Quality insights of university students on dying, death, and death education--a preliminary study in Hong Kong

Death is a subject seldom studied in school and often misunderstood and feared by many people. Children often learn about death from their family and mass media. From the literature review on dying, death, and death education, it may be concluded that people are generally ignorant about the issues of death and dying. There is a need to investigate what young people, such as university students, know about death and dying, and their attitudes toward them. Eight university students were recruited for this study. Most participants have had death experiences. They seldom talked about death and loss. Some of these experiences were quite pleasant but some of them were not. Most participants addressed the need to have "life and death" education in schools at their young age. Such a need is further supported by the incidents of two participants who attempted suicide unsuccessfully when they encountered a life problem which they could not solve.     

Deathbed visions from India: a study of family observations in northern Kerala

This is an interview-based study of 104 families and their observations of the last weeks and days of a dying family member. Forty families reported "unusual experiences and behaviors" from the dying person in their last period of life. Thirty of these dying persons displayed behavior consistent with deathbed visions-interacting or speaking with deceased relatives, mostly their dead parents. There were six cases of reported premonitions of death and five possible confusional states with one patient reported to have had both a deathbed vision and confusional experiences. Socio-demographic factors such as gender, age, occupation, or cause and place of death were not found to be significant. Hindu patients appeared to be more likely than Muslim patients to report these experiences. Use of opiates (or not) did not appear to influence reports. The findings are discussed with reference to past studies of deathbed visions as well as their implications for the future pastoral care of dying people and their families.     

Older adults' attitudes toward death: links to perceptions of health and concerns about end-of-life issues

The current study had two primary goals, to determine whether: 1) self-rated mental and physical health, pain, and experience with health problems were predictors of elderly adults' attitudes toward death; and 2) death attitudes predict end-of-life medical treatment concerns. Participants were 109 adults, 65 years of age or older (M=78.74 years), recruited from the local community. Regression analysis indicated that poorer perceived physical health predicted a greater likelihood of viewing death as an escape, and poorer perceived mental health predicted a greater fear of death. Viewing death as an escape and fearing death predicted end-of-life medical treatment concerns; a greater endorsement of either attitude predicted more concern. Possible explanations for the links between perceived health, attitudes toward death, and concern about end-of-life issues are suggested.     

A sociocultural analysis of death anxiety among older Japanese urbanites in a citizens' movement

By examining the experiences of death anxiety and attitudes toward personal deaths among members of a citizens' movement, the Grave-Free Promotion Society (GFPS), this study considers the applicability of the view that culture and high self-esteem serve as defenses against death anxiety in Japan's changing society. The GFPS promotes the scattering of ashes over the conventional interment of cremated remains in a family grave. GFPS members often lack descendants to care for a family grave, the neglect of which is thought to endanger the deceased's peaceful rest. By returning the dead to nature through ash scattering, the GFPS provides an alternative strategy of managing its members' posthumous well-being. GFPS members often report that their choice of ash scattering has reduced their anxiety about their personal deaths and improved the quality of their lives. Based upon these findings, this study offers some suggestions for increasing cultural sensitivities of test instruments commonly used to examine death anxiety among older persons for use in a Japanese context.     

Assessing adults' difficulty in coping with funerals

The death of a loved one requires many adults to make decisions about a variety of details regarding funeral arrangements. Based upon data collected from 348 adults (M age = 34.21) who had attended the funeral of a loved one within the last year, a scale consisting of 50 items regarding the difficulties each had experienced with regard to events prior to, during, and after the funeral, was developed. Cronbach's Alpha coefficient for this measure of difficulty was .96. Principal components analysis of these data indicated that difficulty in coping with funerals could be understood in light of six factors explaining 56% of the common variance among relationships between items: 1) protocol/mechanics of the funeral; 2) general personal and interpersonal difficulties related to the death/funeral; 3) trust in the funeral industry; 4) concerns regarding the cemetery; 5) issues pertaining to grief; and 6) post-funeral personal responsibilities. With regard to both overall difficulty and the above six factors, older adults experienced fewer difficulties, as did those who more actively participated in funeral rituals. In contrast, those who reported more personal and bereavement-related distress experienced more difficulties. Findings of the current study have value both in identifying persons for whom funerals may undermine bereavement adjustment and in identifying appropriate intervention and aftercare services for such individuals.     

General beliefs about the world as defensive mechanisms against death anxiety

Death ideation and death anxiety represent the cognitive and affective dimensions of death attitudes, respectively. General beliefs about the world are proposed to be useful defensive mechanisms protecting persons against the death anxiety provoked by death ideation. SEM is employed to test the proposed mediation model, using a sample of 133 Hong Kong Chinese university students. Results showed that death ideation was significantly and inversely linked to belief in social cynicism, reward for application, and fate control. Moreover, higher levels of belief in fate control and lower levels of religiosity predicted greater death anxiety. Only belief in fate control partially mediated the relationship between death ideation and death anxiety. Discussion focused on how social axioms serve as useful defensive mechanisms against death anxiety.     

Researching "good death" in a Hong Kong palliative care program: a clinical data-mining study

This study operationalizes and assesses the percentage of "good deaths" achieved among Chinese cancer patients in a palliative care program, the profile of these patients, the relationship between patients with a good death and psychosocial factors, and the differences in background factors, and physical and psychosocial conditions between patients who experienced a good death and those who did not. Clinical data mining was the research method used. Records of deceased cancer patients between 2003 and 2005 in a palliative care unit were the sole data source. Good death was operationally defined as the patient's record indicating no pain (physical) or anxiety (psychological), and having open and honest communication with family (social) in the final assessment by the Support Team Assessment Schedule (STAS) just before death. Using these criteria, about one-fifth of patients (21.5%; 137 out of 638) experienced a good death. Those with a good death were significantly older and were in palliative care longer. Their records also indicated lower levels of constipation, insomnia, oral discomfort, and family anxiety at their first and at their final STAS assessments. Good death was positively associated with recorded indicators of fullness in life, caregivers' acceptance and support, and negatively with reported feelings of upset about changes in the course of their illness. The results heighten awareness among social workers and other healthcare professionals about the value of good death in patients in palliative care. This empirically-based awareness can foster professionals' ability to set intervention objectives to help patients in palliative care achieve this universally accepted goal.     

The Effects of Expectation Disconfirmation on Appraisal,Affect, and Behavioral Intentions

People's risk perceptions can have powerful effects on their outcomes, yet little is known about how people respond to risk information that disconfirms a prior expectation. We experimentally examined the affective, cognitive, and behavioral consequences of expectation disconfirmation in the context of risk perceptions. Participants were randomly assigned and then prompted toward either a high or low personal risk estimate regarding a fictitious health threat. All participants then received the same risk feedback, which presented either a negative disconfirmation experience (i.e., worse than expected) in the high‐risk estimate condition or a positive disconfirmation experience (i.e., better than expected) in the low‐risk estimate condition. Participants who experienced the negative disconfirmation reported stronger intentions to prevent the threat in the future compared to participants who experienced the positive disconfirmation. This effect was mediated by both disappointment about the risk feedback and perceptions of the severity of the threat. These findings have implications for risk communication, suggesting that the provision of objective risk information may improve or diminish the likelihood of behavior change depending on people's initial expectations and their emotional and cognitive reactions to the information.     

“名字”,还是“卖点”,消费者如何加工双重信息?

在营销实践中存在大量的仿洋和仿古品牌名称,因为品牌名称作为信息确实会影响消费者的认知和态度。基于信息加工的角度,本文探讨了消费者如何加工品牌名称等多重信息。通过实验研究发现品牌名称与产品功能诉求在互补型匹配时传播效果更好,而且其效果具有一般性。这一结果有助于在更抽象的信息加工层面理解仿洋和仿古品牌名称的应用效果,因而更好地调控消费者的反应。     

Effects of Knowledge on Attitude Formation and Change Toward Genetically Modified Foods

In three waves, this study investigates the impact of risk and benefit knowledge on attitude formation toward genetically modified (GM) foods as well as the moderating effect of knowledge level on attitude change caused by receiving information. The data in Wave 1 (N = 561) demonstrate that both benefit and risk knowledge either directly contribute to attitude formation or indirectly affect attitudes through the mediating roles of benefit and risk perceptions. Overall, benefit and risk knowledge affect consumer attitudes positively and negatively, respectively. In Wave 2, 486 participants from Wave 1 were provided with information about GM foods, and their attitudes were assessed. Three weeks later, 433 of these participants again reported their attitudes. The results indicate that compared with the benefit and mixed information, risk information has a greater and longer lasting impact on attitude change, which results in lower acceptance of GM foods. Furthermore, risk information more strongly influences participants with a higher knowledge level. The moderating effect of knowledge on attitude change may result from these participants’ better understanding of and greater trust in the information. These findings highlight the important role of knowledge in attitude formation and attitude change toward GM foods as well as the necessity of considering the determinants of attitude formation in attitude change studies.     

