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A Cross-Cultural Evaluation of the Construct Validity of Templer's Death Anxiety Scale: A Systematic Review

Sharif Nia H, Lehto RH, Pahlevan Sharif S, Mashrouteh M, Goudarzian AH, Rahmatpour P, et al.

Omega (Westport), 2021 Sep;83(4):760-776.
PMID: 31366310 DOI: 10.1177/0030222819865407

Ensuring use of valid and reliable scales for evaluating death anxiety that are relevant to the cultural context where they are applied is essential. The purpose of the study was to conduct a systematic review of the psychometric properties of Templer's Death Anxiety Scale (DAS) across cultures. PubMed, Scopus, Web of Knowledge, SID, and Magiran databases were systematically searched for studies published between 1970 and 2017 using Mesh terms. Two independent researchers used Quality Assessment of Diagnostic Accuracy Studies and Checklist of Standards for Reporting of Diagnostic Accuracy to evaluate study quality. Included studies were conducted in Iran, United States, Italy, China, Egypt, Spain, and Australia. Overall study quality was acceptable in 15 evaluated articles. However, findings demonstrated that two (one study), three (seven studies), four (four studies), and five factors (three studies) were extracted across the respective studies. Confirmatory concurrent validity was assessed in two studies. While Templer's DAS has stood the test of time as a commonly used index of capturing the conscious experience of death anxiety, there are psychometric inconsistencies in identified factor solutions across cultures. Findings emphasize the need for continued evaluation of how the DAS is translated in specific countries with assessment in relation to other death construct tools.

Matched MeSH terms: Attitude to Death*
Fulltext Life After Death in a Chinese Community

MOHD HAFIZOL AMIN BIN RAMLI, NUR AMELIA BINTI MAZLAN, SITI AIDA BINTI AZMI, MUHD SARJI BIN AWANG BULAT, PARVEEN KAUR

Trends in Undergraduate Research, 2018;1(1):0-0.
MyJurnal

According to San Fillipo (2006), death is not the end of one’s existence, but rather than a transition from one life to another. However, it is different based on how the society and individuals see the concept of death itself and how they understand about it. Thus, this article aims to explore the understanding of the relationship between culture and religion that become their identity in terms of death and life after. Qualitative approach is adopted for this study. Indeed, interview and empirical observation were used to obtain quality data.

Matched MeSH terms: Attitude to Death
Death anxiety in Malaysian and Australian university students

Schumaker JF, Barraclough RA, Vagg LM

J Soc Psychol, 1988 Feb;128(1):41-7.
PMID: 3367644
Matched MeSH terms: Attitude to Death*
Fulltext The concept of "badi" as a pathogenic stress: 2 case reports

Hassan R

Singapore Med J, 1987 Oct;28(5):459-61.
PMID: 3433117
Matched MeSH terms: Attitude to Death*
Fulltext Quality of Life and Illness Acceptance among End-Stage Renal Disease (ESRD) Patients on Hemodialysis: The Moderating Effect of Death Anxiety during COVID-19 pandemic

Mushtaque I, Awais-E-Yazdan M, Zahra R, Anas M

Omega (Westport), 2024 Jun;89(2):567-586.
PMID: 35254867 DOI: 10.1177/00302228221075202

The purpose of the study was to examine the quality of life and illness acceptance among ESRD patients with the moderating effects of death anxiety. The cross-sectional design was incorporated. The sample was comprised of 240 participants. Individuals with ESRD on hemodialysis were approached above 20 years of age. A self-administered questionnaire was used for data collection. The results revealed that COVID-19 has a significant impact on the quality of life of patients and their illness acceptance. Covid-19 affected the general health of patients, their psychological health, as well as their social relationships. The results also confirmed that death anxiety negatively moderates the relationship between quality of life and illness acceptance among ESRD patients. This study will shed light on the need to provide appropriate psychosocial care as well as supportive therapies to people with end-stage renal disease who are experiencing mental distress during and after the COVID-19 outbreak.

Matched MeSH terms: Attitude to Death*
Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program

Wong LP, Tan SL, Alias H, Sia TE, Saw A

Omega (Westport), 2023 Nov;88(1):157-170.
PMID: 34490819 DOI: 10.1177/00302228211043613

This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p death and psychophysical-symptom experience associated with cadaver dissection.

Matched MeSH terms: Attitude to Death
Psychometric evaluation of the Persian version of the Templer's Death Anxiety Scale in cancer patients

Soleimani MA, Yaghoobzadeh A, Bahrami N, Sharif SP, Sharif Nia H

Death Stud, 2016 10;40(9):547-557.
PMID: 27259574 DOI: 10.1080/07481187.2016.1187688

In this study, 398 Iranian cancer patients completed the 15-item Templer's Death Anxiety Scale (TDAS). Tests of internal consistency, principal components analysis, and confirmatory factor analysis were conducted to assess the internal consistency and factorial validity of the Persian TDAS. The construct reliability statistic and average variance extracted were also calculated to measure construct reliability, convergent validity, and discriminant validity. Principal components analysis indicated a 3-component solution, which was generally supported in the confirmatory analysis. However, acceptable cutoffs for construct reliability, convergent validity, and discriminant validity were not fulfilled for the three subscales that were derived from the principal component analysis. This study demonstrated both the advantages and potential limitations of using the TDAS with Persian-speaking cancer patients.

Matched MeSH terms: Attitude to Death*
Psychometric Properties of the Death Anxiety Scale-Extended among Patients with End-Stage Renal Disease

Sharif Nia H, Pahlevan Sharif S, Koocher GP, Yaghoobzadeh A, Haghdoost AA, Mar Win MT, et al.

Omega (Westport), 2020 Feb;80(3):380-396.
PMID: 28982272 DOI: 10.1177/0030222817733220

This study aimed to evaluate the validity and reliability of the Persian version of Death Anxiety Scale-Extended (DAS-E). A total of 507 patients with end-stage renal disease completed the DAS-E. The factor structure of the scale was evaluated using exploratory factor analysis with an oblique rotation and confirmatory factor analysis. The content and construct validity of the DAS-E were assessed. Average variance extracted, maximum shared squared variance, and average shared squared variance were estimated to assess discriminant and convergent validity. Reliability was assessed using Cronbach's alpha coefficient (α = .839 and .831), composite reliability (CR = .845 and .832), Theta (θ = .893 and .867), and McDonald Omega (Ω = .796 and .743). The analysis indicated a two-factor solution. Reliability and discriminant validity of the factors was established. Findings revealed that the present scale was a valid and reliable instrument that can be used in assessment of death anxiety in Iranian patients with end-stage renal disease.

Matched MeSH terms: Attitude to Death*
Mediating effects of social and personal religiosity on the psychological well being of widowed elderly people

Momtaz YA, Ibrahim R, Hamid TA, Yahaya N

Omega (Westport), 2010;61(2):145-62.
PMID: 20712141

Spousal death is one the most stressful life events that seriously affects the psychological well being of widowed. This study examined the mediating effects of social and personal religiosity on the psychological well being of widowed elderly people. The sample for this study was comprised of 1367 widowed and married elderly Muslims from Malaysia. Psychological well being, religiosity, and physical health were measured using WHO-5 Well being Index, Intrinsic Extrinsic religiosity scale, and a checklist of 16 physical health problems, respectively. Data analysis was conducted using the Statistical Package for Social Sciences (version-13). As expected, bivariate correlation analysis revealed that widowhood is statistically and negatively associated with psychological well being. Results of multiple hierarchical regression analyses and Sobel test showed that only the indirect effect of widowhood through personal religiosity was statistically significant (Sobel = -2.79, p < .01). Sobel test for social religiosity was not significant (Sobel = -1.54, p > .05). The results of this study confirmed earlier studies, which found that widowhood negatively affects psychological well being of elderly people. Overall, the findings show that the potential solace provided by religiosity can decrease the negative effects of widowhood on the psychological well being of widowed elderly people.

Matched MeSH terms: Attitude to Death/ethnology*
Handling spiritual questions of terminally ill patients

Loh KY

Int J Palliat Nurs, 2004 Nov;10(11):550-1; discussion 552-3.
PMID: 15580111
Matched MeSH terms: Attitude to Death/ethnology*
Fulltext The development and validation of the advance care planning questionnaire in Malaysia

Lai PS, Mohd Mudri S, Chinna K, Othman S

BMC Med Ethics, 2016 10 18;17(1):61.
PMID: 27756366

BACKGROUND: Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual's awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia.

METHODS: The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration.

RESULTS: Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate (response rate = 93.9 %). Factor analysis on the 22 items measured on a Likert-scale revealed four domains: "feelings regarding advance care planning", "justifications for advance care planning", "justifications for not having advance care planning: fate and religion", and "justifications for not having advance care planning: avoid thinking about death". The Cronbach's alpha values for items each domain ranged from 0.637-0.915. In test-retest, kappa values ranged from 0.738-0.947.

CONCLUSIONS: The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning.

Matched MeSH terms: Attitude to Death*
Fulltext Factors that hinder organ donation: religio-cultural or lack of information and trust

Tumin M, Noh A, Jajri I, Chong CS, Manikam R, Abdullah N

Exp Clin Transplant, 2013 Jun;11(3):207-10.
PMID: 23432623 DOI: 10.6002/ect.2012.0194

This paper examines factors that influence Malaysian persons with a tertiary level of education on their willingness to donate organs.

Matched MeSH terms: Attitude to Death/ethnology
Current status of organ transplant in Islamic countries

Ghods AJ

Exp Clin Transplant, 2015 Apr;13 Suppl 1:13-7.
PMID: 25894121

The Organization of Islamic Cooperation consists of 57 member states whose people are mainly followers of the Islamic religion. During the past several decades, organ transplants have been increasingly used for the treatment of end-stage organ failures worldwide. This study is to investigate the current status of organ transplant in Islamic countries.

Matched MeSH terms: Attitude to Death/ethnology
Spiritual distress in a terminally ill patient with breast cancer

Loh KY

Int J Palliat Nurs, 2004 Mar;10(3):131-2.
PMID: 15126957
Matched MeSH terms: Attitude to Death/ethnology
Fulltext Management of the dead during COVID-19 outbreak in Malaysia

Khoo LS, Hasmi AH, Ibrahim MA, Mahmood MS

Forensic Sci Med Pathol, 2020 09;16(3):463-470.
PMID: 32519316 DOI: 10.1007/s12024-020-00269-6

The emergence of a novel human coronavirus, SARS-CoV-2, causing severe respiratory tract infections in humans, is affecting all countries of the world and has become a global health concern. Since the virus was first identified in December 2019, the number of deaths have been propagating exponentially, causing countries across the world, including Malaysia, to increase emergency measures to combat the virus. Due to the fact that the COVID-19 pandemic does not discriminate its victims, it is of paramount importance to construct a plan for management of the dead for all suspected or confirmed COVID-19 cases, including the unidentified deceased, as an essential portion of the humanitarian forensic action approach. This document provides an overview on ways to maximize the local collective capacity from various government agencies to manage the dead based on the prevailing regulations and legislation in the country, in preparation for possible large scale deaths from this pandemic. The National Institute of Forensic Medicine Malaysia has improvised procedures and guidelines for management of the dead within the existing regulations in order to achieve a balance between medicolegal requirements and the safety of personnel managing the bodies of the deceased with suspected or confirmed COVID-19 infection; at the site of death, during transport, during postmortem procedures, storage and preparation before and during burial or cremation as well as environmental cleaning and disinfection, involving various agencies in the country. A form of temporary controlled burial is as an option to allow the reinvestigation of a decedent to help formally identify victims of the pandemic such as undocumented migrants or refugees who were previously not identified. Due to the different legal requirements and mortality rates between countries, there is no one-size-fits-all approach to the management of the dead. Whenever possible, every opportunity and assistance must be given to families to mourn their loved ones, even in times of crisis or an outbreak, in order to sustain an appropriate level of dignity and respect.

Matched MeSH terms: Attitude to Death*
The experiences of suffering of palliative care patients in Malaysia: a thematic analysis

Beng TS, Guan NC, Seang LK, Pathmawathi S, Ming MF, Jane LE, et al.

Am J Hosp Palliat Care, 2014 Feb;31(1):45-56.
PMID: 22956340 DOI: 10.1177/1049909112458721

A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering in 20 adult palliative care inpatients of University Malaya Medical Centre. The results were thematically analyzed. Ten basic themes were generated (1) loss and change → differential suffering, (2) care dependence → dependent suffering, (3) family stress → empathic suffering, (4) disease and dying → terminal suffering, (5) health care staff encounters → interactional suffering, (6) hospital environment → environmental suffering, (7) physical symptoms → sensory suffering, (8) emotional reactions → emotional suffering, (9) cognitive reactions → cognitive suffering, and (10) spiritual reactions → spiritual suffering. An existential-experiential model of suffering was conceptualized from the analysis. This model may inform the development of interventions in the prevention and management of suffering.

