Effectiveness of end-of-life educational interventions at improving nurses and nursing students' attitude toward death and care of dying patients: A systematic review and meta-analysis

To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients. A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials. English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020. A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level. Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement. Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices.