Med Pathol 2013;[In press].  Back to cited text no. 16
17.Scherwitz L, Pullman M, McHenry P, Gao B, Ostaseski F. A contemplative care approach to training and supporting hospice volunteers: A prospective study of spiritual practice, well-being, and fear of death. Explore (NY) 2006;2:304-13.  Back to cited text no. 17
18.Claxton-Oldfield S, Crain M, Claxton-Oldfield J. Death anxiety and death competency: The impact of a palliative care volunteer training program. Am J Hosp Palliat Care 2006;23:464-8.  Back to cited text no. 18
19.Kumar SP, Sisodia V. Reporting of 'death and bereavement care': A systematic review and quantitative analysis of research publications in palliative care journals. IInt J Health Allied Sci 2013;2:176-84.  Back to cited text no. 19


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