Perceived benefits and psychosocial outcomes of a brief existential family intervention for cancer patients/survivors

This study assessed a range of benefits from participation in a brief existential intervention consisting of a semi-structured videotaped interview with cancer patients and their families designed to illuminate a life legacy for the family (the Life Tape Project [LTP]). Results indicated the majority reported intervention-specific benefits, especially in the areas of symbolic immortality (passing on personal values and philosophy), self-reflection and growth, and improved family cohesion and communication. Participants, particularly those who had perceived their cancer as a threat of death, serious injury, or threat to their physical integrity, and responded with intense fear or helplessness, also reported more general reductions in mood disturbance, improvements in aspects of well-being (including overall quality of life), satisfaction with the understanding they received, and enhanced cancer-related posttraumatic growth. In short, the LTP is a brief, inexpensive, existential intervention that can yield broad positive psychosocial changes for a majority of participants.     

Concern About HIV and AIDS Among Older People in the Slums of Nairobi,Kenya

The article explores the way that social networks and personal experiences affect perceived HIV‐related concerns among people aged 50 years or older living in a low resource neighborhood with high HIV prevalence in Nairobi, Kenya. Multiple logistic regression is used to model the association between the reporting of an HIV‐related concern and individual‐level characteristics, personal experiences, and social interaction. The main concerns regarding HIV reported by older people in the study included caring for orphaned children (65%), caring for people with AIDS (48%), and losing material and social support from adult children (36%). Interestingly, 38% of respondents voiced concerns about HIV infection among older people. Respondents who had been individually affected by HIV and AIDS, who were part of a wide social network, or who participated in community activities were frequently more likely to report a concern. The findings highlight the significance of the role of social interaction and social networks in the diffusion of information and knowledge. These findings have implications for HIV and AIDS policy and programs, highlighting the potential for social networks and community‐level interventions to educate and increase awareness about HIV and AIDS among older people. Community leaders can make good peer educators and communication agents for HIV/AIDS campaigns. Additionally, the recognized high level of personal vulnerability to HIV infection among older people suggests the need for targeted sexual behavior change programs among this often neglected group.     

False expectations? Expectations vs. probabilities for dying

It is widely recognized that the code of the physician has undergone dramatic changes in the last century--changes which have serious implications for the patient-physician relationship. This is an ethnographic study examining how certain changes in the role and abilities of biomedical physicians have affected patient attitudes and expectations about end-of-life care. In-home interviews were conducted with eighteen persons age fifty-five and older, including a sample of Hemlock Society members. Results indicate a broad spectrum of end-of-life concerns including capacity, autonomy, pain, and burden to loved ones. Most participants reported a reluctance to begin a discussion of death or future deteriorating capacity with their physicians. Instead, when conversations about death were reported, they had been largely limited to the scenarios of catastrophic illness (e.g., hospitalization, ventilator, etc.) and the Living Will. While this discussion does not overlook the utility of the Living Will, it proposes the reliance on this document for preparing patients for end-of-life care is inadequate.     

Predictors of children's understandings of death: age, cognitive ability, death experience and maternal communicative competence

A child's age, cognitive ability, and exposure to death in the environment have been documented as major factors affecting the formation of a mature death concept. The present study investigated the relationships between these three factors (age, cognitive ability, and death experience) and children's understandings of death, as well as the relationship between mothers' communicative competence and children's understandings of death. Thirty-seven children (ages 48-96 months) completed three cognitive tasks and answered four dichotomous questions about death. Their mothers (N = 37) responded in writing to 16 questions about death that children are likely to ask. Results showed significant relationships between age and understanding, between seriation ability and understanding, and between death experience and understanding. There was no statistically significant relationship between maternal response competence and children's understandings of death. Implications are discussed.     