Matched MeSH terms: Attitude to Death
Factors associated with nurses' perceptions about quality of end-of-life care

Hussin EOD, Wong LP, Chong MC, Subramanian P

Int Nurs Rev, 2018 Jun;65(2):200-208.
PMID: 29430644 DOI: 10.1111/inr.12428

AIM: To examine the factors associated with nurses' perceptions of the quality of end-of-life care.
BACKGROUND: With increasing demand for hospitals to provide end-of-life care, the low quality of palliative care provided in hospital settings is an issue of growing concern in developing countries. Most dying patients receive their care from general nurses, irrespective of the nurses' specialty or level of training.
METHOD: A structured cross-sectional questionnaire survey was conducted of 553 nurses working at a teaching hospital in Malaysia.
RESULTS: The mean scores for nurses' knowledge about end-of-life care, their attitudes towards end-of-life care and the perceived quality of end-of-life care were low. The factors identified as significantly associated with the quality of end-of-life care were nurses' levels of knowledge and their attitudes towards end-of-life care.
DISCUSSION: Factors that contributed to the low quality of end-of-life care were inadequate knowledge and negative attitudes. These findings may reflect that end-of-life care education is not well integrated into nursing education.
CONCLUSION: The findings of this study suggest that there is a need to increase the nurses' level of knowledge and improve their attitude towards end-of-life care in order to enhance the quality of care provided to dying patients.
IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of knowledge, as well as providing adequate emotional support for nurses who care for dying patients and their families. Nurses should be proactive in increasing their knowledge and adopting more positive attitudes towards end-of-life care.

Matched MeSH terms: Attitude to Death
Fulltext A time-series prediction model of acute myocardial infarction in northern of Iran: the risk of climate change and religious mourning

Sharif Nia H, Gorgulu O, Naghavi N, Froelicher ES, Fomani FK, Goudarzian AH, et al.

BMC Cardiovasc Disord, 2021 11 23;21(1):563.
PMID: 34814834 DOI: 10.1186/s12872-021-02372-0

BACKGROUND: Although various studies have been conducted on the effects of seasonal climate changes or emotional variables on the risk of AMI, many of them have limitations to determine the predictable model. The currents study is conducted to assess the effects of meteorological and emotional variables on the incidence and epidemiological occurrence of acute myocardial infarction (AMI) in Sari (capital of Mazandaran, Iran) during 2011-2018.
METHODS: In this study, a time series analysis was used to determine the variation of variables over time. All series were seasonally adjusted and Poisson regression analysis was performed. In the analysis of meteorological data and emotional distress due to religious mourning events, the best results were obtained by autoregressive moving average (ARMA) (5,5) model.
RESULTS: It was determined that average temperature, sunshine, and rain variables had a significant effect on death. A total of 2375 AMI's were enrolled. Average temperate (°C) and sunshine hours a day (h/day) had a statistically significant relationship with the number of AMI's (β = 0.011, P = 0.014). For every extra degree of temperature increase, the risk of AMI rose [OR = 1.011 (95%CI 1.00, 1.02)]. For every extra hour of sunshine, a day a statistically significant increase [OR = 1.02 (95% CI 1.01, 1.04)] in AMI risk occurred (β = 0.025, P = 0.001). Religious mourning events increase the risk of AMI 1.05 times more. The other independent variables have no significant effects on AMI's (P > 0.05).
CONCLUSION: Results demonstrate that sunshine hours and the average temperature had a significant effect on the risk of AMI. Moreover, emotional distress due to religious morning events increases AMI. More specific research on this topic is recommended.

Matched MeSH terms: Attitude to Death
Temporal changes in psychobehavioral responses during the 2009 H1N1 influenza pandemic

Wong LP, Sam IC

Prev Med, 2010 Jul;51(1):92-3.
PMID: 20403375 DOI: 10.1016/j.ypmed.2010.04.010

This paper aimed to examine the temporal changes in psychobehavioral responses in relation to reported 2009 H1N1 influenza deaths.

Matched MeSH terms: Attitude to Death
Fulltext Role of the Nasogastric Tube and Lingzhi (Ganoderma lucidum) in Palliative Care

Wang X, Huang Y, Radha Krishna L, Puvanendran R

J Pain Symptom Manage, 2016 Apr;51(4):794-799.
PMID: 26891608 DOI: 10.1016/j.jpainsymman.2015.11.028

Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT). Focusing on the questions pertaining to end-of-life decision-making in Asia, we consider the issues surrounding the use of NGT and lingzhi in palliative care (PC) and the implementation of NGT for administering lingzhi in a PC setting, particularly in light of a dearth of data on such treatment measures among PC patients.

Matched MeSH terms: Attitude to Death

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