Perception of Mobile Phone and Base Station Risks

Perceptions of risks associated with mobile phones, base stations, and other sources of electromagnetic fields (EMF) were examined. Data from a telephone survey conducted in the German- and French-speaking parts of Switzerland are presented (N = 1,015). Participants assessed both risks and benefits associated with nine different sources of EMF. Trust in the authorities regulating these hazards was assessed as well. In addition, participants answered a set of questions related to attitudes toward EMF and toward mobile phone base stations. According to respondents' assessments, high-voltage transmission lines are the most risky source of EMF. Mobile phones and mobile phone base stations received lower risk ratings. Results showed that trust in authorities was positively associated with perceived benefits and negatively associated with perceived risks. People who use their mobile phones frequently perceived lower risks and higher benefits than people who use their mobile phones infrequently. People who believed they lived close to a base station did not significantly differ in their level of risks associated with mobile phone base stations from people who did not believe they lived close to a base station. Regarding risk regulation, a majority of participants were in favor of fixing limiting values based on the worst-case scenario. Correlations suggest that belief in paranormal phenomena is related to level of perceived risks associated with EMF. Furthermore, people who believed that most chemical substances cause cancer also worried more about EMF than people who did not believe that chemical substances are that harmful. Practical implications of the results are discussed.     

The Effects of Precautionary Messages about Electromagnetic Fields from Mobile Phones and Base Stations Revisited: The Role of Recipient Characteristics

Precautionary messages have been shown to increase recipients’ threat perceptions about radio‐frequency electromagnetic fields (RF‐EMFs) emitted by mobile phones and mobile phone base stations. The current study explored the interplay of variables on the side of message recipients with this effect. The individual difference variables of interest were gender, trait anxiety, personal need for structure, and personal fear of invalidity. Furthermore, the study determined whether the increased threat perception is accompanied by emotional distress. A total of 298 university students answered a survey after reading either a basic text about RF‐EMFs or a text including precautionary information. Linear multiple regression with interactions analyses showed that the effect of precautionary messages differed for people with different levels of trait anxiety. How trait anxiety was related to the effect of precautionary messages in turn depended on participants’ gender. Personal need for structure and personal fear of invalidity were mostly unrelated to the effect of precautionary messages. Regarding participants’ emotional distress, we found no difference in state anxiety scores between those participants who received precautionary information and those who did not. The findings show that the effects of precautionary messages on threat perception depend on individual difference variables such as recipients’ trait anxiety and gender. Also, the fact that precautionary communication did not result in heightened state anxiety challenges the assumption that precautionary messages induce fear or anxiety.     

Deathbed visions from the Republic of Moldova: a content analysis of family observations

This is an interview-based study of 102 families and their observations of the last weeks and days of a dying family member. Forty-one families reported hearing about "visions," "hallucinations," or "dreams" from their dying loved one before their death. Of these 41 mixed cases, 37 cases demonstrated classic features of deathbed visions-reports of seeing dead relatives or friends communicating to the dying person. This article reports a content analysis of these 37 cases in order to identify the major psychosocial themes that seem to be conveyed by these kinds of experiences. Six major themes are identified. These themes are: support, comfort, companionship, reunion, prognosis, and choice and control. Implications of these themes are discussed in relation to their role in providing significant support for the psychological morale and social well being of dying people.     

Medical decision-making around the time of death of cognitively impaired nursing home residents: a pilot study

The purpose of this article is to describe the end-of-life process in the nursing home for three groups of cognitively-impaired nursing home residents: those who died with a medical decision-making process prior to death; those who died without such a decision-making process; and those who had a status-change event and a medical decision-making process, and did not die prior to data collection. Residents had experienced a medical status-change event within the 24 hours prior to data collection, and were unable to make their own decisions due to cognitive impairment. Data on the decision-making process during the event, including the type of event, the considerations used in making the decisions, and who was involved in making these decisions were collected from the residents' charts and through interviews with their physicians or nurse practitioners. When there was no decision-making process immediately prior to death, a decision-making process was usually reported to have occurred previously, with most decisions calling either for comfort care or limitation of care. When comparing those events leading to death with other status-change events, those who died were more likely to have suffered from troubled breathing than those who remained alive. Hospitalization was used only among those who survived, whereas diagnostic tests and comfort care were used more often with those who died. Those who died had more treatments considered and chosen than did those who remained alive. For half of those who died, physicians felt that they would have preferred less treatment for themselves if they were in the place of the decedents. The results represent preliminary data concerning decision-making processes surrounding death of the cognitively-impaired in the nursing home. Additional research is needed to elucidate the trends uncovered in this study.